Proof of Non-Incarcerated Status

Submit a copy of one of the following documents.

  1. Official release papers from the institution or Department of Corrections.
  2. Parole papers.
  3. Non-Incarceration Attestation Form.
  4. 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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