Rule 18-17-5.4 - DocumentationA document may serve to prove more than one requirement and need not be submitted more than once. The following is a list of acceptable proof for each requirement:
A. Proof of Age (child)1) Long Form Birth Certificate2) Record of Live Birth for children under the age of three (3) months until birth certificate is receivedB. Proof of Income (family) - Eligibility is based on gross family income. Applicants must provide proof of income for the last thirty (30) days to include one (1) of the following:1) Check stubs a. One (1) if paid monthly- must include the most recent check stub issued; orb. Two (2) if paid bi-monthly- must include the last two consecutively issued check stubs; orc. Four (4) if paid weekly-must include the last four consecutively issued check stubs.2) Estimated quarterly tax report3) Federal 1040 tax form - line 9 (total income)4) Schedule C Form 1040 - line 7 (gross income)5) New Employment or Temporary Agency Employment - letter from the employer on company letterhead verifying employment start date, income, rate of pay, and number of hours worked.6) Paid in Cash - a wage verification form, or a notarized letter from the employer verifying start date of employment, income, rate of pay, and number of hours worked. The letter must also include the employer's name, address, telephone number, and state that the employee is paid in cash.7) Paid by Personal Check - applicants must submit copies of the front and back of two checks that have cleared the bank.8) Self-Employed with Filed Tax Return:a. completed Wage Verification Form, andb. copy of an Estimated Quarterly Tax Report orc. 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. The amount located on Line 22 of the Federal 1040 Tax Form to determine income eligibility.9) Self-Employed, New Business- for businesses started within the current tax year a. completed Wage Verification Form, andb. current business license 45 CFR 98.20; 45 CFR 98.21; Miss. Code Ann. § 43-1-2(4); Miss. Code Ann. § 43-1- 4Revised: May 2023