Annual Recertification Packet - HCV

 Phone: 352.369.2636 | Fax: 352.369.2642
1629 N.W. 4th Street Ocala, FL 34475

Failure to submit this package by the deadline date may result in termination of your assistance. Attach all necessary documentation and verification for each household member. Please make sure all required documents are signed.

Please review the following checklist and attach all necessary documents and verification for EACH family member within your household. Verification submitted cannot be more than 60 days old.

Photos of documents sent in the body of an email cannot be printed in a usable format. They will not be accepted. Documents sent by email should be in the form of a PDF file attachment.

• Employment Verification: If employed, seasonally employed, or have had more than one employer in the past 12 months provide the name, address, and phone number of each employer AND the last current consecutive paystubs. You must also provide verification concerning any previously reported income you no longer receive. 
  
  
• Self Employment: If self-employed, provide a complete signed copy of your most recent tax return, business license, and a copy of the profit/loss statements including receipts.
  
  
• Unemployment: Most recent copy of the Award Letter issued from the Department of Labor indicating the weekly benefit amount.
  
  
• Public Assistance/Temporary Assistance for Needy Families (TANF): Most recent copy of the Award Letter issued from the assisting state or government agency. 
  
  
• Child Support/Alimony: At least 2 months of payment history issued from the Division of Family and Children Services, Court Order, and/or Divorce Decree indicating monthly payment.
  
  
• Pension/Annuity: Most recent copy of the Award Letter indicating the month/weekly benefit amount.
  
  
• Veterans Benefits: Most recent copy of the award letter issued from the Department of Veterans Affairs indicating the monthly/weekly benefit amount.
  
  
• Full or Part-Time Student (For Students 18 years or older ONLY): Current enrollment and financial aid information from school's Registrar or Admissions Office. Documentation provided should state full-time or part-time status.
  
  
• SSI/Social Security Benefits: Most recent copy of current Award Letter from the Social Security Administration. Include documentation for each household member currently receiving benefits.
  
  
• Medical and Pharmacy Expense (Elderly and Disabled Only): Provide printouts reflecting the amount paid for unreimbursed pharmacy costs and medical expense/s. Do NOT provide any confidential medical information along with the expense printouts.
  
  
• Contributions/Bill Assistance: Provide a written statement from the organization or individual providing you cash or assistance which includes the name, address, and phone number of organization or individual and the frequency and amount provided to you.
  
  
• Bank Statements: Current bank statement for all household member accounts including but not limited to: checking/savings, bonds, stocks, money market accounts, etc.
  
  
• Childcare Expenses: Childcare expense verification from childcare provider for children age 12 and under.

The following documents are required for New Members of your household.

• Social Security Cards
• Birth Certificates
• Immigration/Naturalization Documents (if applicable)
• Photo Identification (for Adults Only)

All fields marked with an * must be completed, or form will not submit.