Please carefully review all of the choices below. Select "Yes" under the statement that best describes your situation. Complete all fields related to your choice, and attach all required documentation.
In the event of job loss, you should be unemployed for 10 weeks before you submit this form.
Additional documents will be requested below.
Please complete the table below and provide documentation for the person with the decreased income.
For every source of income listed below, report the amount expected from January 1, 2020 through December 31, 2020.
If none of the conditions apply, please write a letter describing your situation and attach it below.