• For all below, please specify if spousal or child and which members of the home are receiving this support
• Court order (only if receiving amount ordered)
• Domestic relations printout (last 30 days) –humanservices.state.pa.us
• Way2Go card printout (last 30 days) GoProgam.com
• Bank Statement (last 30 days)

• Statement from Social Services
• Letter from the adoption agency or state or county office stating amount of compensation that will be received
• Copy of all (last 30 days)

• Dividend Statement
• Bank Statement showing payment

• Benefits statement
• Copy of disability pay statements (last 30 days)
• Bank statement (last 30 days)

• Pension board letter
• Copy of pension check with stub attached from current year
• Pension benefit statement from current year
• 1099 From previous tax year
• Copy of Form 5498 for Roth IRA from previous year
• Bank statement from current year

• Copy of the current lease or rental agreement
• Copy of a receipt for the rent from the last 30 days
  • A confirmed signed statement from a renter stating they pay you rental income signed in the last 30 days

• Monthly Royalty Statement
• Copy of royalty check (last 30 days)
• Bank Statement (last 30 days)

• Other income should be used when reporting undocumented income, such as:
  • Cash Jobs
  • Assistance from family and friends
  • Other unverified sources of income
• Income from eBay, Etsy, Instacart, DoorDash, and similar platforms is not considered Other Income since monthly earning statements should be available. This type of income is considered self-employment.
• Cannot exceed $1000 or you must obtain some form of documentation.
  • If the amount exceeds $1000, you must submit written document from the payer of this income.
• You will fill out an other income form located within the application.

• Paystubs for the last 30 days
• Letter from employer on company letterhead stating hours work and pay (either total or hourly).
• Any form of proof must show gross income not net income.
• New jobs- if you do not have statements for a full 30 days, please submit a letter from your employer.

School teachers/bus drivers during off season if not paid year round:

• Last paystub received-include note stating you are seasonal but this is the last paycheck received.

Military Pay:

• Military LES (Leave & Earnings Statement) from last 30 days

• Federal Tax Return 1040 and schedule C (all pages)
  • If in partnership, Schedule K1 & Schedule E
• Quarterly profit and loss statement from accountant from the most recent quarter
• QuickBooks or other type of online ledger profit and loss from the most recent quarter

Other options- Please note these do not provide the benefit of business deductions.

Subcontractor or Commission only:

• 1099 for previous tax year.

Uber/Lyft/DoorDash/Instacart/Only Fans/AirBnB/ Etsy/e Bay, ETC:

Screenshots or monthly reports as documentation showing gross income for the last 30  days.

• Social Security Benefit Statement (also called Award Letter) Current year
• Statement or Screenshot from socialsecurity.gov/myaccount
• Bank Statement from the current year
• Copy of 1099 from previous year
• If you do not have any forms shown above, please contact social security at 1-800-772-1213 to request a current benefit statement.

• W2 or 1099 from the previous year
• Letter stating the offertory amount of the stipend (yearly/monthly) from the current year

• Notice of financial determination
• Unemployment printout – uc.pa.gov

• Copy of utility check from current year if paid directly to you.
• If reimbursed on a card, printout from the card (last 30 days)
• Document from housing authority that lists the utility reimbursement

• Letter from VA (current year)
• Benefit statement (current year)
• Bank Statement from last 30 days

• Letter of determination
• Benefits statement from last 30 days
• Copy of pay statements (last 30 days)
• Bank statement from last 30 days

• Used when no member of the household receives any form of income.
• You will fill out a zero income form located within the application, attesting that no member of the home receives income.