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Get PeachCare for Kids Income Verification Form

_______________________ ***YOU MUST SEND PROOF OF ALL INCOME TO GET HEALTH BENEFITS*** Earned Income is money received for doing a job. Send proofs of income for all family members for the last four weeks: include pay dates. Complete each space below. If you have more than one job, list each job in a new row. If a family member is not employed, it is important to check “No”. See Checklist for details on what proofs of income you need to provide. Is this family Did you include Is income from .

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