[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-348802-105":53,"doc-detail-348802-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","income-verification-form-english","Income Verification Form - English","","Income Verification Form for confirming employment income for SoonerCare. Collects member identity details, case identifiers, and up to 30 days of paycheck information. Requires employer information, employment specifics such as hire date, pay rate, pay frequency, overtime, leave status, and leave type or unpaid status. Includes separate sections for irregular schedules, 1099 contractors or cash-paid work, and terminated employment, plus employer and member signatures.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/income-verification-form-english/348802/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/income-verification-form-english/348802.png","ImageObject",442,249,{"name":88,"@type":89},"Connor ","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-22","2026-09-22",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",7,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What is the purpose of the Income Verification Form?","Question",{"text":109,"@type":110},"It verifies employment income for SoonerCare. It requests information from employment records and paycheck details to support eligibility.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What documents or data are required for employment income verification?",{"text":114,"@type":110},"Provide copies of current paystubs if you have 30 days. The form also requests up to 30 days of paycheck information, including taxable gross or gross check amount and deductions guidance.",{"name":116,"@type":107,"acceptedAnswer":117},"Which signature sections must be completed?",{"text":118,"@type":110},"The form includes an Employer Signature section and a Member Signature section. Each requires printed name, signature, and today’s date, with the member attesting the information is true and correct.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},348802,1790469986,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},687207022233,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","INCOME VERIFICATION FORM  \nThis Income Verification form is used to verify employment income. If you have 30 days of current paystubs, please provide copies of them. If you are self-employed, please fill out the Self-Employed Cash Income Statement or send in a current profit/loss sheet (not from your taxes) .  \nWhen completed, upload this document to your SoonerCare member portal or mail it to:  \nOklahoma Health Care Authority  \nP.O. Box 548804  \nOklahoma City, OK 73034  \n\n| MEMBER INFORMATION |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| Member printed name: |  |  |  |  | Today’s Date: |  |  |\n| Fill out one of the following: |  |  |  |  |  |  |  |\n| SoonerCare case \\#: |  |  | Member ID \\#: |  | SSN\\#: |  |  |\n\nPlease give the Oklahoma Health Care Authority any information requested from your records concerning my  \nemployment.  \n\n| EMPLOYER INFORMATION |  |\n| --- | --- |\n| Employer company name: |  |\n| Employer address: |  |\n\n(Street address) (City, state) (Zip)  \n\n| EMPLOYMENT INFORMATION |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Complete this section if the employee is currently employed with your business. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Date of hire: |  |  |  |  |  | Date first pay was or is to be received: |  |  |  |  |  |  |  |  |  |\n| Number of hours in first paycheck: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Gross amount (before taxes) of first paycheck: |  |  |  |  |  |  |  |  | $ |  |  |  |  |  |  |\n| Is the first paycheck for a full pay period? |  |  |  |  |  |  |  |  |  | Yes |  |  |  | No |  |\n| Number of hours worked in a regular work week: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Hourly pay rate: |  |  | $ |  |  |  |  |  | Overtime hourly pay rate: |  |  |  |  |  | $ |\n| Check how often paid and when: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  | Monthly, date paid: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  | Every two weeks, date paid: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  | Twice monthly, dates paid: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  | Weekly, day paid: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  | Daily |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Is the employee on paid leave? |  |  |  |  | Yes |  |  | No |  |  |  |  |  |  |  |\n| What kind of paid leave? |  |  |  | (medical, workers comp, disability, etc.) |  |  |  |  |  |  |  |  |  |  |  |\n| Is employee currently on leave without pay? |  |  |  |  |  |  |  | Yes |  |  |  | No |  |  |  |\n| Expected return to work date: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n\nList the last 30 days of paycheck information including any pretax deductions below.  \nIf taxable gross is known, do not list the pretax deductions.  \n\n| Date check\u003Cbr>received | Taxable\u003Cbr>Gross | Gross amount of check | Total pretax\u003Cbr>deductions | 401k-pretax\u003Cbr>IRA | Bonuses/commission, overtime, other: |\n| --- | --- | --- | --- | --- | --- |\n|  |  |  |  |  |  |\n|  |  |  |  |  |  |\n|  |  |  |  |  |  |\n|  |  |  |  |  |  |\n|  |  |  |  |  |  |\n\n\n| IRREGULAR EMPLOYMENT |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- |\n| Complete this section if the employee is currently employed with your business and has irregular hours. |  |  |  |  |  |  |\n| How many days per month do you work? |  |  |  |  |  |  |\n| How many hours have you worked in the last 30 days? |  |  |  |  |  |  |\n| What is your hourly pay rate: |  | $ |  |  | Daily rate: | $ |\n| Check how often paid and when: |  |  |  |  |  |  |\n|  | Monthly, date paid: |  |  |  |  |  |\n|  | Every two weeks, date paid: |  |  |  |  |  |\n|  | Twice monthly, dates paid: |  |  |  |  |  |\n|  | Weekly, day paid: |  |  |  |  |  |\n|  | Daily |  |  |  |  |  |\n\nList 30 days of paycheck information including any pretax deductions below.  \nIf taxable gross is known, do not list the pretax deductions.  \n\n| Date check\u003Cbr>received | Taxable\u003Cbr>Gross | G","cbCaihzXUvBVnwI2","https://ap.wps.com/l/cbCaihzXUvBVnwI2","pdf",341417,"English","# Member Information\n# Employer Information\n# Employment Information\n## 30 Days Paycheck Details\n# Irregular Employment\n## 30 Days Paycheck Details\n# 1099 Contractor or Paid in Cash\n## 30 Days Paycheck Details\n# Terminated Employment Information\n# Employer Signature\n# Member Signature","[{\"question\":\"What is the purpose of the Income Verification Form?\",\"answer\":\"It verifies employment income for SoonerCare. It requests information from employment records and paycheck details to support eligibility.\"},{\"question\":\"What documents or data are required for employment income verification?\",\"answer\":\"Provide copies of current paystubs if you have 30 days. The form also requests up to 30 days of paycheck information, including taxable gross or gross check amount and deductions guidance.\"},{\"question\":\"Which signature sections must be completed?\",\"answer\":\"The form includes an Employer Signature section and a Member Signature section. Each requires printed name, signature, and today’s date, with the member attesting the information is true and correct.\"}]","Income Verification Form - English | PDF",1790078894]