Acceptable Proof of Income

Acceptable Documentation

Tax Documentation

Tax Filing Status

Documentation of your actual tax filing status is not needed. However, the following information is required:

  • Are any of the persons listed on your CHIP application or renewal planning to file a federal income tax return next year? – List only those individuals that will be filing
  • If married – will you be filing jointly with your spouse? Include your spouse's name
  • Will any of the persons filing taxes claim any dependents on their tax return? List the tax filer’s name and the dependent’s name(s) and dates of birth
  • Will any of the persons listed on the application be claimed as a dependent on someone else’s tax return? List the other tax filer’s name and date of birth, also list the name of the person they will be claiming as dependent

Tax Deductions

Acceptable proof of the following deductions is your most current federal income tax return 1040 or 1040A.

  • Educator expenses
  • Certain business expenses of reservists, performing artists and fee-basis government officials
  • Health savings account deduction
  • Moving expenses (job related only)
  • Self employment SEP, SIMPLE, and qualified plans
  • Self employed health insurance deduction
  • Penalty on early withdrawal of savings
  • Alimony paid
  • IRA Deduction
  • Student loan interest deduction
  • Tuition and fees – Higher Education only
  • Domestic production activities deductions

Citizenship and Identity Documentation

Citizenship and Identity Documentation

A child must be a citizen of the United States (U.S.), a U.S. national or lawfully residing as determined by the US Citizenship and Immigration Service.

  • United States Citizens
  • Proof of citizenship and identity 1/30/2014
  • U. S. Passport
  • A Certificate of Naturalization (Department of Homeland Security (DHS) Forms N-550 or N-570)
  • A Certificate of U.S. Citizenship (DHS Forms N-560 or N-561)
  • Documents issued by a federally recognized Indian tribe
    • Proof of Citizenship only
  • Birth Certificate
  • Certification of birth – issued by DHS (Form DC-1350)
  • A report of birth abroad of U.S. Citizen (Form FS-240)
  • A certification of birth abroad (Form FS-545)
    • Proof of Identity
  • Affidavit – Proof of identity (contact Member Services at 800.543.7101 to obtain a copy)
  • Current School photo ID
  • Valid driver’s license
  • Non-U.S. Citizen Verification – need copy of front and back
    • I-551 – Alien Registration card (green card)
    • I-94 – Arrival/Department Record – must be stamped
    • I-688B – Employment Authorization card –  must be stamped
    • I-766 – Employment Authorization document –  must be stamped
    • I-571 – Refugee Travel document
    • Passport stamped on the inside cover by USCIS
    • Visa coded T-2, T-3, T-4, or T-5
    • Certification letter from the office of Refugee Resettlement (ORR)

Income Documentation

Wages

Wages

Paystubs dated within the past 60 days of the application/renewal signature date. If not, income should be entered as nonverified.

Pay stubs should include:

Letter from the employer – Only acceptable if employer does not provide paystubs. Letter must indicate that and acceptable if:

  • On employer letterhead or signed by employer
  • Hours worked per pay (if hourly wage given)
  • Amount earned per hour or gross amount per pay period
  • Frequency of pay period
  • If indication of OT – details must be given
  • Business ledger from employer – must include the above info.
  • W2 (use box 18 per PID), 1099 form, tax return – Only acceptable for:
    • Subcontractors – who do not claim as self-employment income (due to no out of pocket expenses)
    • Seasonal Workers – need both W2 and 1099 (for UC) 1/30/2014
    • Substitute Teachers

Business Income

Business Income

Business income any business income not being reported for tax filing purposes requires a year-to-date profit and loss statement.

Sole Proprietorship

  • 1040 federal tax form with all schedules from the previous calendar year – Mid April is the cutoff for determining which years return is acceptable (tax filing deadline). Line 31 of Schedule C should match Line 12 of the 1040 form if there is only one Schedule C.
  • A year-to-date Profit and Loss– Only acceptable for new self employment businesses or a drastic change from previous year.

If extension was filed for previous year’s taxes, proof of the extension must be received.

The profit and loss must include:

  • Business name
  • Time period covered (example – Today is 8/25 – profit and loss should be from 1/1 through 7/31)
  • Gross income earned in that period
  • Line item list of expenses for the period (insurance, gas, utilities, etc)
  • Net profit figure for the period.

Partnership

1040 federal tax form with all schedules from the previous calendar year – Mid April is the cutoff for determining which years return is acceptable (tax filing deadline) - Line 32 on Schedule E should match Line 17 of tax form if no other income on Schedule E of tax form

A year-to-date Profit and Loss– only acceptable for new self employment business or a drastic change from previous years.

The profit and loss must include:

  • Business name
  • Time period covered (example – Today is 8/25 – profit and loss should be from 1/1 through 7/31)
  • Gross income earned in that period
  • Line item list of expenses for the period (insurance, gas, utilities, etc)
  • Net profit figure for the period.

S-Corporation or C-Corporation

S-Corportation and C-Corporation

  • Must have both the tax form and pay stubs
  • Pay stub dated within the past 60 days for each officer living in household 1/30/2014
  • 1040 tax form with all schedules - Line 32 on Schedule E should match Line 17 of tax form if no other income on Schedule E of tax form or profit on paystubs or business records.

A year-to-date Profit and Loss– only acceptable for new self employment businesses or a drastic change from previous year.

The profit and loss must include:

  • Business name
  • Time period covered (example – Today is 8/25 – profit and loss should be from 1/1 through 7/31)
  • Gross income earned in that period
  • Line item list of expenses for the period (insurance, gas, utilities, etc)
  • Net profit figure for the period

A self declaration letter is not acceptable

Unemployment and Workers’ Compensation

Unemployment

Must include:

  • Benefit Payment History
  • Current claim summary (shows EUC start date, weekly benefit rate, remaining balance and EUC end date)

Workers' Compensation

  • Award Letters
  • Check Stubs – must show deduction or “Weekly Benefit Rate”
  • Letter from lawyer showing gross amount received
  • Bank Statement – If no other proof available

Retirement / Pension / IRA Distributions

Retirement / Pension

  • Award letters
  • Check Stubs
  • 1099 forms
  • Bank Statement – If not other proof available

IRA Distributions

  • Previous year’s federal income tax return
  • 1099 form/tax Form
  • Statement from financial institution

Alimony / Social Security

Alimony –Court Ordered

  • Copy of divorce decree (most acceptable because this will show an end date of the alimony if any)
  • Computerized print out from PACSES
  • Copy of Court Order
  • Federal income tax form – line 11. Only if alimony was received for the entire previous year

Social Security

  • Award letters – from current year
  • 1099 form – Only acceptable if no increase approved for current year
  • A current copy of the check – for adults, must verify if there is a Medicare deduction
  • Bank Statement – If no other proof available - for adults, must verify if there is a Medicare deduction

Interest, Dividends or Capital Gains

Interest, Dividends or Capital Gains

  • Previous year’s federal income tax return
  • 1099 form/tax Form
  • Statement from financial institution

Rental Property Income and Royalties

Rental Property Income and Royalties

  • Previous year’s tax return

Taxable Refunds, Credits or Offsets of State/Local Income Taxes

Taxable Refunds, Credits or Offsets of State/Local Income Taxes

  • Previous year’s federal income tax return – Line 10

Stipends, Scholarships, Educational Awards, Fellowship Grants, etc

Stipends, Scholarships, Educational Awards, Fellowship Grants, etc 2

  • Letter showing amount being received

2 Only include if income is to be used for items other then education (i.e. living expenses)