California Department of Social Services - State Hearings Division
Notes from the Training Bureau - December 10, 2002

Income verification used to determine current month eligibility reported by an applicant on the MC 210 (Statement of Facts) may be used to determine income eligibility for each retroactive month provided that the applicant reports no change on the MC 210A (Supplemental Statement of Facts for Retroactive Coverage). Only one pay stub is required to verify income provided it accurately reflects retroactive income. Thus if an applicant reports receiving $200 weekly income on his MC 210 and provides a pay stub dated May 6 verifying $200 weekly income, the county may use that pay stub to determine the applicants weekly income for the retroactive months of March and April so long as the applicant reported no change of income on his MC 210A form.