(1) To verify the eligibility determination, a random sample of families will be required to participate in an eligibility verification review and provide documentation to verify the income information as stated on their applications.

(a) A family will have 14 days from the date of the written request by the department to submit the required income documentation.

(b) If a family does not provide documentation, CHIP-eligible applicants will be taken off the CHIP waiting list or disenrolled, as appropriate.

(c) A family who provides documentation after 14 days will have the application reprocessed as if it is a new application.

(2) If an enrollee's family income exceeds CHIP income guidelines, the enrollment will be terminated or if applicable, the applicant's name will be removed from the waiting list.

(3) For purposes of this rule, necessary income documentation may include one or more of the following:

(a) pay stubs or other pay statements;

(b) employee's W-2 forms;

(c) state or federal income tax returns;

(d) union records;

(e) check copies;

(f) self-employment bookkeeping records;

(g) sales and expenditure records;

(h) employer's wage or payroll records;

(i) award notices or award letters;

(j) correspondence from an employer specifying a benefit;

(k) records of any government payor; or

(l) other appropriate, persuasive documentation may be accepted at the discretion of the department.