Verification Of Receipt Of Unemployment Benefits printable pdf download

Verification Of Receipt Of Unemployment Benefits

Verification of Receipt of Unemployment Benefits

Re:

Social Security #:

Claim #: _______________________________

Dear Sir / Madam:

We are required to verify the incomes of all family members living in or applying for Public

Housing or Section 8 Housing. We ask your cooperation by supplying the information requested

below about the referenced person. We will use any information you provide only to determine

the family’s eligibility and rent, and will keep the information confidential.

We would greatly appreciate your prompt return of this letter. Note that the person referenced

has authorized your release of the information.

If you have any questions, please call

___________________________________.

Gross Weekly Payment:

$ ___________

Is Claimant eligible for further benefits?

Yes ____ / No ____

Date of Initial payment

___________

Duration of Benefits

___________

How many weeks of Benefits remaining?

___________

Amount of Benefits remaining?

___________

Termination date of Benefits is?

___________

Agency Name: ______________________________ Address: ___________________________

Name of Person Completing this Form: ________________________ Date: ________________

Title: ____________________________________________ Signature: ____________

Applicant / Tenant Release:

I _________________________ hereby authorize the release of the requested above information.

___________________________________

_______________________

Signature

Date

Verification Of Receipt Of Unemployment Benefits