**Please provide all that applies for all household members:**

• Social security/numbers and Dates of Birth (all household members)
• SNAP/ Food Stamps or DSS Cash Budget sheet OR SSI if any household member receives these benefits
• Documentation of four weeks of income within three months prior to application date for all household members aged 18 and over
• Gas bill (if you heat with gas) OR Oil/propane/kerosene vendor name (if you heat with a deliverable fuel)
• Electric bill (all households must provide electric bill)
• Rent receipt or Section 8 letter and landlord contact information if you rent.
  • Rent receipt or lease is required if your heat is included in rent.

Please bring documentation of gross income from all sources for the most recent four weeks (6 or 12 months if self-employed)

• Pay stubs from earnings (last 4 if paid weekly or 2 if paid bi-weekly)
• Social Security, SSDI and/or SSI (most recent award letter or direct deposit on bank statement)
• Pension current stub, statement or letter from company stating gross monthly amount. Note: We cannot use bank statement deposit to verify pension income.
• Unemployment (payment history printout from Dept. of Labor dated within 24 hours prior to appointment)
• website: ctdol.state.ct.us follow link for unemployment information
• Child support/Alimony (court document, direct deposit to bank statement or signed letter from absent parent stating amount and frequency of payments)
• Rental income from your rental units/properties (lease, rent receipt)
• Self-employment Income (notarized worksheet showing 6 or 12 months income and expenses)
• Worksheet must be completed using income and expenses from last 6 or 12 complete months and must be submitted with a copy of last filed tax return.
• Contributions by friends/relatives (signed and dated letter from friend/relative w/ their address & contact information, stating amount and frequency of financial assistance)
• DSS State Cash Assistance award letter and SNAP/Food Stamp award notice, if you have it
• Worker’s compensation (check stubs or attorney’s letter/statement)

*You may be required to provide additional documentation not listed above.