2. Adult Income-Eligible Program
If you are not receiving Public Assistance, you will need to verify your income eligibility with a document from the list below. If you are receiving Public Assistance, you do not need to verify income, but will need to provide verification of assistance through Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF).
Income Verification of ALL family members in the household who have worked during the last six months:
- Six months of most recent pay stubs
- Alimony statement
- SSI/SSDI statement
- Family size verification (if applicable: birth certificates, child custody/guardianship court decree
| Household Income by Family Size within last 12 months. |
|---|
| Family Size | Priority of Service
100% FPI | Eligible
250% |
| 1 | $15,650 | $39,125 |
| 2 | $21,150 | $52,875 |
| 3 | $26,650 | $66,625 |
| 4 | $32,150 | $80,375 |
| 5 | $37,650 | $94,125 |
| 6 | $43,150 | $107,875 |
| 7 | $48,650 | $121,625 |
| 8 | $54,150 | $135,375 |
Other documents that may be necessary, if applicable:
Verification of Disability – Letter from Division of Social Security (SSI or SSDI) for employment or training only.
Verification of Homelessness – Letter from Shelter, etc.
Verification of Foster Care Child – Court Custody Documents, etc.