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Chart of acceptable documents

Revised Date:

April 18, 2017

Acceptable Forms of Verification Chart

The following table is a suggested list of reliable sources of verification for each eligibility factor. Any source, including verbal, written, and email statements, can be used as long as it meets the "Criteria for Evaluating Verification".

What to verify	Acceptable verification
Child Support obligation	Court papers Division of Child Support data Statement from custodial parent Receipt
Citizenship and identity	See Citizenship and Identity Documents - Tier 1-4
Deductions for MAGI-based	IRS 1040 form showing allowed deduction School verification showing allowable deduction Verification showing moving costs, alimony paid, etc.
Dependent care expenses	Statement from the provider Bills or receipts SSPS data
Disability	Award letter from SSA DDDS disability approval Collateral contact with SSA Collateral contact with VA Decision from disability program specialist (ABD cash)
Immigration status	Permanent Resident Card (Form I-551) Refugee Travel Document (Form I-571) Valid foreign passport with I-94 stamp of admission Visa with I-94 stamp of admission See National Immigration Law Center (NILC) for documents used to verify immigration status
Income	Pay stubs Employer statement by telephone or in writing Division of Child Support data ACES Interfaces Bank statement that shows direct deposits (as long as amount shown is gross and not net) Collateral contact SOLQ TALX/The Work Number IRS 1040 if it is accurate of current income Profit and loss statement
Medical expenses	Bills/Receipts Statement from the provider
Pregnancy	Accept individual's statement of pregnancy and EDD
Residency	Accept individual's declaration unless questionable Collateral statement Rental or lease agreement Statement from landlord Mortgage papers Utility company records or bills
Resources	Bank statements Insurance documents Vehicle registration Stock certificates Courthouse records Property tax statement
Shelter costs	Landlord statement Current lease Rent or mortgage receipt Utility bills Collateral contact
Social Security Number	Social Security card Application for SSN SSA printouts or documents Birth document that states SSN was applied for
Tax filing status	Accept attestation unless questionable

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Health care services and supports

General eligibility requirements that apply to all Apple Health programs

Chart of acceptable documents

Acceptable Forms of Verification Chart

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