Confirming the Information in Your Application

When you apply through Connect for Health Colorado, we may request you provide documentation to verify the information you provided in your application.

If you do not provide the documents we request by the deadline, you might lose the financial help you are getting to lower the cost of your health insurance plan.

You may need to send more than one document, so be sure to read the list carefully. When you are ready to submit the documents:

  1. Log-in to your Connect for Health Colorado account
  2. Go to the “My Documents” section of your account
  3. Select the appropriate document type
  4. Upload the document

Click the item below for descriptions of documents you can submit to verify your information:

  • Household Income
  • Identity
  • United States Citizenship
  • Immigration Status
  • Social Security Number
  • Incarceration Status
  • Verify that you do not qualify for or are not enrolled in other health coverage
  • American Indian or Alaskan Native Status
  • Life (proof you have been falsely identified as deceased)

When providing income documents, be sure your document includes the following information:

  • The first and last name of the individual who earns the income;
  • The source of the income;
  • The specific amount earned for that source of income; and
  • The time period for the source of income (weekly, monthly, annual).

Here are the documents you can submit to confirm your yearly income:

  • Last year’s 1040 federal or state tax return
  • Wages and tax statement (W-2 and/ or 1099, including 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099SS, 1099INT). Note: It must contain the employer name (if applicable)
  • Pay stub. Note: If a pay stub includes overtime, please indicate average overtime amount per paycheck.
  • Social Security Administration Statements (Social Security Benefits Letter)
  • Unemployment Benefits Letter. Note: It must contain the source/agency, benefits amount, and duration (start and end date, if applicable)

Documents to confirm self-employment income

  • Self-employment ledger documentation (can be a Schedule C, the most recent quarterly or year-to-date profit and loss statement, or a self-employment ledger). Note: It must contain the company name, the dates covered by the ledger, and the net income from profit/loss.
  • 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

Documents to confirm unearned income

  • Annuity statement
  • Statement of pension distribution from any government or private source
  • Worker’s compensation letter
  • Prizes, settlements, and awards, including court-ordered awards letter
  • Proof of gifts and contributions
  • Proof of inheritances in cash or property
  • Proof of strike pay and other benefits from unions
  • Sales receipts or other proof of money received from the sale, exchange, or replacement of things you own
  • Interests and dividends income statement
  • Loan statement showing loan proceeds
  • Royalty income statement or 1099-MISC
  • Proof of bonus/incentive payments
  • Proof of severance pay
  • Pay stub indicating sick pay
  • Letter, deposit, or other proof of deferred compensation payments
  • Pay stub indicating substitute/assistant pay
  • Pay stub indicating vacation pay
  • Proof of residuals
  • Letter, deposit, or other proof of travel/business reimbursement pay

Note: If your circumstances have changed, and your available income documentation does not reflect your actual current annual income, please write the annual amount and an explanation on the documentation that you provide. Please note that you still must provide a document from the list above, and that Connect for Health Colorado may reach out to you for further information.

  • Driver’s License issued by a state or territory showing either a photograph of the individual and/or identifying information of the individual such as name, age, sex, race, height, weight, or eye color
  • School identification card that includes a photograph
  • Voter Registration card
  • U.S. Military Card, draft record, or Military dependent’s identification card
  • Identification card issued by the federal, state, or local government that includes a photograph
  • U.S. or foreign passport (expired passport may be used), U.S. passport card, or identification card issued by a foreign embassy or consulate that includes a photograph
  • Certificate of Naturalization (Form N-550 or N-570) or Certificate of U.S. Citizenship (Form N-560 or N-561)
  • Permanent Resident card or Alien Registration Receipt card (Form I-551)
  • Native American tribal document that includes a photograph
  • U.S. Coast Guard Merchant or Mariner card
  • Finding of identity from a federal agency or state government agency including but not limited to public assistance, law enforcement, internal revenue or tax bureau, or corrections agency, if the agency has verified and certified the identity of the individual

For children under the age of 16:

  • A clinic, doctor, or school record
  • In the absence of the previous, a written statement signed under penalty of perjury by the parents or guardian stating the date and place of birth (cannot be used in conjunction with a citizenship affidavit)

If you cannot provide a copy of any of the identity documents above, you must provide a copy of two of the following documents:

  • Birth certificate
  • Social Security card
  • Marriage certificate
  • Divorce decree
  • Employer identification card
  • High school or college diploma
  • Property deed or title document
  • Adoption decree
  • Foreign school record that includes a photograph
  • Notice from public benefits agency
  • Union or worker’s center identification card
  • U.S. passport
  • Certificate of Naturalization (N-550/N-570)
  • Certificate of Citizenship (N-560/N-561)
  • State-issued enhanced driver’s license (available in Michigan, New York, Vermont, and Washington)
  • Document from federally-recognized Indian tribe that includes your name and the name of the federally-recognized Indian tribe that issued the document, and shows your membership, enrollment, or affiliation with the tribe. Documents you can provide include:
    • A tribal enrollment card
    • A Certificate of Degree of Indian Blood
    • A tribal census document
    • Documents on tribal letterhead signed by a tribal official

If you don’t have any of the documents above, you can submit 2 documents — one from each list below.

You can submit one of these documents:

  • U.S. public 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 (IR3 or IH3)

AND one of these documents (that has a photograph or other information, like your name, age, race, height, weight, eye color, or address):

  • 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 card or draft record or military dependent’s identification 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 under 19 years old)
  • 2 documents containing consistent information that verifies your identity, like employer IDs, high school and college diplomas, marriage certificates, divorce decrees, property deeds, or titles
  • Permanent Resident Card, “Green Card” (I-551)
  • Re-entry Permit (I-327)
  • Refugee Travel Document (I-571)
  • Employment Authorization Card (I-766)
  • Machine Readable Immigrant Visa (with temporary I-551 language)
  • Temporary I-551 Stamp (on Passport or I-94/I-94A)
  • Foreign passport
  • Arrival/Departure Record (I-94/I-94A)
  • Arrival/Departure Record in foreign passport (I-94)
  • Certificate of Eligibility for Nonimmigrant Student Status (I-20)
  • Certificate of Eligibility for Exchange Visitor Status (DS-2019)
  • Notice of Action (I-797)
  • Document indicating a member of a federally recognized Indian tribe or American Indian born in Canada
  • Certification from U.S. Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR)
  • Document indicating withholding of removal (or withholding of deportation)
  • Administrative order staying removal issued by the Department of Homeland Security
  • Office of Refugee Resettlement (ORR) eligibility letter (if under 18)
  • Resident of American Samoa Card

Documents must include your first name, last name, and SSN.

  • Social Security card
  • 1040 Tax Return (federal or state versions acceptable)
  • W2 and/or 1099s (includes 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099S, 1099INT)
  • W4 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 Order Granting a Name Change, that must have your original first and last name, new first and last name, and SSN
  • Divorce decree
  • Official release papers from the institution or Department of Corrections
  • 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 (like for college students)
  • Bank or credit card statement showing transaction history (showing only your name, but not a joint account)
  • Military records
  • Cell phone bill (showing only your name)
  • Lease (must be an active lease where you’re currently residing)
  • Signed notarized statement from the individual with alleged false incarceration inconsistency showing that you’re living in the community and includes your name, date of birth, and address
  • Written statement from someone within the community which shows your name, date of birth, address, phone number, your relationship with the person with alleged false incarceration inconsistency (if it’s not you), and that you’re present and participating within the community
  • Rent receipts (showing only your name)
  • A written explanation of circumstances as to why you don’t have documentation

TRICARE

Peace Corps

Medicare

Veteran’s Affairs (VA)

  • Tribal Enrollment/Membership card from a federally-recognized tribe
  • Document issued by Bureau of Indian Affairs (BIA) recognizing you as American Indian/Alaska Native
  • Authentic document from a federally-recognized tribe declaring your membership
  • Certificate of Degree of Indian Blood
  • Certificate of Indian status card
  • I-872 American Indian Card
  • Document issued by Indian Health Service (IHS) showing that you were/are eligible for IHS services as an American Indian/Alaska Native
  • U.S. American Indian/Alaska Native tribal enrollment or shareholder documentation
  • Letter from the Marketplace granting a tribal exemption based on tribal membership or Alaska Native shareholder status
  • A signed statement that you have not been falsely identified as deceased

Ready to submit your documents?

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