Page 23 - Desert Oracle September 2020

Required Signed copy

Proof of Gross Income for Family
Caregiver and Qualified Family Pay stub
Member’s Income Combined Income taxes
Earn $75,000/year or less in gross Veteran Award Letter

income Social Security
(Caregiver + Qualified Family Member Income (SSI) award
= gross income) Any public benefit
or award letter (TANF,

As a couple, earn less than SNAP, etc.)
$150,000/year in gross income
(caregiver + spouse + qualified family
member = gross income)

Proof of Medical Need Medical Need

Assistance from the family caregiver Verification Form
with one or more activities of daily (provided, click on
living, (ADL) form to download)
(toileting, bathing, dressing, grooming,

eating, mobility, or transferring)

Arizona driver’s
license
Proof of Age

18 years or older ID card (with
birthdate)
Birth certificate