Common use of Verbal Statement Clause in Contracts

Verbal Statement. Types of income for which verbal verification is allowable are indicated in the table below with an in the box marked “Verbal Verification.” A verbal statement must be collected from a third party responsible for documenting this type of income information (example: TANF/Public assistance could be collected via verbal statement from DSHS). A verbal statement must be documented by a written attestation from a case manager or staff person responsible for collecting the statement. The staff person should record the following: ✓ Date of statement, ✓ Name of client, ✓ Name of company or organization, ✓ Name of individual writing the statement, ✓ Wages or income amount, ✓ Hour worked per week (if applicable). ✓ Signature of individual writing the statement 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: Written Verification Verbal Verification Self- Attestation No Income 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, Xxxxxx 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. Guidelines Changes SFY24 Section Previous Wording Changes 05/17/22

Verbal Statement. Types of income for which verbal verification is allowable are indicated in the table below with an in the box marked “Verbal Verification.” A verbal statement must be collected from a third party responsible for documenting this type of income information (example: TANF/Public assistance could be collected via verbal statement from DSHS). A verbal statement must be documented by a written attestation from a case manager or staff person responsible for collecting the statement. The staff person should record the following: ✓ Date of statement, ✓ Name of client, ✓ Name of company or organization, ✓ Name of individual writing the statement, ✓ Wages or income amount, ✓ Hour worked per week (if applicable). ✓ Signature of individual writing the statement 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. Page | 38 Type of Income Preferred Documentation If preferred documentation is not available, the following are acceptable forms of documentation: Written Verification Verbal Verification Self- Attestation No Income 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, Xxxxxx 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. Page | 39 Guidelines Changes SFY24 Section Previous Wording Changes 05/17/22