| REASON FOR HARDSHIP WITHDRAWAL AND CHECKLIST |
| REASON | REQUIRED DOCUMENTATION AND INFORMATION THAT MUST BE REFLECTED ON DOCUMENTATION | UNACCEPTABLE REASONS/DOCUMENTATION |
Unreimbursed medical expenses for medical care previously incurred or anticipated by: - You
- Your spouse
- Your child
- Your dependent
| - Explanation of Benefits (EOB) from provider dated within the past 12 months that reflects the amount paid by the insurance company and reflects the amount owed by the insured, OR
- A bill from provider dated within the past 12 months that indicates the amount still owed and indicates the costs not reimbursed by the insurance company, OR
- A bill from provider dated within the past 12 months that indicates the amount still owed, and the Explanation of Benefits (EOB) from provider dated within the past 12 months that reflects the amount paid by the insurance company and the amount owed by the insured, OR
- A bill dated within the past 12 months that indicates the amount still owed, and a letter written and signed by me to certify that I do not have insurance.
| - Medical bills that do not show portion paid by insurance
- Collection agency notices
- Bills already paid
|
Tuition, related educational fees, room and board for the next 12 months post- secondary education for: - You
- Your spouse
- Your child
- Your dependent
| - Itemized tuition bill, and/or Room and Board statement provided by the school, which must:
- be dated within 4 months of the beginning of the quarter or semester, and provide an actual amount due, and
- contain student’s name, and
- be due in the next 12 months
AND/OR - Related Educational Fees
- Textbooks bill or receipt dated within the last 4 months, or
- Off campus lease agreement signed and within the same time as the tuition bill, or
- Miscellaneous fees charged by the school - provide supporting documentation
| - Estimate for tuition with no student name (general estimate from school). You need to provide an actual tuition bill.
- Student loans
- Financial aid award letters
- Bills already paid (except for textbooks)
|
| Purchase of your principal residence or costs directly related to your purchase (excluding mortgage payments) | - If borrowing, loan estimate from lender, and
- Signed purchase contract or intent-to-purchase agreement
The above documents must: - be dated within last 60 days, and
- reflect the address of the residence being purchased, and
- reflect the purchase price, and
- reflect the amount of the down payment, and
- reflect a closing date in the future, and
- reflect signatures of both buyer and seller
- If building, you must also provide a copy of the signed builder’s permit or builder’s contract
- If purchasing a mobile home, you must also provide a copy of the Deed to show that you own the land
| - Rental/lease agreement for purchase of a primary residence
- Mortgage applications
- Truth in lending disclosures
- Bills already paid
- Land purchases only
|
| Repair of principal residence, that would qualify as a casualty deduction under the Internal Revenue Code, such as a fire or storm | - Letter explaining what caused the casualty, and
- Statement from your insurance company stating the loss is not covered, and
- Billing statement or cost estimate
The above documents must: - be dated within last 4 months, and
- reflect the amount necessary to repair principal residence, and
- include the property address, and
- have a future payment due date
| - General estimate for repair (no property address, not dated or amount owed)
- Routine maintenance, remodeling, additions, non-attached buildings and garages
- Bills already paid
|
| Prevention of mortgage foreclosure or eviction from your principal residence | - Proof of pending foreclosure or pending eviction
- Tax lien, or
- Bank/mortgage statement, or
- Letter from bank/mortgage company, or
- Copy of the court document substantiating the eviction or foreclosure legal proceedings, or a Notice to Quit in the case of evictions. If the Notice to Quit does not state the amount owed to prevent eviction, then you must include a signed and dated letter from the landlord either notarized or on company letterhead
The above documents must: - be dated within last 4 months, and
- reflect the amount necessary to prevent eviction/ foreclosure, and
- contain eviction/foreclosure date. This date must be in the future, and
- include the property address, and
- have a future payment due date
- If the current address on record is a PO Box, a document from a municipal or government agency providing proof of physical address. (Example: Utility bill or drivers license)
| - IRS tax liens that do not specify address of property to be foreclosed
- Late payment statements that do not threaten eviction or foreclosure
- Lease agreements
- Bills already paid
|
Funeral/Burial expenses for: - Your spouse
- Your child
- Your parent
- Your dependent
| - Copy of death certificate, and
- Funeral/burial statement which must:
- reflect name of deceased, and
- reflect date of services provided within the past 90 days, and
- reflect your name as individual billed, and
- include itemized funeral/burial expenses, and
- have a future payment due date
| - Pre-purchase of lot or headstone
- Bills already paid
|
If you selected an immediate and heavy financial need for your dependent: A dependent is anyone who meets the definition of a Qualifying Child or Qualifying Relative as described in Section 152 of the Internal Revenue Code, determined without regard to subsections (b)(1), (b)(2), and (d)(1)(B) thereof. |
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