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Tech Clean California Customer Agreement

Income Documentation Requirements

Sources of Income and Allowable Documentation

The chart below contains examples of required income documents. You must include documentation of income from all sources for ALL people living in the household who are 18 years or older. Income documents must be current and must include gross income (before deductions).

CalFresh/SNAP (Supplemental Nutrition Assistance Program)

  • Award letter or Notice of Action letter

  • Screenshot/print screen from issuing agency

  • Screenshot/print screen from website (CA.gov) showing current participation

CALWORKS TANF (Temporary Assistance for Needy Families)

  • Award letter or Notice of Action letter

  • Bank statement with direct deposit source (gross amount) attached

  • Affidavit of income

  • Screenshot/print screen agency

  • Copy of uncashed check

Tribal TANF (Temporary Assistance for Needy Families)

  • Award letter or Notice of Action letter

  • Bank statement with direct deposit source (gross amount)

  • Screenshot/print screen from issuing agency

Tribal Head start

  • Award setter or Notice of Action letter

Bureau of Indian Affairs

  • Award letter or Notice of Action letter

  • Bank statement with direct deposit source (gross amount)

  • Screenshot/print screen from issuing agency

  • Copy of uncashed check

Medi-Cal

  • 3rd party Medi-CAL card (LA Care, IEHP, HealthNet, etc.)

  • Adoption Assistance or Foster Care award letter

  • Award letter or Notice of Action letter

  • Issuance History Printout Stamped by the County

  • 1095-B from the Department of Health Care Services

  • Benefits ID card (issued within 12 months)

  • Screenshot/print screen from issuing agency

  • Screenshot/print screen from website

Medi-Cal for Families

  • Award letter or Notice of Action letter

  • Current (within 60 days) premium statement (not past due)

  • Screenshot/print screen from issuing agency

  • Screenshot/print screen from website

  • Tax Form 1095-B

Medi-Cal/Medi-Caid Assistance

  • Award letter/Notice of Action letter

  • Benefits ID card with a valid issue date within the past 12 months of enrollment date

  • Tax Form 1095-B

SSI (Supplemental Security Income)

  • Award letter or Notice of Action letter

  • Bank statement with direct deposit source (gross amount)

  • Form SSA-1099

  • Screenshot/print screen from issuing agency

  • Copy of uncashed check

  • Caseworker may fax information to Program Representative

WIC (Women, Infants and Children)

  • Award letter or Notice of Action letter

  • WIC phone app screenshot/print screen

National School Lunch Program (NSLP)

  • Case-by-case

LIHEAP (Low Income Home Energy Assistance Program)

  • Proof of LIHEAP benefit on utility bill

  • Eligibility notice from LIHEAP Service Provider

LIHWAP (Low Income Home Water Assistance Program)

  • Proof of LIHWAP benefit on utility bill

  • Eligibility notice from LIHWAP Service Provider

Disadvantaged Communities—Single Family Solar Homes (DAC-SASH)

  • Letter or proof of program enrollment/participation

Energy Savings Assistance Program (ESA)

  • Letter or proof of program enrollment/participation

Self-Generation Incentive Program (SGIP)

  • Letter or proof of program enrollment/participation

Single Family Affordable Solar Homes (SASH)

  • Letter or proof of program enrollment/participation

Weatherization Assistance Program (WAP)

  • Letter or proof of program enrollment/participation

Pension/401K(IRA) disbursement

  • Bank statement with direct deposit source (gross amount)

  • Check or check stubs

  • Award letter/Notice of Action letter

  • Federal income tax filing with W2s and/or 1099s attached

  • Form 1099

Disability or unemployment

  • Award letter/Notice of Action letter

  • Copy of Check or check stubs

  • Screenshot/print screen from issuing agency with linking document(s)

  • Federal income tax filing with W2s and/or 1099s attached

Foster Care/VA Benefits/Workers Comp.

  • Award letter/Notice of Action letter

  • Copy of Check or check stubs

  • Screenshot/print screen from issuing agency with linking document(s)

  • Federal income tax filing with W2s and/or 1099s attached

SSA (Social Security)

  • Bank statement with direct deposit source (gross amount)

  • Copy of Uncashed check(s)

  • Screenshot/print screen from issuing agency showing current participation

  • Award letter/Notice of Action letter

  • Federal income tax filing with W2s and/or 1099s attached

  • Form 1099

Capital or Other Gains

  • Federal income tax filing with W2s and/or 1099s attached

Self-employment/Business Earnings

  • Federal income tax filing with Schedule C attached

  • Affidavit of income

Monetary gift(s)

  • Bank statement with direct deposit source (gross amount)

  • Affidavit of income

Alimony or child support

  • Most Recent Court Documents

  • Copy of Check or check stubs

  • Affidavit of income

  • Notarized document

  • Bank statement with direct deposit source (gross amount)

Interest/Dividends

  • Bank statement with direct deposit source (gross amount)

  • Customer’s investment statement(s)

  • Federal income tax filing with W2s and/or 1099s attached

Insurance/Legal Settlements/Annuities

  • Bank statement with direct deposit source (gross amount)

  • Settlement Document

  • Annuity Letter

  • Copy of Check Stub

Wages/Salaries/Commissions

  • Federal income tax filing with W2s and/or 1099s attached

  • Payroll check stub(s) or deposit notice(s)

  • Affidavit from the employer (for cash wages only and only for one employer)

School Grants/Scholarships/Student Aid/Foreign Exchange

  • Cancelled check(s)

  • Award letter/Notice of Action letter

Per capita Tribal Payments

  • Copy of check or bank statement showing direct deposit

Proceeds made from Loans

  • Signed and dated letter

Documentation of Assets

  • Signed self-certification statement stating how you support your household and certifying that you meet the current income guidelines established for participation. (i.e. money in bank accounts)

Documentation of Housing Subsidies

  • Annual or recertification determination letter

Documentation of transferred funds

  • Bank statement or receipt showing transaction

Documentation of Asset Liquidation

  • Bill of Sale, signed payment receipt, or signed and dated statement

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