Tri-County Services

Intake Checklist for Visits - C&A

Child and Adolescent:  Financial information needed for routine assessment appointment

Child

  • Birth Certificate
  • Social Security Card
  • Insurance Card (if applicable)

Parent(s)/Guardian(s)

  • Current Driver's License or other state-issued identification
     
  • Social Security Card
     
  • Proof of Residence (i.e. A utility bill in parent's name or a utility bill with letter from the person whose name is on the bill stating that the child and parent live in the home.)
     
  • Proof of Income (both parents). Non-working parent(s) NEED a wage detail statement issued by the TEXAS WORKFORCE or bring proof of unemployment insurance income.
     
  • Proof of custody - if divorced will need divorce papers, if living with someone other than the biological parents they must have a written notorized letter from parents, if ordered by court must have court papers.
     
  • If living with someone (grandparent, aunt, uncle, friend, and/or cousin, etc.), other than the parent, we count the parent's income unless the people they are living with have legal guardianship through the courts, then we count their income.
     
  • We do not need proof of step-parent's income, only the biological parent, unless the step-parent has legally adopted the child.