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Title 5: Centrally Administered Programs Page 40 Iowa Department of Human Services Employees’ Manual Chapter E: Healthy and Well Kids in Iowa (hawk-i) Income Revised August 20, 2010 Verification of Income When using income from a period other than the 30 days before the date of application, the reason shall be documented in the case file.

1. A hawk-i application is received February 23 from Mr. C. All questions are answered and Mr. C sends the following pay stubs with the application: Pay date 2-13 2-06 1-30 1-23 Gross Pay $750.00 $750.00 $750.00 $750.00 The 30-day period before the application date would includes the pay date of 2-20 and that pay stub is missing. However, since Mr. C says on the application that this income is expected to continue for the next 12 months and, since the pay stubs submitted confirm weekly pay of $750.00, these pay stubs can be accepted. If they are accepted, no further income verification is requested. The counselor documents in the case file the reason pay stubs from a period other than the 30 days before the application date were used. 2. A hawk-i application is received April 5 from Ms. D. All questions are answered and Ms. D sends the following pay stubs with the application. Pay date 3-26 3-12 2-27 2-13 1-30 1-16 1-02 Gross Pay $1,234.56 $987.65 $765.43 $543.21 $450.00 $450.00 $450.00 In Section 8 on the application, Ms. D writes, “The work in my office picks up during each quarter, so my income goes up. But, when the new quarter begins, I start back at my usual salary. This ‘up and down’ happens every quarter and will continue to happen for the next 12 months.” Since the income from the 30-day period before April 5 will not continue at the same rate for each of the next 12 months, it cannot be used. Instead, the best information available may be the income from the 90-day period before April 5 or a W-2 form from last year. The counselor documents in the case file the reason income from a period longer than the 30 days before the application date is used.