No Income Statement

This form is used to confirm that you currently have no earned or taxable household income. It helps us apply our review criteria fairly and determine eligibility and award levels for the STRIPE Program. If you are not receiving income at this time, completing this statement allows you to move forward in the application process without submitting income documents.

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Income Attestation

I certify that I currently have no earned or taxable household income. This includes income from employment, self-employment, unemployment, or any other sources. I understand that this statement is required to determine eligibility and award level for assistance through the STRIPE Program.

I further acknowledge:

  • This information is true and correct to the best of my knowledge.
  • If my household income changes during the application or review period, I will notify the program.
  • Providing false or misleading information may affect my eligibility for current or future assistance.
Certification

By submitting this form, I affirm that the information provided above is accurate and complete.