Recertification of Annual Income by Government Programs
Recertification of Annual Income by Government Programs
THE PURPOSE OF THIS FORM IS TO CERTIFY THAT ___________________________ (NAME OF
HOUSEHOLD) RESIDING AT __________________________________________________________
(ADDRESS) RECEIVES BENEFITS UNDER _________________________________________________
(NAME OF GOVERNMENT PROGRAM). AS SUCH, THE ANNUAL INCOME OF THIS HOUSEHOLD HAS BEEN
EXAMINED AND DETERMINED TO BE BELOW $___________________ (INCOME LIMIT FOR THE PROGRAM
FOR A FAMILY OF ___ [HOUSEHOLD SIZE]).
CERTIFIED BY:
SIGNATURE OF AUTHORIZED REPRESENTATIVE ___________________________________________
NAME (PRINT) ___________________________________________________
TITLE __________________________________________________________
AGENCY _______________________________________________________
DATE __________________________________________________________
-----------------------
WARNING: TITLE 18, SECTION 1001 OF THE U.S. CODE STATES THAT A PERSON IS GUILTY OF A FELONY FOR KNOWINGLY AND WILLINGLY MAKING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OF THE UNITED STATES GOVERNMENT.
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- test foundations of us government chapters 1 and 2
- the articles of the constitution worksheets answer key
- eopf electronic official personnel folder
- principles of united states democracy
- appendix a under secretary of defense for acquisition
- usda aphis home landing page
- individual development plan united states office of
- state application 7 0 format
- instructions complete this declaration for each member of
- department of state
Related searches
- government programs to buy home
- government programs for homeowners repairs
- government programs for homeowners
- government programs for seniors little known
- government programs for seniors
- free government programs for seniors
- government programs for the elderly
- government programs for home buying
- government programs for homeowners hardship
- federal government income by year
- government programs for small businesses
- government programs for first time home buyers