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There are many documents that can be provided to verify your income. Types of income verification documents are listed below, including options for people who are self-employed or who have unearned income. Once you decide which documents to provide, gather your documents and log in to your NY State of Health account. There, you can follow the steps to update your application and income. 

Below is a list of approved documents and helpful details.

Types of Income Verification Documents

• 1040 Federal or State Tax Return: Must contain your first and last name, income amount, and tax year. If you file Schedule 1, you must submit it with your 1040.
• Wages and Tax Statement: (W-2 and/or 1099, including 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099SS, 1099INT). Must contain your first and last name, income amount, tax year, and employer name (if applicable).
• Pay Stub: Must contain your first and last name, income amount, and pay period or frequency of pay with the date of payment. If a pay stub includes overtime, tell us the average overtime amount per paycheck.
• Self-Employment Ledger Documentation: (can be a Schedule C, the most recent quarterly or year-to-date profit and loss statement, or a self-employment ledger). Must contain your first and last name, company name, and income amount. If you’re submitting a self-employment ledger, include the dates covered by the ledger, and the net income from profit/loss.
• Social Security Administration Statements: (Social Security Benefits Letter). Must contain first and last name, benefit amount, and frequency of pay.
• Unemployment Benefits Letter: Must contain your first and last name, source/agency, benefits amount, and duration (start and end date, if applicable).
• A Written Explanation Form: To submit this form, select “Other” from the drop-down menu when you’re on the upload screen in the application.

Self-Employment Verification Documents

• 1040 SE with Schedule C, F, or SE (for self-employment income)
• 1065 Schedule K1 with Schedule E
• Tax return
• Bookkeeping records
• Receipts for all allowable expenses
• Signed time sheets and receipt of payroll, if you have employees
• Most recent quarterly or year-to-date profit and loss statement
• A Written Explanation Form: To submit this form, select “Other” from the drop-down menu when you’re on the upload screen in the application.

Unearned Income Verification Documents

• Annuity statement
• Statement of pension distribution from any government or private source
• Worker’s compensation letter
• Prizes, settlements, and awards, including court-ordered awards letter
• Proof of gifts and contributions
• Proof of inheritances in cash or property
• Proof of strike pay and other benefits from unions
• Sales receipts or other proof of money received from the sale, exchange, or replacement of things you own
• Interests and dividends income statement
• Loan statement showing loan proceeds
• Royalty income statement or 1099-MISC
• Proof of bonus/incentive payments
• Proof of severance pay
• Pay stub indicating sick pay
• Letter, deposit, or other proof of deferred compensation payments
• Pay stub indicating substitute/assistant pay
• Pay stub indicating vacation pay
• Proof of residuals
• Letter, deposit, or other proof of travel/business reimbursement pay
• A Written Explanation Form: To submit this form, select “Other” from the drop-down menu when you’re on the upload screen in the application.

Get more details for other income situations.

When you enroll in a Marketplace plan, you’ll need to submit documents to confirm your immigration status.  Below is a list of documents that you can submit: 

• Permanent Resident Card, “Green Card” (I-551)
• Reentry Permit (I-327)
• Refugee Travel Document (I-571)
• Employment Authorization Card (I-766)
• Machine Readable Immigrant Visa (with temporary I-551 language)
• Temporary I-551 Stamp (on Passport or I-94/I-94A)
• Foreign passport
• Arrival/Departure Record (I-94/I-94A)
• Arrival/Departure Record in foreign passport (I-94)
• Certificate of Eligibility for Nonimmigrant Student Status (I-20)
• Certificate of Eligibility for Exchange Visitor Status (DS-2019)
• Notice of Action (I-797)
• Document indicating a member of a federally recognized Indian tribe or American Indian born in Canada
• Certification from U.S. Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR)
• Document indicating withholding of removal (or withholding of deportation)
• Office of Refugee Resettlement (ORR) eligibility letter (if under 18)
• USCIS Acknowledgment of Receipt (I-797C)

Your monthly premium amount may adjust for your new plan-year coverage. When you receive your renewal information, be sure to review this closely. We have other plans that can offer you different monthly premium amounts and other out-of-pocket cost savings. Visit NY State of Health to review different plan options.

Update your account and annual income information to see if you qualify for financial assistance. Log in to your NY State of Health account to get started. You can also explore other Ambetter from Fidelis Care plan options and our rewards program that can help you save on your healthcare costs.

If you don’t verify your income, you may not receive the right amount of financial assistance. If you do not provide accurate income, you may receive a lower tax credit than you qualify for. That means possibly paying more for your insurance than you should. If this happens, you can receive a refund when filing your taxes. There is also a chance that you will be given a higher tax credit than you qualify for. In this case, you would have to repay the difference when you file your taxes.