Income Verification

HEC Income Verification – Additional Information Checklist

____ Select only one Option, sign and date the HEC Form 200-1A, Income Verification Response.

____ Spouse’s signature and date on the HEC Form 220-1, Spouse Reported Income Verification.

____ Complete, sign, and date the enclosed Declaration of Representative form or provide a

Power of Attorney.

____ Spouse’s Social Security Number, Date of Birth, Date of Marriage.

____ Dependent’s name, Social Security Number, Date of Birth and date become dependent.

____ Copy of signed and dated 2003 U.S. Individual Income Tax Return with all

attachments/schedules.

____ Copy of W-2 Wages/Earning Statement for income year (_ _ _ _) (Veteran, Dependent, or

Spouse).

____ Copy of Divorce Decree or Legal Separation Papers.

____ Copy of paid receipts for out-of-pocket medical expenses for Veteran and family members

for income year (_ _ _ _).

____ Copy of Account Statements that show IRA was rolled over.

____ Copy of paid receipts for funeral/burial expenses for immediate family member(s).

____ Copy of paid receipts for Veteran’s tuition, fees, and book expenses for college or

vocational training.

____ Copy of Form SSA-1099, Social Security Benefit Statement for income year (_ _ _ _)

(Veteran, Dependent, or Spouse). Call toll free 1-800-772-1213 to obtain a form if you do

not have your copy.

____ Check the box on HEC Form 200-1A, Income Verification Response, attesting the real

estate sales was your primary residence for income year (_ _ _ _), if applicable.

Other: _______________________________________________________________________

HEC Form 220-1 (MMM YYYY) Page 2 of 1