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Please complete each section which has been marked on Page 1 AND Page 2 of this form. Section I – GENERAL INFORMATION. 1. Name of Employee:_____ *Social Security Number:_____
This form should be used to report or verify income and/or net worth. Changes to income and net worth over multiple years must be reported on a separate VA Form 21P-0969 for each year.
Verification of Employment/Loss of Income (CF-ES 2620) Download.
Individuals can also make changes, apply for additional assistance, check case status and more using the MyACCESS Portal. If you are unable to apply online and need a paper application, please use the forms below.
If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form. Lender or Local Processing Agency (LPA) completes Items 1 through 6 and has the applicant sign in Item 7. Forward the completed form directly to the employer named in Item 1.
Income Verification is a process VA uses to match Veterans’ gross household income information obtained from the Internal Revenue Service (IRS) and Social Security Administration (SSA). Gross household income includes income of the Veteran, spouse and dependent children.
The above named individual has applied for assistance from the State of Florida. In order to determine eligibility, the department must have verification of all income and resources. Please complete Section II. Attached is a signed authorization for the release of this information.
