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section 3 - income information Employer: Please complete the following information about each pay received during the period specified below. (Use additional paper or computer printout if necessary.)

Information on DHS Applications and Forms grouped by category.

THIS FORM MUST BE COMPLETED BY YOUR EMPLOYER AND RETURNED TO THE ADDRESS AT THE RIGHT WITHIN 10 BUSINESS DAYS.

Verification. You will be asked to prove much of the information you provided on your application. Most proof, or verification, must be "current" and dated within the last 30 days. We may need to contact a third party such as your landlord or employer in order to verify your situation.

Apr 1, 2025 · Income Trust Form: PDF: 01/01/2025: Income Trust Fact Sheet: PDF: 07/01/2022: Your Guide To Medicaid Estate Recovery In Arkansas: PDF: 01/30/2018: SNAP Forms & Documents. Title ... Employment Verification; DHS Policies; Facebook Twitter Youtube Instagram. Contact Us. Divisions & Offices: Donaghey Plaza, P.O. Box 1437, Little Rock, AR 72203.

A Verification Checklist was mailed to Claimant on September 29, 2010, requesting one of the following: a work schedule showing number of hours worked; pay stubs showing number of hours worked; a DHS-38 Employment Verification; a DHS-3569 Agricultural Worker Income Verification or a signed statement from employer stating hours worked.

To view or change an existing income record, select the appropriate income related LUW from the left navigation. An income related LUW is a series of data collection screens. Com-pletion is required to collect the information needed to determine countable income.

DHS-FIA 500 Medical Report Form. 0500-B Verification of Activity Participation Form.pdf

All requests must be submitted in writing via US mail to the address below, via fax to 501.682.6553 or via email to [email protected]. Requests must include a signed and dated Verification of Employment (VOE) …

Search Forms by Name/Number - in the "Form" field enter all or part of the form name or number. by Division - choose the desired division from the "Division" field.