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Pre-Exposure Prophylaxis Assistance Program (PrEP-AP)

Acceptable Supporting Documentation Checklist for Minors and Clients with Confidentiality Concerns

One item from each section is required unless otherwise indicated. Additional documents may be needed to determine eligibility.

*Note: Minors are individuals aged 12–17 as defined in Section 6926 of the Family Code. Clients with Confidentiality Concerns refers to a client who has insurance through a parent, guardian, spouse, or domestic partner, but cannot use this insurance to access PrEP for confidentiality reasons.

Proof of Identity*

  • Drivers License
  • State of local ID card (e.g. DMV issued ID, Municipal ID, student ID, or an ID from the Department of Corrections [CAL-ID])
  • U.S. Passport
  • Permanent Residence Card
  • Employment authorization card
  • Military ID card
  • Photo ID issued by a foreign government (e.g. voter registration card, passport, or consulate ID card)
  • Birth certificate (only if client does not have one of the IDs listed above)
  • Provider Verification of Identity Form (PDF)
  • Request for Services Form (PDF) (for use with minors only)**

*Note: Expired cards may be used if no other form of picture ID is available
**Note: If a minor is unable to furnish any of the other IDs listed, the Request for Services Form can be used to establish their identity and status as a minor. This form is required to participate in PrEP-AP, even if it is not used for identity documentation purposes.

Proof of California Residency (Not applicable for minors)*

These documents must be dated within thirty days, be in the client’s name, and include the client’s residential address: 

  • California rent or mortgage receipt
  • Current utility bill with the service address listed in California (a cell phone bill is not acceptable)
  • Employment paycheck stub

These documents must be dated within one year, be in the client’s name, and include the client’s residential address:

  • Rental/lease agreement or annual lease renewal documentation
  • Rent Increase Notice
  • Notice of Change in Terms of Tenancy
  • Voter registration card
  • Vehicle registration (not expired)
  • W-2 or 1099 (prior tax year documents will be accepted until February 15th. After February 15th, only current tax year documents will be accepted.)
  • Social Security/Disability Award Letter (SSI, SSDI)
  • California Employment Development Department (EDD) award letter
  • Filed State or Federal tax return
  • Public housing letter on official letterhead from Housing and Urban Development (HUD) or a county agency
  • Notice of Action from the Department of Health Care Services

*Note: Clients who do not have the above residency documentation may prove residency by completing and submitting the Residency Verification Affidavit form (PDF). A letter from the client’s PrEP-AP enrollment worker, on agency letterhead and containing the same information as found on the Residency Verification Affidavit form, is also acceptable.

HIV Negative Status

Must be dated within six months of PrEP-AP application:

  • Negative HIV lab results (lab results must be a print out from a lab, a medical record from a provider or rapid HIV Test stating the client’s name, test result, and test date)
  • PrEP-AP Provider Referral Form (PDF) signed by a PrEP-AP Network Provider

Additional Forms (provide all that apply)

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