18 Miss. Code. R. 17-5.4 - Documentation
A document may serve to prove more than one requirement and need not be submitted more than once. The following is a list of acceptable proof for each requirement:
A. Proof of
Age (child)
1) Long Form Birth
Certificate
2) Record of Live Birth
for children under the age of three (3) months until birth certificate is
received
B. Proof of
Income (family) - Eligibility is based on gross family income. Applicants must
provide proof of income for the last thirty (30) days to include one (1) of the
following:
1) Check stubs
a. One (1) if paid monthly- must include the
most recent check stub issued; or
b. Two (2) if paid bi-monthly- must include
the last two consecutively issued check stubs; or
c. Four (4) if paid weekly-must include the
last four consecutively issued check stubs.
2) Estimated quarterly tax report
3) Federal 1040 tax form - line 9 (total
income)
4) Schedule C Form 1040 -
line 7 (gross income)
5) New
Employment or Temporary Agency Employment - letter from the employer on company
letterhead verifying employment start date, income, rate of pay, and number of
hours worked.
6) Paid in Cash - a
wage verification form, or a notarized letter from the employer verifying start
date of employment, income, rate of pay, and number of hours worked. The letter
must also include the employer's name, address, telephone number, and state
that the employee is paid in cash.
7) Paid by Personal Check - applicants must
submit copies of the front and back of two checks that have cleared the
bank.
8) Self-Employed with Filed
Tax Return:
a. completed Wage Verification
Form, and
b. copy of an Estimated
Quarterly Tax Report or
c. Federal
1040 Tax Form with the Profit/Loss Statement (Schedule C). The Total Sales and
Receipts amount located on the Profit/Loss Statement will be used to determine
if the work requirement has been met. The amount located on Line 22 of the
Federal 1040 Tax Form to determine income eligibility.
9) Self-Employed, New Business- for
businesses started within the current tax year
a. completed Wage Verification Form,
and
b. current business license
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