Eligibility & Enrollment
Find out if you are eligible, get important documents, as well as next steps and instructions for eligibility and enrollment.
Eligibility and Enrollment Checklist
The Ryan White HIV/AIDS Program is the largest federally-funded care and treatment service program for people living with HIV. Review the checklist below to find out if you are eligible or get all the documents you need in our Eligibility and Enrollment Forms.
Proof of HIV Diagnosis
All clients must provide upon initial enrollment only one (1) medical document from the list below indicating HIV infection.
- Western Blot
- Letter on physician’s letterhead, with signature of doctor, indicating that the applicant is HIV positive with diagnosis date.
- Electronic medical record from physician’s office, with electronic signature of doctor, indicating that the applicant is HIV positive.
- Positive HIV test (immunoassay) and detectable viral load (HIV RNA)
- Two positive HIV tests (immunoassays- should be different assays based on different antigens or different principles)
- Request for Proof of Diagnosis Form completed by applicant’s physician (CGD 15-39)
Proof of Nevada Residency
All clients must provide upon initial enrollment and annually one (1) document from the list below.
- Current Lease/Rental Agreement (most recent)
- Rent/Mortgage Receipt (dated within the past 30 days)
- Any Bill, Invoice, or Correspondence (dated within the past 30 days)
- Paycheck Stubs with Your Address (most recent)
- Letter from a Government Agency (most recent)
- Other Verifiable Government-Issued ID with Address (most recent)
- Dependent Support Form (CGD 15-48) or a Letter
- Verification of Residence (CGD 15-50) or a Letter from Landlord
- Current Nevada Driver’s License or State ID Card
- Consulate Identification Card
- Resident Alien Card
- Proof of Property Taxes Paid (most recent)
- Voter Registration/Vehicle Registration (most recent)
- Prison Release Papers
- Attestation of Homelessness (provided in the application)
Proof of Income Level
Proof of household income not to exceed 400% Federal Poverty Level (FPL) based on their Modified Adjusted Gross Income (MAGI). Household income includes the income of anyone client claims on their taxes or the income of someone who claims the client on their taxes. Provided upon initial enrollment and annually.
- Paycheck Stubs or Employment Statement for the last month (most recent)
- Annual Award Letter: Social Security, Supplemental Social Security (SSI), Social Security Disability Income (SSDI), Veterans Benefits, Annual Pension, Retirement, etc. (most recent)
- Other Award Letter: Temporary Assistance for Needy Families (TANF), Unemployment, Child support/alimony etc. (most recent)
- One (1) Month of Bank Statements (only if pay stubs or annual statements cannot be provided) (most recent)
- Pre-Paid Debit Card Statements (most recent)
- Profit and Loss Statement from Self-Employment (CGD 16-04)
- Other Source of Income (provide relevant documents)
- Attestation of No Income (provided in the application)
Recertification – Every Six (6) Months During Your Half-Birth Month
A recertification application must be submitted every six months: CGD 18-06a Universal Six Month Self-Attestation. This application can be found below in the Universal Eligibility and Enrollment Documents Section below. If there has been a change in residency or income since the last application, the client must submit corresponding documents to show proof of the change.
Universal Eligibility and Enrollment Forms & Common Guidance
Open the toggles below to view links to important documents and forms.
Universal Eligibility and Enrollment Forms
- 18-04A Universal Eligibility Application (REVISED)
- 18-04A Universal Eligibility Application – Spanish (REVISED)
- 18-06A Six-month Self-Attestation (REVISED)
- 18-06A Six-month Self-Attestation – Spanish (REVISED)
- 23-01 Client Change of Information Form(s) (NEW)
- 23-01 Client Change of Information Form(s) – Spanish (NEW)
- Supplement Forms (REVISED)
- Supplement Forms – Spanish (REVISED)
- 19-08 Dental Insurance Form