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Title 5: Centrally Administered Programs Page 42 Iowa Department of Human Services Employees’ Manual Chapter E: Healthy and Well Kids in Iowa (hawk-i) Income Revised July 3, 2009 Verification of Income

Since Mrs. F has stated that she has been continuously employed at the same place for the entire calendar year and that she expects her income to continue at the same rate for the next 12 months, the verification is considered complete. No additional pay stubs are needed. 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 June 23 from Mr. and Mrs. G. All questions are answered. Mrs. G is unemployed and Mr. G sends the following weekly pay stubs with the application. Pay date 6-18 6-11 6-04 5-28 Gross Pay $1,109.10 $159.50 $207.34 $1,080.76 Mr. G states on the application that he expected his income to continue at the same rate for the next 12 months but does not explain the extreme fluctuation in his weekly amounts. There is no year-to-date information on the pay stubs. It cannot be determined from the pay stubs submitted if Mr. G’s pay fluctuates like this every month. The counselor contacts the G family before requesting additional pay stubs. The Gs explain that Mr. G was ill during the weeks with the low pay amounts and that he has little sick leave accrued. Mr. G is now back to work, so the counselor explains that either the pay stubs dated May 14 and May 21 will be needed or that Mr. G could obtain a signed and dated statement from his employer. Mr. G chooses to submit the pay stubs. Annualized gross income is determined using the pay stubs dated May 14, 21, 28, and June 18. The counselor documents in the case file the reason nonconsecutive pay stubs were used. 3. A hawk-i application is received May 27 from Ms. H. The application contains a name and address but is not signed. Ms. H states on the unsigned application that she is paid $1,250 every two weeks and that she expects her income to continue at this rate for the next 12 months. Ms. H sends the following biweekly pay stubs with the unsigned application. Pay date 5-21 5-07 Gross Pay $1,250.00 $1,250.00