Certification of Homeless Status and Residency - Form 5862
In July 2022, the Missouri ID Access Coalition was successful in collaboration with the Department of Revenue to create Form 5862 - Certification of Homeless Status and Residency. This form allows people without a permanent or stable address to use the address of a “homeless service provider” as defined on the form to in order to get their Missouri state ID*. This certification form requires that a homeless services provider attest to the named individual’s state of homelessness at the time the certification is completed and that the provider believes the named individual resides within the boundaries of Missouri.
*This form can only be used for a nondriver, non-REAL ID. This form meets the requirement for proof of residency only. An applicant will still have to provide all other required documentation.
How To Use Form 5862
Section 1 must be completed by the person who is applying for their ID and needs a “proof of residency” option. Applicant must sign their name at the bottom of Section 1.
Section 2 is to be completed by the “homeless service provider.” You must provide your tax ID number to verify your agency with the Department of Revenue. Keep in mind, the address of your agency is the address that will be on the applicant’s ID. Please note, the agency’s address will be the address on the person’s ID. It will be sent to your address when the permanent card is ready.
