Community Impact for Christ

ELIGIBILITY REQUIREMENTS

Anyone who is a resident of our service area (Berkeley, Charleston, and Dorchester Counties) meets the financial guidelines (Income below 200% of Federal Poverty Level) and is uninsured if Medical and/or Dental service is requested.

Current information on all persons residing in each particular household is required before any services will be provided. That information will include the following items:

1. Name, address, date of birth, current Photo Identification and telephone numbers (including an emergency contact) of the person who is head of household.

2. Copy of current utility bill, rent receipt, lease or other document in the name of the head of household indicating the residence address is within the CIFC service area.

3. Name, relationship, date of birth, ethnicity and gender of all persons residing in household.

4. Social Security card, birth certificate, passport to verify children.

5. Picture identification of all persons 18 years of age or older.

6. Name, employer name, hours worked per week, rate of pay and/or monthly gross pay for each person in the household who is employed. Must provide a W2, a paystub, or 1040 as proof of income.

7. Amount of income or assistance received in any other form from any agency or program (Social Security, SSI, Food Stamps, disability, etc.).

8. All clients over eighteen must sign a Release of Information (ROI). If requesting Medical or Dental a Patient Agreement form must be signed.

This family, residence and financial information is necessary in order to verify that the total household income is no more than 200% of poverty level in accordance with guidelines for client eligibility. Until this information is completed and eligibility is approved only limited services may be provided.