Sources of Verification - Residency

Sources of Verification - Age/Relationship

GENERALLY AVAILABLE FROM THE RECIPIENT:

1.Birth Certificate

2.Baptismal Certificate

3.Confirmation Papers

4.Military Service Papers

5.Immigration Papers

6.Naturalization Papers

7.Hospital Birth Records

8.Adoption Record

9.Passport

10.Voter Registration Card

11.Family Records (Bible, Birthday Books, Geneology, Newspaper Birth Announcements)

12.Marriage License

13.Driver's License

14.Employee ID. Card

15.Life Insurance Policy

16.Support Decree

17.School Records

OTHER SOURCES:

A.State or Federal Census Records

B.Statement from Person Attending Birth (e.g., Physician, Mid-WifeNurse, Relative, etc.)

C.Medical Records

Sources of Verification - Citizenship/Alien Status

GENERALLY AVAILABLE FROM THE RECIPIENT:

1.Naturalization Papers/Certifications of citizenship (INS Form I-179, INS Form I-197)

2.Permanent Visa

3.Birth Certificate/Hospital Birth Records

4.Refugee Registration Cards

5.U.S. Passport

6.INS ID Card

7.Baptismal Record (Only when place and date of birth is shown.)

8.Family Bible/Religious Records

9.Military Service Records

10.Indian Census Records

11.Voter Registration Cards

12.Signed statement from a U.S. citizen which declares under penalties of perjury that individual in question is a U.S. citizen

13.Alien Registration Cards/Re-entry Permits

14.INS Form I-151 or I-551 (Form I-151 will not be valid after August 1, 1993.)

15.INS Form I-94 if annotated with either:

a) Sections 203(a)(7), 207, 208, 212(d)(5), 243(h), or 241(b)(3) of the Immigration and Nationality Act: or

b)One or a combination of the following terms: Refugee, Parolee, or Asylee.

16.INS Form G-641, "Application for Verification of Information from INS Records", when annotated at bottom by INS representative as lawful admission for humanitarian reasons

17.Documentation that alien is classified pursuant to Sections: 101(a)(2), 203(a), 204(a)(1)(a), 207, 208, 212(d)(5),241(b)(3), 243(h), or 244(a)(3), of the Immigration and Nationality Act

18.Court order stating that deportation has been withheld pursuant to Section 241(b)(3) or 243(h) or of the Immigration and Nationality Act

19.INS Form I-688

20.Verified citizenship for OWF Program

OTHER SOURCES:

16.State Department Records

17.Immigration and Naturalization Service

Sources of Verification - Work Registration

The following sources may be used to verify the exempt status of persons not required to register for work

A.AGE, CARETAKER OF CHILD UNDER 6 :

1.Birth Certificate

2.Adoption Papers/Records

3.Hospital/Clinic Records

4.Church Records

5.Baptismal Certificate

6.Bureau of Vital Statistics

7.U.S. Passport

8.Family Bible

9.Census Records

B.DISABILITY:

1.Receipt of Temporary or Permanent Disability Benefits From a Government or Private Source Including SSA, SSI, RSDI, DA, or Worker's Compensation.

2.Statement From a Medical Authority

C.SUBJECT TO AND COMPLYING WITH OWF:

1.Appropriate Documentary Evidence or Documentation in the Case Record

D.CARETAKER OF INCAPACITATED PERSON:

1.Collateral Contact

E.UNEMPLOYMENT COMPENSATION:

1.Letter or Official Document Showing Receipt of UCB

2.Documentation in Case Record or Contact with SESA to Verify that Person Applied for UC and Registered for Work with SESA

F.PARTICIPANT IN ADDICT OR ALCOHLICTREATMENTCENTER:

1.Documentation or Contact with Center

G.SELF-EMPLOYED AT LEAST 30 HOURS A WEEK OR RECEIVING WEEKLY EARNINGS EQUAL TO FEDERAL MINIMUM WAGE X 30 HOURS:

1.Business Records or Form IRS 1040 (Tax Return)

2.Copy of Contract or Contact with Crew Chief or Employer for Migrant and Seasonal Workers.

H.EMPLOYED AT LEAST 30 HOURS A WEEK OR RECEIVING WEEKLY EARNINGS EQUAL TO FEDERAL MINIMUM WAGE X 30 HOURS:

1.Statement From Employer

I.STUDENT:

1.Contact with School Authorities

J.VERIFICATION OF CURRENT REGISTRATION:

1.Forms ES-511, ES - 511c,ODHS 7446, or ODHS 7449

2.SESA Printout

3.Contact with SESA or Work Program Staff

4.Case Record.

Sources of Verification - Income

Sources of Verification - Medical and Dependent Care Expenses

MEDICAL EXPENSES

GENERALLY AVAILABLE FROM THE RECIPIENT:

1.Billing Statements

2.Itemized Receipts

3.Medicare Card Indicating Part "B" Coverage

4.Health Insurance Policy Showing Premium

5.Medicine/Pill Bottles with Costs on Label

6.Statement From Pharmacy

7.Repayment Agreement with Physician/Hospital

8.Statement From Doctor Verifying Over-The-Counter Drug Prescribed

9.Bill for Visiting Nurse, Homemaker, Home Health Aide, Etc.

10.Lodging/Transportation Receipts From Obtaining Medical Treatment or Services

11.Receipts for Dog Food/Veterinarian Service for Seeing Eye/Hearing Dog

12.Bill or Receipt for Prescribed Equipment and /or Medical Supplies (Includes Rental Costs)

OTHER SOURCES:

1.Statement From Collateral Contact

DEPENDENT CARE

GENERALLY AVAILABLE FROM THE RECIPIENT:

1.Cancelled Checks

2.Paid Receipts

OTHER SOURCES:

1.Contact with Dependent Care Provider

Sources of Verification - Shelter Costs

1.CONTINUING SHELTER COSTS:

1.Rent Receipt

2.Mortgage Payment Book

3.Rent/Lease Agreement

4.Statement from Bank or Mortgage Company

5.Statement from HUD

6.Statement from Person with Whom A/R Shares Shelter Costs

7.Receipt/Stub for Campground Fees

B.ACTUAL UTILITIES:

1.Utility Bills

2.Cancelled Checks for Utilities

3.Contact with Organization Providing Utility

4.Statement from Utility Company

5.Statement/Receipt from Land lord for Utilities

C.DISASTER DAMAGE:

1. Bills

2. Contact with Party Providing Reimbursement

D.TAXES AND INSURANCE:

1.Property Tax Statements

2.Fire Insurance/Homeowners Policy or Billing Statements

3.Bills or Correspondence with Taxing Authority or Insurance Agency Which Show the Amount of Taxes and Whether They are Included in the Mortgage Amount.

4.Tax and Insurance Statement

E.UNOCCUPIED HOMES:

1.Receipts

2.Contact with Mortgage Company or Land lord.

3.Collateral Contact

F.OTHER:

1.Real Estate Sales Agreement

2.Receipt for Firewood

3.Statement from Collateral Contact

C-8 Sources of Verification - Social Security Numbers

GENERALLY AVAILABLE FROM THE RECIPIENT:

1.Social Security Card

2.Official Document Containing SSN

3.Copy of SSA - 5028, Receipt for Application for SSN

OTHER SOURCES:

1.BENDEX or SDX

2.SSN Verified in Case Record for OWF, Medicaid or Similar Program

3.Copy of SS-5, Application for SSN

4.Collateral Contact with Social Security Administration

Sources of Verification - Resources

LIQUID RESOURCES

GENERALLY AVAILABLE FROM THE RECIPIENT:

1.Bank Books

2.Stock Certificates

3.Bond Certificates

4.Mortgages

5.Notes

6.Securities

7.Credit Union Statements

8.Savings and Loan Statements

9.Bank Statements

10.Payment Check for Lump Sum

OTHER SOURCES:

1.Bank Records

2.Stock Brokers

3.Credit Union Records

4.Judgement and Lien Records

5.Savings and Loan Records

6.Credit Applications

7.Charge Account Applications

NON-LIQUID RESOURCES

GENERALLY AVAILABLE FROM THE RECIPIENT:

1.Deed

2.Sales Agreement

3.Mortgages

4.Life Estate Agreement

5.Articles of Agreement

6.Real Estate Tax Receipts

7.School Tax Receipts

8.Income Tax Return

9.Will

10.Life Insurance Policy

11.Burial Arrangement Contract

OTHER SOURCES:

1.Court House Records

2.Tax Records

3.Title Search

4.Utility Company Records

5.Charge Account or Charge Account Application Records

6.Written Value Assessment from Local Business (e.g., Auto, Boat, etc.)

7.NADA Bluebook

8.Statement from Insurance Company Indicating Cash Value of Policy

9.Statement Showing Current Value of Burial Plot

10.Real Estate Tax Transfer Division

11.Municipal Inspection Compliance Records

12.State Department of Motor Vehicles

13.Car Dealers

14.Sales Slips

15.Local Merchants

16.Catalog

17.Insurance Appraisal

18.Banks

19.Real Estate Firms