Proof of Non-Incarcerated Status
Submit a copy of one of the following documents.
- Official release papers from the institution or Department of Corrections.
- Parole papers.
- Non-Incarceration Attestation Form.
A written letter. The letter should contain:
- Your case number (if you have one).
- The date.
- The following: “I, [YOUR NAME], am not incarcerated (in jail, prison, correctional facility, or similar penal institution) for the entire period during which I am seeking coverage through Covered California. I declare under the penalty of perjury, under the laws of State of California, that what I stated in this letter is true and correct.”
- Your signature.
- Your address (the same one that appears on your application).
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