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WIOA Income Eligibility Worksheet
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DIRECTIONS
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1Only use this worksheet if the participant is using 6 month income to prove economic eligibility.
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2If the family does not have any income and documentation is not available, also use the applicant statement form to explain the participant's situation.
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If an applicant states that he/she is unable to provide evidence that no income was received during the past six months, and that he/she was unemployed for that period, the blank spaces following the words "I certify, under penalty of perjury, that I" may be completed, for example, as follows: "have received no income from any source during the past six months, that I have been unemployed during that time, and have been supported by donations/contributions from relatives and friends." This should be corroborated by the person(s) providing the support.
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3Fill in all information in blue text.
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4All family members must be listed and backup documentation for family size must be submitted. If available, include the ages for siblings. (This shows that it's unrealistic that they would have an income if under 16).

The preferred method of documentation for family size would be collection of a copy of a birth certificate, social security card, or other government issued ID. In the absence of such documentation, applicants may fill out a self-attestation.
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Family is defined as: Two or more persons related by blood. Marriage or degree of court, who are living in a single residence and are included in one or more of the following categories:
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(A) husband, wife, and dependent children
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(B) parent or guardian and dependent children
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(C) husband and wife
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Please Note:
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• Consistent with the policy of the Department of Labor, ETA’s policy is to recognize all marriages (including same-sex marriages) that are lawfully entered in the state of celebration. (ETA TEGL 26-13)
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• Interpreting “husband” and “wife” should be applied in a gender neutral manner in the definition of “family”. (ETA TEGL 26-13)
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• Interpretation of “family” includes same sex spouses. (ETA TEGL 26-13)
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5Back up documentation for all income, income inclusions, and income exclusions must be included in the file, along with the Income Calculation Worksheet. Please ensure the maximum family income reflects the most updated LLSIL.
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6Staffs signature and date are required. Dates must be on or before the date of eligibility. A copy is kept in the participant file.
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