Appendix A: Verification Information Generally Available from the Client

Non-citizen Status

• USCIS forms and documents (see Chapter 522, Appendix A)

• A court order stating that deportation has been withheld pursuant to Section 243(h) of the Immigration and Nationality Act

• USCIS documents such as a letter, notice of eligibility, or identification card which shows that the non-citizen has been admitted under one of the eligible sections

Citizenship

• Naturalization papers

• Hospital birth record

• Baptismal record when place and date of birth is shown

• Birth certificate

• U.S. passport

• Family bible

• Military documents

• Voter registration card

Dependent Care

• Canceled checks

• Tax records

• Paid receipts

• Statement from dependent care provider

Disability

• Pension award notice

• Doctor’s statement

• Railroad Retirement board notice or letter

• Military documents

• VA award notice

• SSI award notice

• SSA notice or letter

• Workers' compensation (WC) award letter

Earned Income

• Pay stub

• W-2

• Income tax return

• Income-producing contract

• Pay envelope

• Wage tax receipts

• Self-employment bookkeeping records

• Statement from the individual, agency or company providing income

• Leave and Earnings Statement (civilian, National Guard, active and retired military and reserves may access and print verification of income by going to myPay link at www.dfas.mil.)

Identity

• Employment photo ID

• Driver’s license

• Pay stub

• Birth certificate

• Voter registration card

• Library card

• Financial institution statement

• U.S. passport

Medical Expenses

• Billing statement

• Medicare Part B card

• Medicine with costs on label

• Repayment agreement with physician or hospital

• Bill for visiting nurse, homemaker, home health aide

• Receipt for food or veterinarian services for a seeing-eye, hearing, or other service animal

• Itemized receipt

• Health insurance premium

• Pharmacy statement

• Doctor’s statement verifying over-the counter drug prescribed

• Lodging or transportation receipt from obtaining medical treatment or services

• Bill or receipt for medical equipment and supplies

Residency

• Voters registration card

• Rent or mortgage receipts that show the address

• Fire insurance policy

• School registration

• Employer’s statement

• Telephone directory

• Letter from HUD

• Certificate for subsidized housing

• Pension or VA award notice

• Library card with address

• Utility bill

• Mail received at address

• Real estate tax receipt or assessment

• Driver’s license

• Statement from nonrelative landlord

• Financial institution statement

• SSA, SSI, or UC award letter

• Income tax return

Resources

• Bank book

• Bond certificate

• Securities certificate

• Check for lump sum payment

• Mortgage

• Sales agreement

• Articles of agreement

• Will

• Burial-arrangement contract

• Stock certificate

• Notes

• Financial institution statement

• Deed

• Real estate tax receipt

• Life estate agreement

• Income tax return

• Life insurance policy

• Insurance appraisal

Shelter Expenses

• Rent or mortgage receipt

• Statement from an individual sharing shelter costs

• Fire insurance bill or receipt

• Receipt for campground fee

• Statement from HUD

• Lease agreement

• Real estate tax receipt or statement

• Receipt for firewood

• Correspondence with taxes and mortgage payment shown

Social Security Number

• Pay stub

• Financial institution statement

• Social Security card

• Cash assistance record

• Income tax return

NOTE: The above documents contain the SSN, but the SSN can be verified only through the Social Security Administration.

Unearned Income

• SSA award letter

• Workers' Compensation award letter

• VA award letter

• Railroad Retirement award letter

• Court order

• Correspondence on benefits

• Correspondence on support payment

• SSI award letter

• Unemployment Compensation (UC) award letter

• Exhaustion of UC Benefit Letter (Department of Labor and Industry Form UC-50)

• Pension award notice

• Benefit payment check

• Divorce or separation decree

• Income tax statement

• Support agreement (The CAO must check PACSES even if applicant/recipient states support is voluntary)

• Rental agreement

• Form 1099 for interest

NOTE: Individuals may get proof of SSA and SSI benefits online by creating an account with the Social Security Administration.  Individuals may create an account by visiting www.ssa.gov/myaccount. The CAO may provide the following information to applicants and recipients about accessing information:

• • Important Information: Changes In Certain Services

  • The Fastest Way To Verify Social Security And Supplemental Security Income Benefits

  • How To Create An Online Account

Utility Expenses

• Utility bill

• Correspondence from utility company

• Cancelled checks for utilities

• Statement or receipt from landlord for utilities

Reissued April 6,2016, replacing March 1, 2012