Unless the assessor determines that all or
some of the supporting documents are not necessary, a claimant must present the
documents listed in this subsection with their application. Except for
affidavits, the assessor's office should not accept original documents from the
claimant. If the assessor's office is presented with original documents , they
must make copies or note the information provided in the documents on a
separate sheet and return these original documents to the claimant. The
claimant must submit the following documents with the application:
(iv) If the claim is
based on a disability, either:
(A) An
affidavit from a licensed physician or certified physician's assistant (medical
or osteopath doctor), a licensed or certified psychologist for disabling mental
impairments, or a licensed podiatrist for disabling impairments of the foot,
that states the claimant is unable to enter into regular gainful employment
because of their disability and the expected term of the disability;
or
(B) Copies of a written
acknowledgment or decision by the Social Security Administration or Veterans
Administration that the claimant is permanently disabled;
(vi) Copies of
documents showing income earned or reported by the claimant, the claimant's
spouse or domestic partner and any cotenants, even when the income is estimated
(income information should be provided to the degree possible and then
confirmed with supporting documents in the follow-up period), such proof must
include to the extent it is relevant:
(A) If
the claimant, the claimant's spouse or domestic partner, or any cotenants
receive Social Security payments, a federal statement showing Social Security
paid (generally, Form SSA-1099);
(B) If the claimant, the claimant's spouse or
domestic partner, or any cotenants receive railroad retirement benefits, a
federal statement showing railroad retirement benefits paid (generally, Forms
RRC-1099 and RRC 1099-R);
(C) If
the claimant, the claimant's spouse or domestic partner, or any cotenants file
federal income tax returns, those returns with supporting forms, schedules,
and, if specifically requested, worksheets for the deductions taken from gross
income (generally, Form 1040 with its supporting forms and
schedules);
(D) If the claimant or
the claimant's spouse or domestic partner has been in a nursing home, assisted
living facility, adult family home, or has been receiving in-home care in
either their home or in the home of a relative for purposes of long-term care,
copies of invoices (or an equivalent billing statement or payment statement)
for nonreimbursed care or documentation to verify the claimant or claimant's
spouse or domestic partner have been receiving care at the home of a
relative;
(E) If the claimant
indicates that the nonreimbursed prescription drug expenses for the claimant
and the claimant's spouse or domestic partner for the period under review
exceeds five hundred dollars, copies of checks or other payment statements
(i.e., pharmacy printout of payments for purchases) showing amounts paid for
nonreimbursed prescription drug expenses;
(F) Copies of documents showing premiums paid
if the claimant or the claimant's spouse or domestic partner pays health care
insurance premiums for medicare under Title XVIII of the Social Security Act
(i.e., 1099, or medicare plan policy declaration);
(G) If no federal returns were filed or
received, the claimant must still provide copies of documents to demonstrate
their income and the income of their spouse or domestic partner and any
cotenants (i.e., federal income statements such as Form W-2 (wages), Form
1099-INT (interest), Form 1099-DIV (dividends), Form 1099-R (pension amounts),
Form 1099-G (unemployment), or Form 1099-Misc. (contract income)). Even
claimants who claim they have no federal income (or an inordinately small
amount of federal income) must have income to maintain themselves and their
residences. In these situations, the claimant must produce copies of documents
demonstrating the source of the funds they are living on (i.e., checking
account registers and bank statements) and the bills for maintaining the
claimant and the residence (i.e., public assistance check stubs, utility
invoices, cable TV invoices, check registers, bank statements, etc.);
and