Page 13 - Indiana

Proof of Eligibility:
Guidelines and Examples

• Benefit statement issued by the VA with the consumer’s name, address, and description of
benefit
• Retirement/pension statement with the consumer’s name, date, and payment amount
• Federal or Tribal notice letter of participation in General Assistance with consumer’s name and
effective date
• Unemployment/workers' compensation statement of benefits with the consumer’s name,
address, and effective date
• Divorce Decree, child support award, or other official document containing income information.

If the document does not cover a 12-month period, we can accept 3 consecutive months of
documentation for pay stub, Social Security Benefit Statement, Veterans Administration Benefit
statement, Retirement/Pension Benefit Statement and Unemployment Statement or Workers
Compensation.

Important Information for Customers Who Wish to Print Out Benefits Statements:

When you sign up new customers, many of them will want to qualify using a SNAP or Medicaid benefits
card. In Indiana, customers cannot use a benefits cards as proof of eligibility if it does not have an issue
date within the last 12 months or a future expiration date. Customers will have to download their
eligibility document online to qualify for Lifeline.

To print out benefits letters, have the customer visit the website below:
http://fssabenefits.in.gov/#/

Acceptable Proofs of Eligibility Examples

Indiana Food Assistance Program (Food Stamp) Card:

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Proprietary and Confidential 1/20/2020