Renewal Documents Checklist

Forms Required

______ Client Information Sheet (one for each adult)

______ United Cooperative Service Sheet

______ Release of Information Sheet

Copies Required

______ Driver’s License or Government Issued Identification*

______ Utility Bill (Electric, Water, Gas)**

______ Lease/Mortgage**

______ Income last 30 days (Check stub, Social Security, etc)***

______ Income before COVID (Before March 15th) – 2 statements

______ Employee letter, unemployment letter, or a document stating when you were                            released from job (if applies)

______ Social Security cards (Every member of the house)****
               or birth certificates  or  Medicaid letter

______ Employee letter, unemployment letter showing your release date or reduced hours

               (if applies)


*Personal ID (All adults in household)

  • Driver’s License or

  • Any government issued ID,  unless approved by Harvest House Management

**Proof of Residence (All adults in household)

  • Utility Bill ( water, gas, electric )

  • Lease/Rental Agreement

  • If you currently live with someone and do not receive a bill in your name a piece of mail addressed to you will be accepted.

***Proof of Income (All adults in household)

  • Pay statement

  • Government award letter ( SSI, SSD, Medicaid, Child Support)

  • Letter from employer signed and dated with salary amount if paid in cash.

****One of the following for each adult and child in your household that you have

      legal guardianship:

  • Social Security card  (All adults and children)

  • Birth certificate

  • Medicaid award letter with adult/child’s name  ( PHOTO COPIES ARE ACCEPTED)


Harvest House requires its clients to present these documents every six months to recertify.

Revised 07/07/2020


Any questions call 817-295-6252 or email Connie at or Sue at


Harvest House Burleson

349 NW Renfro

Burleson, TX 76028



Phone: 817 - 295 - 6252

© 2023 by Your Harvest House Burleson, Texas