Eligibility
Factor |
Acceptable
Proof |
Earnings |
A
statement from the employer which provides the gross amount
and frequency of earnings for each of the 3 months in the
report period. DFA
Form 890A, Quarterly
Wage Verification, or Pay
stubs or envelopes. |
Child care costs |
A
statement, receipts, or bills from the child care provider
which provides the amount and frequency of child care costs
for each of the 3 months of the report period. A
statement from a third-party payor which specifies the amount
subject to reimbursement. |
Mail Delay |
The
postmark on the envelope in which DFA Form 890 was returned
to the District Office is dated prior to the due date. DFA
Form 890, or the envelope, was date stamped by the District
Office on or before the due date. |
Emergency |
|
Illness |
A
signed and dated statement from the parent/caretaker relative
or a physician describing the duration and nature of the illness
and how the illness specifically resulted in late return of
DFA Form 890. A
signed and dated statement from the parent/caretaker relative
describing the duration and nature of the illness and how
the illness specifically resulted in loss of employment. |
Involuntary
loss of employment |
A
signed and dated statement from the employer which indicates
that the individual’s termination
of employment was involuntary, A
layoff or firing notice, Receipt
of unemployment benefits, A
statement from NHES indicating the parent/caretaker relative
is eligible for unemployment benefits, or A
notarized statement from an individual who has direct knowledge
of the circumstances which caused the parent/caretaker relative’s
involuntary loss of employment. |