Revision 17-1; Effective March 15, 2017

 

 

Resources — CW-CCAD Handbook Section 3420

Element Verification Sources Documentation
  1. Bank accounts, checking, savings, certificates of deposit (CD), money market
  • Current bank statement
  • Letter or contact with financial institution or bank
  • Medicaid eligibility (ME) Form H1239
  • Current savings statements
  • Recent entry in a savings passbook
  • Owner, if different from applicant's name
  • Type of account
  • Name and address of financial institution, if not listed on application
  • Source of verification
  • Account number, if not listed on application
  • Account balance and date, if different from face-to-face contact
  • If representative contacted, his name and telephone number
  1. Bonds
  • Newspaper
  • Bank or other financial institution
  • Brokerage firm/securities firm
  • Public library's research department
  • For savings bonds, the U.S. Treasury Office or its publication that is used by banks and is available on request
  • Owner, if different from applicant's name
  • Name of bond issuer and type of bond, if not listed on application
  • Source of verification and date, if different from face-to-face contact
  • Number of bonds and serial numbers (if applicable)
  • Current market or cash value. Corporate and municipal bonds may be discounted so the cash value may be less than the face amount. Some U.S. savings bonds must be held for 60 days before being cashed.
  • If representative contacted, his name and telephone number
  1. Cash on hand, safe deposit boxes
  • Statement of individual
  • Statement of individual regarding the contents
  • Date, if different from face-to-face contact
  1. Notes and mortgages (exempt if buyer fulfilling the contractual obligations)
  • Statement of individual
  • Statement of individual regarding the current market value
  • Date, if different from face-to-face contact
  1. Real property (unless in probate) (If property is exempt because the individual is making a good faith effort to sell, then he must supply evidence of the attempt to sell and the worker must verify that the selling price is at fair market value.)
  • Tax bill or assessment notice
  • Tax assessor
  • Local real estate broker
  • Local bank
  • Owner, if different from applicant's name
  • Source of verification and date, if different from face-to-face date
  • Current equity value of individual's interest
  • If collateral used, pertinent name and telephone number
  1. Revocable trust funds
  • Bank statement
  • Trust agreement
  • Will
  • Trustee
  • Bank representative
  • Name of trustee/beneficiary, if not listed on application
  • Source of verification and date, if different from face-to-face date
  • Accessibility of trust
  • Amount held in trust
  • If collateral used, pertinent name and telephone number
  1. Stocks
  • Recent statement from
    1. Brokerage house
    2. Issuing company
  • Securities firm
  • Newspaper
  • Public library's research department
  • Owner, if different from applicant's name
  • Name of company
  • Source of verification and date, if different from face-to-face contact
  • Number and type of shares
  • Market value
  • Use the closing price on the day of application or recertification
  • If collateral used, pertinent name and telephone number
  1. Vehicles (if not eligible for exclusion)
  • "Blue" or National Automobile Dealers Association (NADA) Book (gold)
  • Newspaper ads
  • Auto dealer
  • Finance company, or bank
  • Owner, if different from applicant's name
  • Year, make, and model
  • Source of verification and date, if different from face-to-face date
  • Market value
  • Equity value
  • If collateral used, pertinent name and telephone number
  • Assess $100 value for inoperable junk vehicle if individual's total resources are less than $4,900 for a single person or $5,900 for a couple
  1. Work equipment (excluded if required for employment, self-employment, or self-support)
  • Individual's estimate of value
  • Dealer
  • Owner, if different from applicant's name
  • Description of property, if not on application
  • Individual's estimate of value
  • Equity value
  • Source of verification and date, if different from face-to-face contact
  • If collateral used, pertinent name and telephone number

 

Income Eligibility — CW-CCAD Handbook Section 3300

Element Verification Sources Documentation
  1. The individual's total earnings (monthly gross)
    1. Money
    2. Wages
    3. Salary
    4. Armed forces pay
    5. Commissions
    6. Tips
    7. Piece-rate payments
    8. Cash bonuses
  • Employer
  • Oral statement
  • Written statement
  • Viewing check stubs
  • Copies of earnings statements (check stubs)
  • Who is employed, if not indicated on application
  • Name, address, telephone number of employer, if not on application
  • Date verified, if different from face-to-face contact
  • How information was verified
    • If by telephone, include name and telephone number of the contact
    • If by viewing, include description of document and date, if different from face-to-face contact
    • Gross amount
    • Frequency of pay
  • Show your calculations
  1. Net income from non-farm self-employment
  • Business receipts/records maintained by individual
  • Most recent Internal Revenue Service (IRS) Form 1040 (Income Tax Return) (In instances where complete verification of self-employment income is impossible, accept the individual's word if the information seems reasonably valid.)
  • Who is self-employed, if not indicated on application
  • Name and kind of business (address and telephone number if different), if not on application
  • Date verified, if different from face-to-face contact
  • Types of records used and period covered
  • Amount of gross income
  • Amount of expenses
    • Costs of purchased goods
    • Rent, heat, light, power
    • Depreciation charges
    • Wages/salaries paid
    • Business taxes (not personal income taxes or Social Security taxes)
  • If amount of net countable income is anticipated to be different, explain reason.
  • Amount of net countable income and calculations used to arrive at countable income.
  1. Net income from farm self-employment
  • Business receipts/records maintained by individual
  • Most recent IRS income tax return
  • Statements from other knowledgeable sources (e.g., county farm agent)
  • Who is self-employed, if not indicated on application
  • Type of farm income, if not indicated on application
  • Date verified, if different from face-to-face contact
  • Type of records used and period covered
  • Amount of gross income
    • Value of products sold
    • Government crop loans
    • Money from rental of farm equipment to others
    • Incidental money from the sale of wood, sand, gravel, etc. Note: Do not include value of fuel, food, or other farm products used for family living
  • Amount of operating expenses
    • Cost of feed, fertilizer, seed, and other farming supplies
    • Cash wages paid to farmhands
    • Depreciation charges
    • Cash rent
    • Interest on farm mortgages
    • Farm building repairs
    • Farm taxes (not personal income taxes or Social Security taxes)
  • If amount of net countable income is anticipated to be different, explain reason.
  • Amount of net countable income and calculations used to arrive at countable income.
  1. Social Security (Retirement, Survivors, and Disability Insurance (RSDI))
    1. Pensions
    2. Survivor's benefits
    3. Permanent disability insurance
  • Recent award letter
  • Recent cost-of-living increase notice from the Social Security Administration (SSA)
  • RSDI check or direct deposit slip
  • WTPY response
  • Form SSA 1610 (use only if no other source is available)
  • Texas Department of Health and Human Services Commission (HHSC) computer inquiry
  • Contact with SSA representative
  • Payee/beneficiary, if not indicated on application
  • Gross benefit amount before deductions for Medicare insurance
  • Claim number/suffix
  • Date received, if different from face-to-face date
  • Source of verification and date, if different from face-to-face contact
  • If SSA representative contacted, name and telephone number
  1. Railroad retirement (RR)
  • Form 1026
  • Recent award letter from RR Board
  • Contact with representative of RR Board
  • Most recent check or direct deposit slip
  • Payee/beneficiary, if different from applicant's name
  • Gross benefit amount before deductions for Medicare insurance
  • Claim number
  • Date received
  • Source of verification and date, if different from face-to-face date
  • If RR representative contacted, name and telephone number
  1. Dividends
    1. Stocks
    2. Membership in associations
  • Recent check stubs or checks
  • Letter from company making payments
  • Telephone contact with representative of company
  • Recent statement from a brokerage house or the company issuing the stock to verify dividends
  • Payee/beneficiary, if different from applicant's name
  • Payor (company)
  • Source of verification and date
  • Account number, if not listed on application
  • Gross amounts
  • Dates received
  • Frequency
  • Reason for dividend
  • If company representative contacted, name and telephone number
  • If excludable, reason for exclusion
  • If countable, show calculations used to arrive at an average amount.
  1. Net rental income
    1. House, store or other property
    2. Boarders or lodgers
  • Business receipts/records maintained by individual
  • Most recent IRS income tax return
  • Statements from individual and renter
  • Copy of lease or rent check
  • Type of rental income, if not indicated on application
  • Date verified, if different from face-to-face contact
  • Types of records used and period covered
  • Amount of gross income
  • Amount of expenses
    • Property tax receipts
    • Mortgage payment interest
    • Insurance payments
    • Bills for repair and upkeep of property Note: Capital expenditures for additions or improvements and depreciation are not deductible
  • If amount of income is anticipated to be different, explain reason.
  • Amount of net countable income and calculations used to arrive at countable income.
  1. Net income from lease of mineral rights
    1. Gross royalty payments
    2. Yearly lease payments
  • Royalty interest statements (check stubs)
  • Contact with representative of oil company
  • Check stub from lease payments
  • Name of payor/payee, if different from applicant's name
  • Source of verification and date, if different from face-to-face date
  • Account number
  • Amount of yearly lease payments
  • Gross amounts over past 12 months (royalty payments)
  • Dates received
  • Frequency
  • If representative contacted, name and telephone number
  • Deduction amounts
    • Excise taxes
    • Property taxes Note: Federal windfall profits taxes are not deductible—may have to add it back if company deducted it
  • Amount of net countable income and calculations used to arrive at a 12-month average (royalty payments)
  1. Income from mortgages or contracts (notes)
    1. Negotiable and
    2. Non-negotiable
  • Copy of contract
  • Copy of document with the statement of terms of repayment
  • Copy of recent check from payor
  • Contact with bank representative
  • Statements from the individual and payor
  • Name of payee/payor, if different from applicant's name
  • Source of verification and date, if different from face-to-face contact
  • Payment amount
  • Frequency
  • Date received
  • If representative contacted, name and telephone number
  1. Public assistance
    1. Temporary Assistance for Needy Families (TANF)
    2. Supplemental Security Income (SSI)
    3. General assistance from county or city
    4. Medicaid Qualified Medicare Beneficiary (MQMB)
    5. Qualified Medicare Beneficiary (QMB) only
    6. Specified Low-Income Medicare Beneficiary (SLMB) only
    7. Qualifying Individuals (QI) coverage
    8. Food stamps
  • HHSC computer inquiry
  • Most recent SSI award letter or SSI check
  • Most recent individual notice or check
  • Contact with a representative
    • Texas Works worker
    • MEPD case specialist
    • SSI representative
    • City or county worker
  • TANF case record
  • Name of recipient, if different from applicant's name
  • Type of benefit
  • Source of verification and date, if different from face-to-face contact
  • Benefit amount
  • Date received
  • If representative contacted, name and telephone number
  1. Private pensions (retirement benefits)
    1. Former employer
    2. Union
    3. Insurance company
  • Current check stub
  • Pension plan
  • Letter from company
  • Contact with company representative
  • Name of payor/payee/beneficiary, if different from applicant's name
  • Source of verification and date, if different from face-to-face contact
  • Gross benefits amount
  • Date received
  • Claim number
  • Whether any increase is anticipated
  • If representative contacted, name and telephone number
  1. Civil service annuity (CSA)
  • Recent CSA increase award card
  • Letter from CSA
  • Contact with CSA representative
  • Current check
  • Form 1243
  • Name of payee/beneficiary, if different from applicant's name
  • Source of verification and date, if different from face-to-face contact
  • Gross benefit amount before deductions for health insurance
  • Date received
  • Claim number
  • If representative contacted, name and telephone number
  1. Irrevocable trust funds
  • Trust agreement
  • Will
  • Trustee
  • Representative of bank or financial institution managing trust
  • Recent bank statement
  • Name of trustee/beneficiary, if different from applicant's name
  • Source of verification and date, if different from face-to-face contact
  • Amount and frequency of income from trust to individual
  • Date of bank statement
  • If trustee or representative contacted, name and telephone number
  1. Veterans Administration (VA) benefits
    1. Pension
    2. Compensation (disability)
    3. Subsistence allowance for education and on-the-job training
    4. Refunds paid to ex-servicemen (GI insurance premiums)
  • Current check or direct deposit slip
  • Recent bank statement
  • Form 1240
  • Recent VA Award Letter
  • Contact with VA representative
  • Name of recipient, if different from applicant's name
  • Type of benefit
  • Source of verification and date, if different from face-to-face contact
  • Gross payment amount and exclusions:
    • Aid-and-attendance benefits
    • VA Homebound Elderly Benefits
    • Payments for purchase of medications
  • Date received
  • Claim number
  • If representative contacted, name and telephone number
  1. Educational loans and grants
  • School
  • Organizations
  • Clubs
  • Institutions
  • Award letter
  • Government loans
  • Beneficiary, if different from applicant's name
  • Payor
  • Type of loan or grant
  • Amount received for current living costs
  • Source of verification and date
  • Date received and period covered (frequency)
  • If representative contacted, name and telephone number
  1. Unemployment compensation
    1. Government
    2. Private
    3. Strike benefits from union funds
  • Texas Workforce Commission Form B-11 or other official correspondence
  • Recent check
  • Recent bank statement
  • Contact with government agency, employer, union
  • Payee/payor, if different from applicant's name
  • Source of verification and date, if different from face-to-face contact
  • Gross amount received
  • Date received and period covered (frequency)
  • Claim number
  • If representative contacted, name and telephone number
  1. Worker's compensation and disability payments
  • Recent check
  • Attorney
  • Claim Adjuster
  • Recent bank statement
  • Legal Correspondence
  • Correspondence from insurance company
  • Employer
  • Payee/beneficiary, if different from applicant's name
  • Source of verification and date, if different from face-to-face contact
  • Gross amount received
  • Date received and frequency
  • Length of disability
  • Lump-sum settlement
  • If collateral contacted, name and telephone number
  1. Alimony
  • Contact ex-spouse
  • Divorce Decree
  • Court/payment records
  • Recent check
  • Receipts
  • Payor
  • Source of verification and date, if different from face-to-face contact
  • Amount received
  • Date received and frequency
  • If collateral contacted, pertinent name and telephone number
  1. Cash support payments from friends or relatives (regular monthly)
  • Contact or statement from contributor
  • Recent check
  • Receipts
  • Payee/beneficiary, if different from applicant's name
  • Relationship/name/address and telephone number of payor
  • Source of verification and date, if different from face-to-face contact
  • Amount received and frequency (exclude if infrequent or irregular and less than $20/mo.)
  1. Net income from individual's share of life estate
    1. Mineral lease
      1. Bonus payments
      2. Delays rentals
      3. Shut-in royalty
    2. Other types of leases (farming, grazing, hunting)
    3. Rental
  • Lease agreements
  • Rental agreements
  • Oil company representative
  • Check stubs
  • Lessee or tenant (renter)
  • Payee, if different from applicant's name
  • Payor
  • Source of verification and date, if different from face-to-face contact
  • Gross amount
  • Date received and frequency
  • If representative contacted, name and telephone number
  • Address and telephone number of lessee or tenant
  1. Teacher retirement (TRS)
  • Form 1297
  • Contact with TRS employee
  • Recent check if previously verified no deductions
  • Payee/beneficiary, if different from applicant's name
  • Source of verification and date, if different from face-to-face contact
  • Gross benefit amount
  • Claim number
  • Date received
  • If TRS representative contacted, name and telephone number