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JOB AID 1 INCOME VERIFICATION DOCUMENT EXAMPLES
FOR LEAD ACCEPTING PRODUCERS
8.1.16
2©2016 Copyright California’s Low Cost Auto Insurance | 2
PURPOSE OF JOB AID
• To assist Lead Accepting Producers with
examples of the types of documents that
consumers may provide as proof of income
eligibility
• To provide a document Lead Accepting
Producers can share with consumers as
examples of income verification
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PROOF OF INCOME DOCUMENTATION• Federal or state income tax return for the last year
• IRS form 1099
• IRS form W-2
• Payroll stub
• Medi-Cal card
• An employer verification letter
• Social Security or pension letter
• Utility company/ Lifeline verification
• Electronic Benefit Transfer (EBT) card
• Notification from California Work Opportunity and Responsibility to Kids
(CalWORKS)
• State of California Employment Development Department (EDD) Debit Card or
benefit letters
• Bank Statement as proof of deposits of Social Security payments
• CalFresh (food stamps)
• CalWORKS (welfare)
• SSI (aged, blind, disabled)
• LIHEAP (Low Income Home Energy Assistance)
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IRS FORM 1040 (TAX RETURNS)
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IRS FORM 1099
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IRS FORM W-2 (TAXES)
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PAYROLL CHECK STUB
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BENEFITS CARD (MEDI-CAL, SSI)
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EMPLOYER INCOME VERIFICATION LETTER
March 19, 2016
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SOCIAL SECURITY ADMINISTRATION BENEFITS LETTER
Date: August 09, 2016
Claim Number: XXX-XX-5913A
XXX-XX-5913DI
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UTILITY DISCOUNT (CARE PROGRAM)
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ELECTRONIC BENEFIT TRANSFER (EBT) CARD
13©2016 Copyright California’s Low Cost Auto Insurance | 13
CALIFORNIA EMPLOYMENT DEVELOPMENT
DEPARTMENT(EDD) BENEFITS/DEBIT CARD
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BANK STATEMENT SHOWING DIRECT DEPOSIT OF BENEFITS
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LIHEAP (LOW INCOME HOME ENERGY ASSISTANCE) PROGRAM
