FAMILIES

Self Employment Verification Form

Verification of Self-Employment Form (Rev. 4.13.23).

Step 1 of 3 - Applicant & Business Information

Regarding Self-Employment and Cash-Paid Employment

If you are paid in cash or check and your employer does not take out your taxes, or if you are operating your own business, then you are considered to be self-employed. Self-employed applicants shall provide appropriate documentation sufficient to determine a minimum of 20 hours of employment per week, as well as income and any business expenses incurred.

Parent/Guardian Information

Parent/Guardian Name(Required)
Home Address

Business Information

MM slash DD slash YYYY
Business Address

Required Business Documentation

Please attach the following at initial application and redetermination.

Verification of Income: Provide a copy of your most current/recent federal income tax return (if reflective of current earnings), or this completed form plus two of the documents selected below.

Attached Documentation (select at least two)
Drop files here or
Accepted file types: pdf, jpg, Max. file size: 20 MB, Max. files: 5.