Documents Checklist

Please provide only those documents that apply to you.  If you have any questions, you are welcome to ask us. You may submit your supporting documents via the Secure Client Portal, via email at Abraham@Mazloumi.com, or via fax at 516-283-0250.

Proof of Age

  • US Passport

  • Birth Certificate

  • Driver’s License

  • Baptismal Certificate

Proof of Citizenship

  • US Passport

  • Birth Certificate

  • Naturalization Papers

  • Alien Registration Card

  • Final Adoption Decree

Identity

  • US Passport

  • Photo License

  • School ID

  • US Military ID

  • County ID

Marital Status

  • Marriage Certificate

  • Separation Papers

  • Divorce Decree

  • Spouse’s Death Certificate

Financial Resources

  • Checking Account Statements

  • Money Market Accounts

  • Savings Account Statements

  • Certificates of Deposit

  • Credit Union Accounts

  • Stocks or Bonds

  • Anuities

  • IRA, 401K, 403B, Keogh Accts

  • Title to Automobile & Value

  • Deeds to Property Owned and Listing Agreement

  • Property Proceeds / HUD-1

  • Mortgages

  • Special Needs Trusts Life Insurance Policies with Cash Value Statement

  • Burial Plot Information

  • Prepaid Funeral Contracts

Other

  • Social Security Card (Front and Back)

  • Medicare Card (Front and Back)

  • Additiional Insurance Cards / RX Card

  • Insurance Premium Bill / Payment Coupon

  • POA/

  • Guardianship Documentation

Income

  • Most Recent Pay Stubs

  • Social Security Award Letter

  • Railroad Retirement Award Letter

  • Pension Statement

  • Unemployment Check Srubs

  • Support / Alimony Checks or Court Order

  • VA Award Letter

  • SSI Award Letter

The following living expenses will be taken into account if the Medicaid recipient is placed in a nursing facility but the spouse remains living in the community.Please provide copies of the following:

  • All Income Verifications (Social Security Award Letter, Pension Stub, Etc.)

  • Spouse’s ID & Cards

  • Electric Bills

  • Real Estate Tax Bills

  • Gas/Oil Bills

  • Mortgage Statements

  • Rent Receipts

  • Water/Sewer Bills

  • Home/Renter’s Insurance