2
Exhibit __, IRS tax transcripts from 201_
Exhibit __, wage receipts/pay stubs/W-
Exhibit __, proof of additional, non-taxable income of continuing basis
Exhibit __, foreign tax return from 201_
□ Total household income and assets above 250% of FPG:
Exhibit __, IRS tax transcripts from 201_
Exhibit __, wage receipts/pay stubs/W-
Exhibit __, proof of additional, non-taxable income on continuing basis
Exhibit __, foreign tax return from 201_
Exhibit __, real estate appraisal and mortgage statement showing equity of $___
Exhibit __, stocks and bond portfolio/CDs/IRA/pension indicating full access to proceeds
Exhibit __, 12 months of bank statements indicating a balance between $___ and $___.
□ Applicant s income above 250% of FPG at job with employment authorization:
Exhibit __, IRS tax transcripts from 201_
Exhibit __, wage receipts/pay stubs/W-2s/
Exhibit __, proof of additional, non-taxable income on continuing basis
Exhibit __, foreign tax return from 201_
Exhibit __, current USCIS employment authorization document
□ Enrollment in private (non-ACA subsidized) health insurance:
Exhibit __, Summary of Benefits and Coverage
Exhibit __, document showing dates of insurance termination and renewal
Exhibit __, Form 1095-B Health Coverage
Exhibit __, Form 1095-C, Employer-Provided Health Insurance Offer and Coverage
Exhibit __, IRS Form 8963 Report of Health Insurance Provider Information
Exhibit __, documentation on amount of annual deductible and premium
Exhibit __, health insurance card with effective and expiration dates