*Proof of Income documentation to determine eligibility will require the patient to provide one of the following:
1) Most current W-2 (within 15 months) - gross income (box1)
2) Most recent pay stubs (within 2 months)- gross income,
3) Most current tax returns - adjusted gross income (AGI line 11 on Form 1040 and 1040SR - tax year 2021/2022) (AGI line 8b of 1040 or 1040SR or line 35 of 1040NR - tax year 2021/2022)
4) Official documents/letters from Social security earnings(or other retirement or VA benefits), including unemployment and child support, court orders, welfare checks, workman’s compensation checks, etc.
5) Letter from parent or caretaker, other income from partner or spouse, employer (if patient does not file income tax returns and does not get paid with a check.
6) Self declaration (Patients who are unable to provide written verification must provide a signed statement of income, and why (s)he is unable to provide independent verification).