Application Process

Returning an Application
Your application should be returned to the local Medical Provider you received services from. If the provider is located out of Chaves County, your application should be returned to the Chaves County Health Care Office. Office hours are Monday - Friday 8 a.m. - 5 p.m. unless there is a holiday.

Submission Requirements
  1. Copy of Signed Tax Return: If you were not required to file, you must sign a tax waiver form with provider. We must have all W-2’s with your return or if waiver is signed, a copy of your social security card is necessary.
  2. Proof of Residency: This is proof you have been County Resident for at least 90 days (3 months). The tax return is helpful in determining this, but if a P. O. Box is used as the address on the return, another source of proof of residency is necessary. This could be a driver’s license or I.D. Card by DMV, utility bill, rent receipt, or other source.
  3. Verification: We must have 1 month's worth of consecutive pay stubs, Social Security Benefit verification, V.A. Pension, Unemployment Benefits, General Assistance from ISD, Food Stamp verification, Letter of support with the value of that support or any other source of income.
  4. Self Employment Individuals: Self employed individuals must provide a complete federal return, CRS 1 Reports for one quarter. Income Tax Forms must be signed by whomever filed.
When you submit an application, a photo ID is required. Copies of Social Security Cards are required if a tax waiver is prepared.