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26 6. Paid by Personal Check

• Applicants must submit copies of the front and back of checks that have cleared the bank. One (1) if paid monthly – must include the most recent check issued; or Two (2) if paid bi-monthly – must include the last two consecutively issued check; or Four (4) if paid weekly – must include the last four consecutively issued check. All Documentation must meet the state minimum wage requirement, or the occupation must meet the exempt categories.

7. Self-Employed with Filed Tax Return

• Completed Wage Verification Form, and with anticipated work hours. Manual signature of person completing the form. AND • 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. Gross annual income will be used to determine if the applicant meets income eligibility criteria.

8. Self-Employed, New Business

• For businesses that have been started within the current tax year the current business license must be listed with the Secretary of State, and the hours of operation for the business. Applicants must include documentation of earned income for eligibility verification.

9. Teen parent(s) must submit valid ID for identification.

• State issued ID or current school ID.

10. Wage Verification Form

• MDHS form that can be used by applicants to provide verification of new employment. The Wage Verification form can be found at https://www.mdhs.ms.gov/eccd/parents/forms/.

Source: 45 CFR 98.20; 45 CFR 98.21; Miss. Code Ann. § 43-1-2(4); Miss. Code Ann. § 43-1 Revised: August 2025