Proof of Income
Note: Self-attestation of income in a written statement signed under a penalty of perjury is accepted on a case-by-case basis.
Submit a copy of one of the following documents.
Earned Income: Employer Wages
- Pay stub. It must include:
- Full name of the person or other identifying information to link to the person (e.g. SSN). Social Security card is not necessary.
- Income amount.
- Pay period or frequency of pay with the date of payment.
- Most recently filed Federal Income Tax Form 1040, with any appropriate Schedules. It must include:
- Full name of the person or other identifying information to link to the person (e.g. SSN).
- Income amount.
- Tax year.
- Wage/Income Tax Statement (such as a W2, 1099MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099SS, 1099INT, or 1099NEC, or other form displaying your income and taxes).
- It must contain the person’s first and last name, income amount, year, and employer name (if applicable).
- Employer statement. The employer statement must:
- Be on company letterhead or state the name of the company.
- Be signed by the employer.
- Be no older than 45 days from the date received by Covered California.
- Include the following information:
- Name of employer or company.
- Name of person writing the letter.
- Employer or company address.
- Employer or company telephone number.
- Date of the letter.
- The start date and, if applicable, the end date of the employee’s employment or pay.
- The following two statements:
- “I certify that [first and last name of person employed or receiving income] is/was an employee of [name of company]. [Employee name]’s gross income for this pay period is/was $__________ and frequency of pay is [weekly, every two weeks, twice a month, or monthly]. This letter does not guarantee employment or wages.”
- “The information provided above is true and correct to the best of my knowledge.”
- Signature of the person writing the letter.
- Printed name and job title or position of the person signing the letter.
- View a sample employer statement.
- Foreign Income.
- Pay stub, other documents.
- Use dollar conversion based on date of document.
Earned Income: Self-Employment (includes farm income)
- Self-employment Profit and Loss Statement or Ledger documentation (the most recent quarterly or year-to-date profit and loss statement, or a self-employment ledger). It must contain:
- The person’s first and last name and company name.
- Dates covered and the net income from profit/loss.
- Federal Tax Form 1040 with any appropriate Schedules.
- Annuity statements.
- Statements of pension distribution from any government or private source.
- Prizes, settlements, and awards, including alimony received and court-ordered awards letters. For divorce or separation documents dated after Dec. 31, 2018, alimony received is not counted as taxable income.
- Proof of taxable gifts and contributions.
- Proof of taxable scholarships or grants — for room and board only, not tuition, course-related fees, books or equipment.
- Proof of strike pay and other benefits from unions.
- Sales receipts or other proof of money received from the sale, exchange or replacement of things the person owns.
- Interests and dividends income statement.
- Royalty or residual income statement or 1099-MISC.
- Letter, deposit, or other proof of deferred compensation payments.
- Social Security Administration Statements (Social Security Benefits Letter).
- Retirement, Survivors Disability Insurance (RSDI), Social Security Retirement, Social Security Disability Insurance (SSDI).
- It must contain first and last name, benefit amount, and frequency of pay.
- Unemployment Benefits Letter.
- It must contain the person’s first and last name, source/agency, weekly benefits amount, and duration (start and end date, if applicable).
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