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EARNED INCOME You must verify current employment and the hours worked. Acceptable verifications include: • Employment payroll check stubs • Employment Information-Form 630, signed by employer • Self-employment records This can include a self-employment ledger, client’s ledgers, a Workforce Services self-employment form or other bookkeeping system ledgers. You may also use your own written statement of income and include the type of self employment. It must include a minimum of the most recent three full months of income with the income and hours worked broken down per month. Expenses only need to be reported if you want them subtracted when determining your countable income. UNEARNED INCOME This includes child support paid to the household, monthly cash contributions, or child are costs paid by someone outside of the household. EXPENSES This includes court-ordered child support or alimony. You must report if any other person pays towards child care costs. CHILD CARE NEED (MAY INCLUDE CUSTODY ARRANGEMENTS) Reported child care need is the weekly number of hours that you require child care for employment or Workforce Services-approved activities. Custody may also be verified to determine the need. CHILD CARE PROVIDER You are required to report the name of the child care provider for each child. Providers must verify the start date of care for each child. PARTICIPATION This may include Workforce Services activities that are approved with an Employment Counselor. U.S. CITIZENSHIP (Child Only) You must verify children’s citizenship and age. This may include birth certificates, passports or proof of immigration status in the form of documentation issued by United States Citizenship and Immigration Services (USCIS). -2- To receive assistance paying for child care, you must provide information to show you are eligible.* Some examples include: What is NOT needed: • A social security number The social security number on the application is not required for child care eligibility. • Any information regarding your immigration or work authorization status or the status of your family or household members Using child care benefits will not be considered in public charge determinations. Immigration information is private and confidential. *Other verifications may be required that are not listed here.