Pbv Application Packet - Housing Authority Of Snohomish County Page 8
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38money market funds retirement accounts (company, IRA, Keogh), inheritances, lottery
winnings, or life insurance policies. Provide all pages for each statement.
Real estate.
o Any documents showing ownership in real estate (mortgage statement, tax information,
deed to property, closing/escrow report showing the address, value, and amount owed
on the home.
DEDUCTIONS
Childcare costs.
o A current award letter from DSHS stating your co-pay amount. OR
o Current receipts/printout from childcare provider, showing payment amount and
provider’s contact information
Full time student.
o Verification of student status (i.e. class schedule); or
o A letter on school letterhead stating full time student status for current semester/quarter.
Medical costs.
o Medical deductions are only allowed for households with a disabled or elderly (over age
62) head/co-head/or spouse. Deductions are provided for medical costs for all
household members, even those that are not disabled.
o The total of your anticipated medical expenses must exceed three percent (3%) of your
family’s gross income in order to qualify for an allowance.
o Medical expenses must be recurring expenses that can be expected over the next 12
months.
o Examples of acceptable medical expenses include:
Insurance premiums. A document from the insurance company, a minimum of
two bank statements showing withdrawal for insurance (along with proof of
insurance plan), or paystubs showing withdrawal are acceptable forms of
verification.
Prescriptions. A printout from the pharmacy showing out-of-pocket prescription
costs for the previous twelve months.
Doctor/Dental/Vision/Counseling/Therapy visits. A print-out from the
provider’s office showing the number, dates, and amount paid out-of-pocket for
the previous twelve months.
Medical Monitoring. A 12-month printout for the previous twelve months of
monitoring.
Nursing Services / COPES. A 12-month printout for the previous twelve months
showing your out-of-pocket expense.
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