Fix a Request for Information

Income from a job 

• Paycheck stubs showing employee information, pay date or pay period, and gross pay for the 4 weeks prior to the date listed on your notice. 
• 1040 federal or state tax return information from the previous year if it shows the attested income. 
• Wages and tax statement (W-2 and/or 1099, including 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099SS, 1099INT) showing first/last name, income amount, year and employer name (if applicable). 
• A signed earning statement from your employer showing first/last name, company contact information and gross pay information, signed by the employer and dated.

If you are seasonally employed, any of these proofs should include information about the duration of your employment.

Self-employment 

• Self-employment ledger documentation showing first/last name, company name and income amount. Include the dates covered by the ledger and the net income from profit/loss (can be a Schedule C, the most recent quarterly or year-to-date profit and loss statement or a self-employment ledger) 
• 1040 SE with Schedule C, F, or SE (for self-employment income) 
• 1065 Schedule K1 with Schedule E 
• Tax return 
• Bookkeeping records 
• Receipts for all allowable expenses 
• Signed time sheets and receipt of payroll if you have employees 
• Most recent quarterly or year-to-date profit and loss statement

Social Security Disability or Retirement Benefits 

• Award letter/certificate dated within the last year 
• Annual benefit statement 
• Correspondence from the Social Security Administration with your award status (denied, award amount, still pending) 

Unemployment Benefits 

• Award letter/certificate 
• Monthly benefits statement from the Department of Labor 
• Copy of direct payment card with statement 
• Letter from the Department of Labor with reason for denial

Rental Income 

• Rent checks or rental payment receipts 
• Current lease 
• Signed letter from tenant with monthly rent amount 
• Filed tax return if representative of attested rental income

Other Sources of Income 

• Agricultural income certificate 
• Alimony received: Court order stating alimony amount or signed statement from individual providing alimony with amount, frequency and date divorce/separation was finalized 
• Annuity statement 
• Bank or investment fund statement 
• Cost of living adjustment (COLA) letter and other benefit verification notices 
• Farm income (See acceptable proof of “Self-Employment Income”) 
• Foreign-earned income (See acceptable proof of “Income from a Job”) 
• Gambling income: Form W-2G 
• Interests and dividends income statement 
• Letter, deposit or other proof of deferred compensation payments 
• Letter, deposit or other proof of travel/business reimbursement pay 
• Loan statement showing loan proceeds 
• Military Leave and Earnings statement 
• Pay stub indicating sick pay, substitute/assistant pay or vacation pay 
• Prizes, settlements and awards, including court-ordered awards letter 
• Proof of bonus/incentive payments 
• Proof of gifts and contributions 
• Proof of inheritances in cash or property 
• Proof of residuals 
• Proof of severance pay 
• Proof of strike pay and other benefits from unions 
• Rental, real estate, royalties, partnerships, S-Corps, trusts: Rent checks or rental payment receipts, current lease, signed letter from tenant with monthly rental amount, royalty checks or financial record of payment from trusts 
• Royalty income statement or 1099-MISC 
• Sales receipts or other proof of money received from the sale, exchange or replacement of things you own 
• Statement of pension distribution from any government or private source 
• Worker’s compensation letter 

Immigrant Non-Citizen or a Non-Immigrant Visa Holder 

• I-551 resident alien card (green card) 
• Temporary I-551 resident alien card (temporary green card) 
• I-766 employment authorization card 
• Proof of current visa status (for example, a stamp in your passport or an approval letter from United States Citizenship and Immigration Services (USCIS)) 
• Proof of resolution in immigration court (all pages) 
• Notice of hearing from the Executive Office for Immigration Review 
• Documents (all pages) you provided to or got from USCIS or Immigration and Customs Enforcement (ICE), such as: 
• Confirmation that your application for an immigration status was received 
• Letters to or from USCIS 
• I-797 USCIS Notice of Action 
• Order of Supervision from ICE 
• Other documents to or from USCIS or ICE that show your current status 
• I-94 arrival/departure record 
• An approved immediate relative I-130 petition 
• Refugee Travel Document (I-571) 
• Re-entry Permit (I-327) 
• SEVIS ID (I-20 or DS 2019) (all pages) 
• Office of Refugee Resettlement (ORR) or Office on Trafficking in Persons (OTIP) 
• Certification or eligibility letter (all pages) 
• Immigration or other official document showing grant of: 
• Withholding of removal 
• Asylum 
• Cancellation of removal 
• Administrative closure 
• Administrative order staying removal 
• Order of supervision 
• Proof you lived continuously in the U.S. before 1972 (such as a lease agreement or proof of employment)

Battered Immigrant Non-Citizen 

• Proof of your immigration status 
• Proof/evidence of the harm or abuse (if your immigration document does not already show that you are eligible based on being battered or abused) 
• Proof of your relationship with the abuser (if your immigration document does not already show that you are eligible based on being battered or abused) 
• Proof you no longer reside with the abuser 
• Documents (all pages) that prove your immigration status include but are not limited to: 
• I-797 Notice of Action indicating: 
• Approved I-360 self-petition 
• Pending I-360 self-petition with a prima facie determination 
• Order from the Executive Office for Immigration Review (“EOIR”) granting or finding a prima facie case for suspension of deportation or cancellation of removal 
• I-797 Notice of Action for a pending I-360 self-petition, with incredible evidence of battery or abuse 
• I-797 Notice of Action showing the non-citizen is the beneficiary of a pending or approved I-130 family-based petition and credible evidence of battery or abuse 
• I-94 arrival/departure record annotated with K-3, K-4, V-1, V-2, V-3, CR-1, CR-2, CR-6, CR-7 and credible evidence of battery or abuse 
• I-766 Employment Authorization Document annotated with A9, A15 or C10 with credible evidence of battery or abuse 
• Any other USCIS document showing eligibility under VAWA provisions, supported by credible evidence of battery or abuse if not evident in the document 
• Documents (all pages) that show proof of harm or abuse could include: 
• Court orders, police reports, or statements from law enforcement or judges  
• Medical records or letters from a licensed medical professional 
• Letters or statements from a licensed mental health professional or clergy member who is familiar with your situation 
• Affidavits from others or other evidence that could support your claim, such as proof of a domestic violence conviction or proof of seeking safe haven in a shelter 
• Documents that prove your relationship to the abuser could include: 
• Marriage certificate 
• Birth certificate (for child of an abuser) 

U.S. Citizen or U.S. National 

• U.S. passport 
• Certificate of Naturalization (N-550/N-570) 
• Certificate of Citizenship (N-560/N-561) 
• Document from federally recognized Indian Tribe that includes your name, the name of the Tribe that issued the document, your membership, enrollment and/or affiliation with the Tribe.  
  • Documents you can provide include: 
    • Tribal enrollment card 
    • Certificate of Degree of Indian Blood 
    • Tribal census document 
    • Documents on Tribal letterhead signed by a Tribal official 
• Or you can provide two of the following documents 
  • U.S. birth certificate 
  • Consular Report of Birth Abroad (FS-240, CRBA) 
  • Certification of Report of Birth (DS-1350) 
  • Certification of Birth Abroad (FS-545) 
  • U.S. Citizen Identification Card (I-197 or the prior version I-179) 
  • Northern Mariana Card (I-873) 
  • Final adoption decree showing the person’s name and U.S. place of birth 
  • U.S. Civil Service Employment Record showing employment before June 1, 1976 
  • Military record showing a U.S. place of birth 
  • U.S. medical record from a clinic, hospital, physician, midwife, or institution showing a 
  • U.S. place of birth 
  • U.S. life, health or other insurance record showing U.S. place of birth 
  • Religious record showing U.S. place of birth recorded in the U.S. 
  • School record showing the child’s name and U.S. place of birth 
  • Federal or state census record showing U.S. citizenship or U.S. place of birth 
    • Documentation of a foreign-born adopted child who received automatic U.S. citizenship (IR-3 or IH-3) 
  • Driver’s license issued by a state or territory or ID card issued by the federal, state, or local government 
  • School identification card 
• U.S. military ID card or draft record or military dependent’s ID card 
• U.S. Coast Guard Merchant Mariner card 
• Voter Registration Card 
• A clinic, doctor, hospital or school record, including preschool or day care records (for children age 19 or younger) 
• Two documents containing consistent information that proves your identity, such as employer IDs, high school and college diplomas, marriage certificates, divorce decrees or property deeds or titles

• Social Security card 
• 1040 Tax Return (federal or state versions acceptable) 
• W-2 and/or 1099s (includes 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099S, 1099INT) 
• W-4 Withholding Allowance Certificate (federal or state versions acceptable) 
• 1095 (includes 1095A, 1095B, 1095C) 
• Pay stub documentation 
• Social Security Administration documentation (includes 4029) 
• Military record 
• U.S. military ID card 
• Military dependent’s ID card 
• Unemployment benefits (Unemployment Benefits Letter) 
• Court-ordered name change: Must include your original first and last name, new first and last name, and SSN 
• Divorce decree 

No MEC From a Job or Employer 

• Completed Employer Coverage Tool (PDF) and a cover letter signed by the employer 
• Letter or other documentation from an employer or other documentation with this information: 
  • Statement the employer doesn’t currently offer you (or your family member) coverage 
  • Statement the employer doesn’t provide qualifying health coverage 
  • Statement showing the cost of your share of the premium for the lowest-cost self-only health insurance plan that meets the minimum value standard (factoring in wellness incentives), if offered 
• Health insurance letter that contains confirmation of health coverage and expiration dates for coverage received outside of BeWell. 

No Qualifying Health Coverage Through Medicaid 

• Letter (often called the Notice of Case Action) or statement from a Medicaid agency that shows you or your family members are not enrolled or eligible  
• Letter or (often called the Notice of Case Action) statement from a Medicaid agency showing you or a family member are enrolled in a Medicaid program not considered Qualifying Health Coverage (QHC) 
• A letter describing your recent health coverage including: 
  • The name of the Medicaid program you were enrolled in and when your coverage ended, or 
  • That you were never enrolled in Medicaid, or 
  • The name of the Medicaid program with limited benefits in which you are enrolled that would still allow you to enroll in the Marketplace with help paying for coverage 

If you send document(s) verifying enrollment in one of these programs, you may be able to continue your financial savings for coverage through BeWell: 

• Medicaid coverage only for pregnancy-related services 
• Medicaid coverage only for family planning services

No Qualifying Health Coverage Through Medicare 

Letter or statement from Medicare or the Social Security Administration (SSA) stating you or your family members are: 

• Not eligible for or enrolled in premium-free Medicare Part A. 
• Eligible for (but not enrolled in) Part A coverage that requires premium payments.  
  • Important: A Social Security document that shows you don’t pay a premium for “Medical Insurance” refers to Part B. It is not acceptable for verifying eligibility for Part A. 
• No longer eligible for Social Security Disability Insurance (SSDI) benefits, and your coverage has ended or will end in the next 90 days. 

No Qualifying Health Coverage Through TRICARE 

• Letter or statement from TRICARE that shows the expiration or un-enrollment date of previous health coverage 
• Letter or statement from TRICARE that confirms ineligibility for health coverage 
• Letter, statement, or other document indicating a life change event (like divorce) that would make you or a family member ineligible for TRICARE coverage 
• Letter or statement from TRICARE or other government agency showing you or a family member are enrolled in a TRICARE program not considered qualifying health coverage. If you send document(s) verifying enrollment in one of these programs, you may be able to continue your coverage through BeWell with help paying for coverage: 
• TRICARE Plus 
• Direct care 
• Line-of-duty care 
• Transitional care for service-related conditions 
• TRICARE coverage limited to space-available care in a facility of the uniformed services for individuals excluded from TRICARE coverage for care from private sector providers 

No Qualifying Health Coverage Through Veterans Affairs 

Letter from the VA that shows the expiration date of previous health coverage 

No Qualifying Health Coverage Through Peace Corps 

Letter from the Peace Corps with the expiration date for any previous health coverage or a letter showing you never had this type of coverage 

State Residency 

• Copy of deed and record of most recent mortgage payment  
• If mortgage is paid in full, provide a copy of property tax bill from the most recent year 
• Copy of lease and record of most recent rent payment 
• Mortgage deed showing primary residence 
• Nursery school or daycare records  
• If school is private, additional documentation may be requested 
• School records  
• If school is private, additional documentation may be requested 
• Current utility bill or work order dated within the past 60 days 
• Statement from a homeless shelter 
• Section 8 agreement 
• Homeowner’s insurance agreement 
• Proof of enrollment of custodial dependent in public school 

Non-Incarceration 

• Official release papers from the New Mexico Corrections Department 
• Parole papers 
• Unexpired state ID, driver’s license, work ID or passport 
• Pay stubs 
• Federal, state or local benefit letter 
• Clinic, doctor or hospital records for services provided 
• Medical claim explanation of benefits provided 
• School record/schedule showing enrollment, such as for college students