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Indiana State Department of Health
Children's Special Health Care Services
2 North Meridian St. - Section 7B
Indianapolis, IN 46204
To:OFC Consultants & Caseworkers, First Steps Service Coordinators
Kerri Krause, Lynn Stuart, Debbie Palmisano
Judi Johnson, Training Coordinator
Norma Boykin, Supervisor
Eric Vermeulen, Director
November 22, 2004
Required Documentation for Income Verification
In an effort to keep you informed about income verification and documentation updates instituted by the Children's Special Health Care Services (CSHCS) program, we are summarizing the following clarifications that are effective as of 12/13/2004. Any and all applications dated and signed after this date will be subject to these new changes. Applications signed and dated prior to this date, but received after this date, will not be affected.
Updates, Clarifications and Changes
The CSHCS program requires that supporting documentation (i.e., copy of the yearly amount letter or an SSA Form 1099) for all Social Security and Social Security Supplemental (SS/SSI) income be submitted with the application.
The CSHCS program requires supporting documentation (the most recent Federal 1040) for all earned and unearned income.
The CSHCS program requires supporting documentation (last 3 consecutive pay stubs) when income has drastically changed from the previous year's 1040. Please note that the Federal 1040 should also be submitted in such cases.
The CSHCS program requires supporting documentation (a printout from the Child Support Division) of all child support received one month prior to the date of application.
The CSHCS program requires supporting documentation (written, signed & dated statements) for all in-kind income (for example, notes that state the amount of rent paid by relatives, etc.).