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following: <br />a. Social Security, SSI benefits statements <br />b. Retirement <br />c. Disability <br />d. Child Support / Alimony <br />e. Cal Works (AFDC, Welfare) <br />For these volunteer repair programs only, applicants utilizing direct deposit may use <br />bank statements as evidence of individual income sources. They are not an acceptable <br />substitute for federal or state income tax statements. <br />The City strongly encourages submission of copies of check stubs, Social Security and <br />other such more reliable income statements, and reserves the right to require them <br />should savings and checking accounts statements prove inadequate to fully determine a <br />household's income. Failure to comply with such requests will result in the refusal of a <br />reimbursement request for the affected property. <br />Please provide copies only of all income - related documents submitted. City staff are <br />not authorized to make copies of original documents for subrecipients or applicants, or <br />to mail original documents back to subrecipients or applicants. <br />Request for Payment Documentation <br />❑ Where applicable, copy of lead based paint test <br />❑ Where applicable, and if lead paint was found to be present or presumed to be <br />present, a signed statement asserting that safe work practices were followed <br />❑ Where applicable, copy of lead paint clearance examination results <br />❑ To be provided by the City: Original Work Completion Certificate signed by the <br />City's Rehabilitation Construction Specialist, identifying the work for which <br />payment is sought, and stating that it was performed in accordance with City <br />rehabilitation standards. <br />Exhibit D <br />Page 2 of 4 <br />