Common use of Self-Attestation Clause in Contracts

Self-Attestation. Types of income for which self-attestation is allowable are indicated in the table below with an in the box named “Self-Attestation.” Self-attestation should be used only when all other attempts at collecting other forms of documentation have been exhausted. Self-attestation is documented as a signed and dated written statement by the client that includes: ✓ Sources of income ✓ Income amount ✓ Frequency of income A case manager or staff person must also provide a written statement documenting attempts to obtain other forms of verification and justification for using the self-attestation method. Type of Income Preferred Documentation If preferred documentation is not available, the following are acceptable forms of documentation: Wages and Salary Income Copy of most recent pay stub(s). Self-Employment and Business Income Copy of most recent federal and state tax return, profit and loss report from applicant’s accounting system, or bank statement. Interest and Dividend Income Copy of most recent interest or dividend income statement OR most recent federal and state tax return. Pension/Retirement Income Copy of most recent payment statement, benefit notice from Social Security, pension provider or other source. Unemployment and Disability Income Copy of most recent payment statement or benefit notice TANF/Public Assistance Copy of most recent payment statement, benefit notice, or Department of Social and Health Services (DSHS) Benefits Verification System (BVS). Alimony, Child Support, ▇▇▇▇▇▇ Care Payments Copy of most recent payment statement, notices, or orders. Armed Forces Income Copy of pay stubs, payment statement, or other government issued statement indicating income amount. Student Financial Aid Copy of student financial assistance award letter or other educational institution issued statement indicating amounts.