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Get Fedhealth Income Verification Form

Pensions or annuities R R 3.4 Interest on investments R R 3.5 Rental income R R 3.6 State disability allowance R R 3.7 Trust distributions R R 3.8 Other income R R Please send us copies of the following documents to prove the income that you have declared above: Match the number next to the source of income above with the number given below. 3.1 Last three (3) months (90 consecutive days) bank statements and: If you are employed, send your last three (3) months paysl.

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