Full name of the person or other identifying information to link to the person (e.g. SSN). Social Security card is not necessary.
Pay period or frequency of pay with the date of payment.
Federal Income Tax Form 1040, 1040NR, 1040A, 1040EZ, 1040X with original 1040 from previous year, with any appropriate Schedules. It must include:
Full name of the person or other identifying information to link to the person (e.g. SSN).
Wages and tax statement (W-2 and/or 1099, including 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099SS, 1099INT).
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.
A sample employer statement letter can be viewed here.