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29 | P a g e FFY 2025–2027 CCDF State Plan

Required at Initial Determination Required at Redetermination Description [x] [x] Family income. Describe how you verify: Earned Income Verification. CAPS staff will verify earned income (wages) with one or more of the following: pay stubs or receipts for the most recent four weeks of earnings, most recent 1099 form, most recent W-2 Forms, employer’s wage records, quarterly income tax payment receipts to the IRS (for cash paying jobs or self-employment only), annual income tax returns when presented in the January-March quarter (for cash paying jobs or self-employment only), letter/statement from employer (the letter/statement should be signed and dated on an employer letterhead and include contact information for the employer [phone number, title and relationship to employee], expected/current hire date, number of hours the employee is scheduled/works, and hourly rate of pay [and/or gross salary]) ,documentation from other state eligibility programs, if verification of income is within past six (6) months, employer completed CAPS Employment Verification form (Appendix F) or itemized statement completed by the employer, Military Leave Earning Statement (LES) this is the only acceptable form of verification for a member of the military, family can complete CAPS Self-employment Report form (Appendix CC), business ledgers, business receipts, previous year tax form if submitting before April 15, current tax form if submitting after April 15. Note: The above list is not an all- inclusive list and families have the right to submit other forms of verification/documentation that must be credible to determine income eligibility. Income can also be verified using other eligibility program system sources whenever possible. This information is under CAPS Policy 8.6.1. Unearned Income Verification. CAPS staff will verify unearned income with one or more of the following: check stubs, award letters, social security records, worker’s compensation records, union records, unemployment insurance claim records, documentation from other state eligibility programs, child support system information, court documents. Note: The above list is not all-inclusive, and families have the right to submit other credible forms of verification/ documentation to determine income eligibility. Income can also be verified using other eligibility program system sources whenever possible. This information is