Get Household Size Income Statement

Completing the household size income statement is essential for determining eligibility for various benefits. This guide provides a clear step-by-step approach to filling out the form online, ensuring that users can complete it efficiently and accurately.

Follow the steps to successfully complete the household size income statement.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the first and last names of all enrolled children in the designated section. Ensure that this information is accurate as it helps in identifying the beneficiaries.
3. Proceed to Part 1, where you will check any applicable benefits that a household member currently receives. If your household is receiving FoodShare Wisconsin, Wisconsin Works Cash Benefits, or FDPIR, mark the relevant box and provide the case number.
4. If no household members receive the previously mentioned benefits, skip to Part 2. In this section, you will need to list the total household size and income. Complete the fields reflecting the last month's income by entering the gross income for each household member alongside their names.
5. For each income source, indicate how often it is received by checking the corresponding frequency box. Follow the guidelines to ensure each income is recorded only once.
6. If a household member does not have any income, check the box provided next to their name to indicate this.
7. Moving to Part 3, answer the optional ethnicity and race data collection questions as required. Remember that this information is for statistical reporting only.
8. Finally, an adult household member must sign the form, providing the last four digits of their Social Security Number or marking ‘None’ if they do not have one. Ensure that the signature is dated correctly.
9. Once all sections are completed, review the form for accuracy. You can then save changes, download, print, or share the completed form as necessary.

Start filling out your household size income statement online today!