Please complete the Pre-Screening Form to help us determine what benefit you may be eligible for.

For the best experience translating this form into another language, please access the form using a desktop computer. Please contact SFHP Customer Service at (415) 547-7800, if you have any questions.

Para obtener la mejor experiencia al traducir este formulario a otro idioma, acceda al formulario utilizando una computadora. Comuníquese con el Servicio al cliente de SFHP al (415) 547-7800, si tiene alguna pregunta.

如在填妥這表格時遇上翻譯問題，請使用桌上型電腦完成表格。如有任何疑問，請致電 (415) 547-7800 與SFHP客戶服務聯繫。

Para sa pinakamahusay na karanasan sa pagsasalin ng form na ito sa ibang wika, mangyaring i-access ang form gamit ang desktop computer. Mangyaring makipag-ugnay sa SFHP Customer Service sa (415) 547-7800, kung mayroon kang anumang mga katanungan.

Please upload the following:

• Proof of Identification
  • Acceptable documents include a CA Drivers Licensed/ID, US or Foreign Passport, Student ID, Permanent or Temporary Resident Card, Employment Authorization Card, Certificate of Naturalization, Certificate of US Citizenship, or Foreign ID

• Proof of Residency
  • Acceptable documents include a CA Drivers Licensed/ID, Rental/Lease Agreement, Rental Payment Receipt, DMV Registration, Bank Statement/Letter, Utility Bill, SSI Award Letter, SF City ID Card, Affidavit of Support with 3rd Party Proof of S.F. Residency, Unemployment Benefits Statement, Cable Bill, Renter Insurance

• Proof of Income
  • Acceptable documents include a Pay Stub, Tax Return, Alimony Received, Interest Income, Insurance Annuity Income, Rental Income, Taxable Government Benefits, Pensions/401K Income, 1040 w/ Schedule 1, or Bank Statement

If you have any questions or are unsure whether a document is acceptable, please view the Acceptable Verification Document List or call our Customer Service at 415-547-7800 for assistance.