(1) DVR collects financial information from you to determine whether you must pay any part of the cost of VR services if neither you nor your DVR counselor can verify that you receive assistance or income support from any of the programs identified in WAC 388-891A-1130.

(2) You must complete and sign a DVR financial statement to document your financial status as follows:

(a) If you reported your income tax status as married filing jointly, married filing separately, or another person identified you as a registered domestic partner or dependent, complete the financial statement based on family resources.

(b) If you reported your income tax status as single and were not claimed as a dependent by another person, complete the financial statement based on your own financial resources.

(c) DVR requires you to provide copies of financial records (such as bank statements, tax returns, or documentation of SSI or SSDI benefits received) to establish your financial status. If you do not have copies of documentation to verify your receipt of benefits from public assistance programs, DVR may be able to assist you in obtaining that documentation at your request.

(3) The DVR financial statement requires you to disclose information from the following sources:

(a) Previous year's income tax return, if you filed taxes for the most recent tax year or you were claimed as a dependent on a family member's tax return;

(b) Previous month's bank statements reflecting all income received;

(c) If your previous year's income meets the conditions described in WAC 388-891A-1136, the financial statement requires the following information about your finances:

(i) Monthly income from all sources, including investments and trusts;

(ii) Real and personal assets, including but not limited to bank accounts; and

(iii) Monthly expenses, including housing, food, child care, transportation, health care, other necessities, credit or loan payments, disability-related expenses, and any other financial obligations.

(4) If the results of your financial statement show that you do not have resources available to help pay for your VR services, DVR provides the services at no cost to you.

(5) If your financial status changes, you must report these changes to your DVR counselor.

(6) If you decline to complete the financial statement or decline to contribute to the cost of VR services, DVR will provide only those services listed under WAC 388-891A-1145.