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Effective Date: 
10/1997

Documents

Instructions

Updated: 10/1997

PURPOSE

To serve as a request for verification of 40 quarters of earnings.

PROCEDURE

When to Complete

Staff complete Form H1079 for each household that contains LPRs for whom verification of 40 quarters of earning is being requested. The form is given to the WTPY data entry staff. Workers must ensure that the information included in the form is correct for each person for whom 40 quarters are requested.

Number of Copies

Complete an original for the each person for whom 40 quarters verification is requested.

Form Retention

File in the legal section as required by the CSS Manager's Guide.

DETAILED INSTRUCTIONS

Client Name — Enter the name of the LPR for whom verification of 40 quarters is needed.

Case Name — Enter the name of the person who is the case name.

Case Number — Enter the case number.

Name — Enter the name of the person (self, spouse, or parent) for whom 40 quarters verification is needed.

Relation to Client — Enter either spouse or parent (including stepparent).

SSN — Enter the person's SSN for whom verification is being requested (self, spouse, or parent).

DOB — Enter the date of birth of the person listed.

Date Relationship Began — Enter either of the following dates:

  • date of LPR's marriage to spouse, if using the spouse's quarters,
  • date of marriage between LPR's legal parent and stepparent, when using the stepparent quarters, or
  • date of parent's birth for natural or adoptive children.

Date Relationship Ended — Enter the end date as follows:

  • when using the spouse or stepparent quarters, enter date of death, or
  • when using parent(s) or stepparent(s) quarters, enter the date the child turned 18 years of age.