Factors Of Eligibility Chart

Programs administered by Adult and Family Services (AFS) include: Child Care Subsidy Program (CC), Low Income Home Energy Assistance Program (LIHEAP), SoonerCare (Medicaid) [SC(M)], Supplemental Nutrition Assistance Program (SNAP), State Supplemental Payment (SSP), and Temporary Assistance for Needy Families (TANF). Please note: when a money payment is approved (SSP and TANF), SC(M) is also approved. If SC(M) requires proof of an eligibility factor, it is required for the money payment program also.

Acronyms used in the chart: absent parent (AP), aged/blind/disabled (ABD) related, birth certificate (BC), driver's license (DL), long term care (LTC), Oklahoma Child Support Services (OCSS), Oklahoma Health Care Authority (OHCA), Online Enrollment (OE), Social Security Administration (SSA), Social Security number (SSN), Supplemental Security Income (SSI), United States Citizenship and Immigration Services (USCIS).

Acceptable documents listed are the most common used. Other documents may be acceptable.

Eligibility Factor	Affected Programs	Acceptable documents/contacts
Age	CC 340:40-7-3 SNAP 340:15-1-6 TANF 340:10-5-1	Client statement for CC, SNAP and TANF. For SSP, BC, insurance policy, family records, or census records.
Citizenship/legal alien status	CC 340:40-7-5 LIHEAP 340:20-1-8 SC(M) 317:35-5-25 SNAP 340:50-5-67 TANF 340:10-15-1 CC, LIHEAP, SNAP, SSP, TANF 340:65-3-1	For citizens for all programs but SC(M), client statement is used as long as the SSN is data matched. For SC(M): BC, U.S. passport, Certificate of Naturalization, Certificate of Citizenship issued by USCIS, Medicare card, or tribal membership card.For non-citizens for all programs, alien registration card or documents whose validity is proven through SAVE. See Comprehensive Citizenship and Alien Documents Guide for types of alien registration cards and documents.
Deprivation	TANF 340:10-10-1 (all) 340:10-10-4 (absence)(incapacity) 340:10-10-2(unemployment) 340:10-10-3	Based on death: death certificate, obituary notice from newspaper, funeral program, or notice pertaining to the deceased.Based on absence: name of AP and as much identifying information as known, worker interview with AP and/or written statement from AP, or Form 08AD008E (Adm-95), Non-Custodial Parent Letter, may be used.Based on incapacity: award letter or data exchange screen that shows receipt of SSA disability, SSI, or SSP payments, or medical documentation that can be submitted to approve incapacity.Based on unemployment: employer contact, pay stubs, data exchange screens, tax returns, or for self-employment, business records.
Disability determination	SC(M) 317:35-5-4 SSP 340:15-1-5 & 317:35-5-4 SNAP 340:50-7-31 & 340:50-5-4	Award letter or data exchange screen that shows receipt of SSA disability or SSI or medical documentation that can be submitted to approve disability.
Earned income	CC 340:40-7-10, 40-7-11,40-7-12, & 40-7-13 LIHEAP 340:20-1-11 & 20-1-13 SC(M) ABD related 317:35-5-42 SC(M) OE 317:35-10-26 SNAP 340:50-3-3, 340:50-7-22, 50-7-29, 50-7-30, 50-7-45, & 50-7-46 SSP 340:15-1-4, 15-1-6, & 317:35-7-38 TANF 340:10-3-31, 10-3-32, 10-3-33, 10-3-40, & 10-3-58	Pay stubs that include the person's name or SSN, date of pay, and income before deductions or written statement from or telephone call to an employer, Form 08AD094E (Adm-94), Employment Verification, may be used. For self employed, most recent federal tax return or business records.
Expenses	CC 340:40-7-13 LIHEAP 340:20-1-11 & 20-1-13 SC(M) LTC 317:35-19-21 SC(M) OE 317:35-10-26 SNAP 340:50-7-31 TANF 340:10-3-33	For SNAP, client's statement is acceptable for a shelter, child care, or adult day care expense.For CC, LIHEAP, and SNAP when legally-binding child support is paid to or for a non-household member, a legal document showing child support is court-ordered and a receipt, written statement, or other document showing it is being paid.For LIHEAP and SNAP for disabled or elderly persons, when there is a medical expense, copies of medical bills or health insurance premiums showing the expense is owed and a receipt or other proof that they are being paid.For SC(M) LTC, proof of insurance premiums.For SC(M) OE and TANF when there is a child care expense, a receipt for the expense or a signed statement from the child care provider.
Household composition	CC 340:40-7-6 LIHEAP 340:20-1-10 SC(M) ABD related 317:35-7-36 SC(M) LTC 317:35-17-9 & 317:35-19-20 SC(M) OE 317:35-6-36 SNAP 340:50-5-1, 50-5-2, 50-5-3, 50-5-4, 50-5-5, 50-5-6, 50-5-7, 50-5-8.1, & 50-5-10.1 SSP 340:15-1-5 & 317:35-7-36 TANF 340:10-3-56 & 10-3-57	For all programs, client statement is acceptable unless questionable. Acceptable documents, when questionable, include a written or verbal statement from a landlord, neighbor, or friend or a lease agreement.
Identity	CC 340:40-7-4 SC(M), SSP, TANF 317:35-5-25 SNAP 340:50-5-65	DL, work/school/benefit ID card, BC, voter registration card, pay stub showing name. Photo ID is preferred, but not required.
Immunizations	TANF 340:10-14-1	Immunization records from the Health Department or licensed physician when not attending child care or school.
Insurance coverage	SC(M), SSP, TANF 317:35-5-43	Client statement when policy information is known. When information is not known, copy of insurance card or policy.
Need factor	CC 340:40-7-8	Current work or school schedule, enrollment in a TANF Work activity, or worker call to work or school.
Pursuit of child support	CC 340:40-7-9 SC(M) OE for adult 317:35-5-44 TANF 340:10-10-5, 10-10-6, & 10-10-7	Completion of required forms and cooperation with OCSS unless good cause is requested. If good cause is requested, one or more documents listed on Form 08TA012E (C-9), Cooperation Agreement and Request for Good Cause.
Relationship	TANF 340:10-9-1	Client statement is acceptable unless questionable. If questionable, BC or other legal documents.
Resources	LIHEAP 340:20-1-11 SC(M) ABD related 317:35-5-41, 35-5-41.1, 35-5-41.2, 35-5-41.3, 35-5-41.4, 35-5-41.5, 35-5-41.6, 35-5-41.7, 35-5-41.8, 35-5-41.9, 35-5-41.10, 35-5-41.11 SC(M) LTC 317:35-5-41.8, 317:35-17-10, & 317:35-10-10 SNAP with sponsored alien or expedited eligible 340:50-5-49, 340:50-7-1, & 340:50-11-1 SSP 340:15-1-4 & 317:35-7-38 TANF 340:10-3-1, 10-3-2, 10-3-3, 10-3-4, 10-3-5, 10-3-6, 10-3-9, & 10-3-10	Bank statements, a copy of the life or burial insurance policy, or a copy of a property deed and /or mineral rights and proof of equity, title to a vehicle and the amount owed on it, proof of the value of stocks, bonds, certificate of deposits (CD), or individual retirement accounts (IRA), or trust fund documents.
School attendance	TANF 340:10-13-1	Written or verbal statement from the school, recent report card or school schedule, or completion of Form 08AD010 (Adm-96), School Attendance Verification.
Social Security number	LIHEAP340:20-1-13 SC(M) 317:35-5-27 SNAP 340:50-5-68 TANF 340:10-12-1 LIHEAP, SNAP, SSP, TANF 340:65-3-1	Social Security card, client statement regarding SSN, or proof of application for SSN and acceptance by SSA, Form 08AD101E (Adm-101), SSN Enumeration Referral, may be used for this.
State residence	CC 340:40-7-5 SC(M) ABD related 317:35-5-26 SNAP 340:50-5-66 TANF 340:10-7-1	Client statement is acceptable.
Unearned income	CC 340:40-7-10, 40-7-11, 40-7-12, & 40-7-13 LIHEAP 340:20-1-11 SC(M) ABD related 317:35-5-42 SC(M) OE 317:35-10-26 SSP 340:15-1-4 & 15-1-6 TANF 340:10-3-28, 10-3-39, 10-3-40, & 10-3-58	Award letter, letter from person or agency that provides the income, check stub, benefit payment check, court order, workers' compensation records, or data exchange screens.
Vulnerability	LIHEAP 340:20-1-10, 20-1-12, & 20-1-13	Utility bill or landlord statement.
Work requirement	TANF 340:10-2-1, 10-2-2, 10-2-3, 10-2-4, 10-2-5, 10-2-6, 10-2-6.1, 10-2-7, & 10-2-8	Parent is required to participate in TANF Work unless incapacitated. Forms must be completed and participation verified after certification by completion of Form 08TW013E (TW-13), Time and Progress Report.

Revised May 2012