- (a) Neither the Community Services Block Grant Act, 42 U.S.C. § 9901 et seq., nor applicable United States Department of Health and Human Services regulations specify the type of income documentation that eligible entities should review in determining an applicant’s income eligibility.
- (b) Following are two (2) possible examples of documentation that an eligible entity could review in determining a client’s income: Example 1: Applicants must provide documentation of their household’s source or sources of income. Some examples of acceptable documentation include pay stubs; a current tax return; IRS Form W-2 or 1099; a letter from an employer; a Social Security check or benefits statement; retirement income statement; unemployment insurance benefit statement; child support payments documentation (copies of checks, history of payments, or court papers); or self-employed accounting records. Documentation of current participation in public benefits programs with income eligibility standards at or below the United States Department of Health and Human Services federal poverty guidelines. Applicants who claim no household income must sign a form attesting to that fact and to the accuracy of the information provided to the eligible entity. This form must also be signed by a staff member indicating that the staff member has, in good faith, attempted to verify this condition, and that the information on eligibility in the file is accurate to the best of the staff member’s knowledge. Example 2: Before an applicant is determined to be eligible based on family income, the applicant must submit information to the program concerning the family’s income. Verification must include examination of documents such as individual income tax forms, W-2 forms, pay stubs, pay envelopes, or written statements from employers, if individual income tax forms, W-2 forms, pay stubs, or pay envelopes are not available.