• Date of birth for every member within the household (not just those applying)
• The two most recent pay stubs for each person applying
• Last year’s tax forms (1040EZ or page 1 of 1040) for each person applying
• Social Security number for each person applying
• Driver’s license, Tribal ID or other government-issued ID
• For non-citizens, Green Card or other immigration documents
• Documents for other sources of income (social security, unemployment, self-employment, etc.) for each person applying
• W2 form or Employer Tax ID Number (EIN) for each person applying
• Employer’s address and contact information for each person applying
• Information about any employer-sponsored health insurance (ESI) available to each person applying. Have the employer fill out this form. (Read more about ESI.)
• If you currently have health insurance, know whether it meets minimum essential coverage (MEC) affordability standard. Have the employer fill out this form. (Read more about MEC.)

Roseville Ramsey County Library

2180 Hamline Ave N, Roseville, MN 55113

Yes. Complete and return your renewal form as soon as you can, even if your coverage ends.

We will look at your case again if we get your renewal form within four months after your coverage closed. After that, you will need to reapply.