Child Care - Admin. Rules, Chapt. 1, Purchase of Service

SNAP - 7 CFR 273.2

POWER - W.S. 42-2-105

FACTOR

PRIMARY EVIDENCE

SECONDARY EVIDENCE

AGE

·         Birth Certificate

·         None

·         Adoption papers or records

·         Church records

·         Baptismal certificate

·         Vital statistics records

·         United States passport

·         Family Bible records

·         Indian census records

·         Social Security records

·         Military records

·         School records

·         Census records

·         Driver’s license

·         Court support order

·         Juvenile court records

·         Child welfare records

ASSETS

Bank accounts, CD’s, child

 support, bonds

·        Bank officials

·        Savings bonds

·         None

stocks, mutual funds

·        Certificates of deposit

·        Bank statements

·       ReliaCard statement

·        Viewing certificates, bonds or notes

SNAP only for cash and safety

·         Statement of applicant/recipient

deposit box

·         Notarized statement of contents

Bona fide effort to sell -

·         Statement from realtor

·         None

except for POWER

·         Signed realtor’s agreement to sell property

·         Newspaper clipping

·         Pamphlet of listings

·         Other advertisement

Life insurance

·         Viewing the policy

·         None

except for SNAP

·         Insurance agent

·         Insurance company

·         Lodge or fraternal organization

·         Union

·         VA

·         Employer

·         Funeral director

Promissory notes

·         Viewing notes

·         None

·         Statement from bank officials

Other personal property,

·         Sales receipts/ proof of purchase or sale

·         None

antiques, art work,

·         Catalog

·         Existing insurance appraisal

·         Divorce decree

·         Local merchant

·         Statement from two knowledgeable sources in the community

Real property

·         Statement from county assessor or count clerk where property is located.

·         None

·         Deed/Contract for mortgage

·         Proof of sale

·         Divorce decree

Vehicles - Ownership

·         Registration

·         None

·         Title

·         RIS interface

·         Statement from DMV

·         Proof of purchase or sale

Vehicles - Value

·         Edmunds Automobile Valuation Internet site (trade in value)

·         Appraisal from licensed dealer

·         Payment book

·         Statement from two knowledgeable sources in the community

CHILD SUPPORT

Assigned

Note:  For verification of received child support payments, see Income, Unearned, Support

·         Assignment of support, DFS100/DFS100S

·         Report of non-custodial parent, DFS 543

·         Individual Responsibility Certificate of Understanding

·         None

CITIZENSHIP

By birth or naturalization

(Includes persons born in D.C., Puerto Rico, Guam, U.S. Virgin Islands, Northern Mariana Islands, American Samoa or Swains Island)

For SNAP only:

Verify citizenship only when questionable

·         Birth certificate

·         Citizenship papers

·         U.S. Passport

·         Hospital record of birth

·         Baptismal record showing date and place of birth

·         Military service papers

·         Family Bible

·         Indian census records

·         SDX or TPQY

For SNAP only:

·         Signed statement, under perjury, from a U.S. citizen concerning the client’s citizenship status

·         Voter’s registration card

By permanent residence

·         Immigrant registration card (I-551)

·         Re-entry permit

·         None

Parolee, Asylee, Refugee,

·         USCIS records (see prior section for USCIS address)

·         None

·         I-94 marked refugee conditional entry or paroled

·         Correspondence stating indefinite or voluntary departure, indefinite stay deportation or not under direct order of deportation

·         Correspondence stating immigrant under USCIS order of supervision

·         Correspondence stating immigrant granted deferred action status

·         SDX or TPQY

Victims of trafficking

·         Certified letter for the adult(s) from HHS, Office of Refugee Resettlement 

·         Similar uncertified letter for a child(ren) 

·         None

Canadian Indians

·         Unexpired Form I-551 with code S13

·         Unexpired temporary I-551 stamp on a Canadian passport

·         Form I-94 with the code of S13

·         Letter or other tribal document, certifying at least 50% Indian blood; and

·         Birth certificate or other satisfactory evidence of birth in Canada

Legal immigrant  victim of domestic violence

·         Any official documentation of an approval or a petition pending setting the domestic violence status

·         None

Qualifying quarters

·         Verification from SSA

·         None

·         TPQY interface

·         Wage information not covered by SSA match

Color of law prior to 1/1/72 (PRUCOL)

·         USCIS records

·         Evidence verifying continuous residence prior to 1/1/72:

- School records

- Marriage license

- Voter registration card

- Insurance policy

- Military service records

- Social security card

·         None

DEDUCTIBLE EXPENSES

Dependent care - SNAP only

·         Statement of  provider showing actual or prospective amount

·         None

·         Actual bill(s) from the provider

·         Receipt(s) reflective of what was billed

Legally obligated CS

·          Court order or court records

·         Divorce or separation decrees

·         Support agreements

·         Lawyer’s records

·         Wage withholding statements

·         Employer’s records showing attachment of wages

·         Statements from custodial parent

·         Income tax returns

·         Canceled checks

·         Correspondence regarding support payments

·         Title IV-D and Child Support Enforcement agencies.

·         None

Medical

·         Bills from the providers of health insurance, services and products

·         Statements from providers

·         Health insurance policies describing areas of coverage.

·         None

Self-employment

·           Business ledgers (except for SNAP)

·           Actual receipt of expense

·           Income Tax records

·         None

Shelter - SNAP and POWER only:

·         Rent/mortgage bill(s)

·         Receipt(s) reflective of what was billed

·         Landlord statement

·         Lease agreement/ rental verification form

·         Utility bills

·         Statement of utility provider

·         DFS 105

·         None

·         Receipt of LIEAP

·         Property tax/insurance records

DEPRIVATION

Except SNAP

Death

·         Death certificate

·         Vital statistics record

·         Widow's or survivor's benefits on the deceased parent's SSN

·         VA or military service records

·         Hospital records

·         Funeral director's statement

·         Indian census records

·         Newspaper death notice

·         Institutional records

·         Insurance company records

·         Lodge, club or fraternal organization records

·         Memorial card

Two-parent incapacity claimed

·         DFS 110

·         Statement with information required on DFS 110

·         None

Disability

·         SSI or RSDI benefits for disability

Abandonment

·         Law enforcement records

·         Court records

·         None

Continued absence

POWER

(Require two pieces of secondary evidence only when continued absence is questionable or a report of the non-custodial parent in the assistance unit is received.)

·         Self-declaration statement

·         City directory

·         Correctional institution records

·         Court records

·         Employment records

·         Driver’s license

·         Health insurance card

·         Law enforcement officials

·         Lease agreement

·         Letter with address correction requested

·         Motor vehicle registration

·         Post office

·         Probation office records

·         Records which show non-custodial parent’s current address different from assistance unit

·         Rent receipt from non-relative landlord

·         School records

·         Signed statement from minister or other knowledgeable non-relative

·         Statement from landlord of non-custodial parent or recipient

·         Telephone directory

·         Unemployment compensation records

·         Union records

Fleeing for personal safety or safety of child(ren), domestic violence

·         Court record

·         Medical record

·         Criminal record

·         Law enforcement record

·         Psychological record

·         Child protection record

·         Social service record

·         None

·         Domestic violence agency record

Primary caretaker

·         None

·         School records

·         Signed statement of non-custodial parent

·         Signed statement of minister  or other knowledgeable nonrelative

DISABILITY/INCAPACITY

Individual

·         Official Document or proof of receipt of benefits from:

        - SSI

        - RSDI

        - Railroad Retirement

        - Other governmental agency

        - VA

·         None

Exemption from work registration – SNAP only

·         DFS 110

·         Visual verification by Benefit Specialist

·         Physician’s statement

·         None

Child – CC only

·         Written statement from physician/psychologist

·         None

EDUCATION

·         Degree

·         Diploma

·         Transcript

·         Signed statement from school

·         Class schedule

·         Grade report

·         None

ELDERLY (see AGE)

EMANCIPATION

For CC and POWER only:

·         Marriage certificate

·         Divorce decree

·         Birth certificate

·         Military papers

·         Decree of emancipation

5 YEAR BENEFIT LIMIT

·         Issuance history

·         Verification from prior state(s) of residence

·         None

POWER only:

GOOD CAUSE

For POWER only:

·         Medical records

·         None

Child support claim

·         Written statement of mental health professional

·         Written statement of person other than applicant/recipient

·         Law enforcement records

·         Court or legal records

·         Written statement of child protection or  social service personnel

Employment

·         Physician statement or DFS 110

·         None

·         DWS statement

·         Social service statement

·         Employer statement

·         Statement of other employees or clients

·         OSHA statement

·         Proof of expense

IDENTITY

·         Birth certificate

·         School record

For SNAP only – Any documents which reasonably

·        State issued ID from Revenue Dept.

·        Driver's license

·         Report card

·         Baby's hospital wrist band

establish the applicant’s

·         Voter's registration card

·         Newspaper announcement

identity must be accepted, and no requirement for a specific type of document, such as a birth certificate, may be imposed.

·         Naturalization certificate

·         Marriage certificate

·         Divorce decree

·         Military service records or IDs

·         U.S. Passport

·         Child care or pre-school records

·         Record of child’s membership in a youth organization

·         Church record

·         Clinic, doctor or hospital record

·         Insurance policy

·         Immigration documents

INCOME

Wages and in-kind wages

·         Wage stubs

·         None

·         Employer's statement or DFS 106

·         ESY4

·         BDE (earned income BENDEX)

Self-employment – For CC, SNAP and POWER

For SNAP only

·         Business ledgers

·         Income Tax records

·         Client Statement

·         None

Unearned income

·         Award notice

·         Official correspondence

·         Recent check

·         BDX (BENDEX) printout/interface

·         SSA form 1610

·         SDX printout/ interface

·         UIB (unemployment insurance benefits interface)

·         None

·         Railroad unemployment benefits

·         Third party query (TPQY)

·         BDP (pension BENDEX)

·         UFO (IRS interface)

·         Collateral contact with appropriate agency

Contributions

·         Statement from source of payment

·         None

·         Copy of check

·         Official correspondence

·         DFS 105 Contribution Statement

Grants, scholarships

·         DFS 111 Financial Information

·         None

·         Award notice

·         Official printout/ correspondence

Support payments, retained or excess child support

·         Information from child support authority

·         Clerk of Court in locality of court order

·         Canceled checks from non-custodial parent

·         Divorce or separation decree

·         Statement from source of payment

·         ReliaCard statement

·         Court order/records

·         Support agreement

·          Income tax return

·         Employer’s record of attached wages

·         Official correspondence

·         Child Support Collection Review interface window

·        None

LIVING WITH A RELATIVE

·         Current school record showing address of child and responsible relative

·         Hospital, clinic, health department or physician

·         Court support order

·         Juvenile court record

·         Child welfare record

·         Statement of minister, priest or rabbi

·         Signed statement from a non-relative

·         Visually observing child in the home

·         Non-relative landlord's statement

LOANS – BONA FIDE

·         Written agreement, signed by all parties, to repay the loan within a specified time

·         Evidence the loan was obtained from an individual or establishment engaged in the business of making loans

·         None

PRISONERS

SNAP only:

·         TPQY interface

·         None

RELATIONSHIP

Child and relative same or different surname

·         Birth certificate(s)

·         Adoption papers or official records

·         Indian census records

·         Marriage license

·         Hospital or clinic records of birth

·         Church records of birth, parentage

·         Divorce decree

·         Vital statistics records

·         Baptismal certificate or records

Paternity or presumed paternal relative

·         Marriage certificate

·         Birth certificate

·         Paternity papers

·         Court order

·         Adoption papers

·         Indian census records

·         U.S. Passport

·         Records of verification if father listed or paternal relative listed and relationship identified:

- Social Security records

- Hospital/Clinic/Health

  Department records

- Child welfare agency records

- Census Bureau records

- Income tax records

- Insurance policy

- School/juvenile court records

- Military/veterans records

- Wills/deeds/trusts, etc.

- Baptismal certificate

·         Notarized statements from both parents (except for POWER)

RESIDENCE

·         Contribution/Eating Arrangement/Shelter Statement (DFS 105)

·         Statement of applicant/recipient

·         None

·         Landlord statement

·         Employer’s statement

·         Collateral contact

·         Post Office records/statement

·         Tax office records

·         Rent/mortgage receipts

·         Item of mail with assistance unit name, address and current postmark

·         Driver’s license/DMV records

·         Voter registration card

·         High school diploma

·         Utility bills

·         Wages

·         School records

·         Rental Verification (DFS 109)

SCHOOL ATTENDANCE/ STUDENT STATUS

Secondary and Post-secondary

·         Statement from/contact with school authorities

·         DFS111

·         Current report card

·         Correspondence from school authorities

·         Registration information

·         Correspondence from scholarship source

·         Signed statement from non relative with knowledge of child’s attendance

Moved from another state and not pre-registered

·         School authorities from other state

·         Child welfare record

·         Statement of client

·         Report card

·         Signed statement of non relative

SNAP only

·         Statement from school authorities

·         DFS 111

SSN

POWER :

Verification is required only through the SSA interface for SNAP.  (See Section 605).

·         Social Security card

·         Documents/ printouts from SSA

·         SSA 1610

·         TPQY

·         SSN until next Periodic Review (for POWER only)

·         Military discharge form DD-214

·         BENDEX/SDX

·         Letter from hospital staff person

SNAP (See Section 605)

·         Previously validated within two years and the evidence is still available