Charles County Resource Parent Portal

Resource Parent Income Verification

Charles County Department of Social ServicesEmployment and Income Documentation FormThis form documents employment, wages, and financial stability for resource parent assessment.

Important: A recent copy of a current pay stub(s), with date of pay and amount should be attached to this form. Please have your supporting documentation ready to describe in the form fields below.

Resource Parent Income Verification Form

This form will be processed by your selected caseworker(s) and used for income verification assessment.

Form Details

Please provide the required information below.

Important Notice

Please select your assigned caseworker(s) from the list below. You can select multiple caseworkers if needed. If you are unsure who your caseworker is, please contact CCDSS at (301) 609-6000 before proceeding.

Caseworker Selection *

This form will be sent to your selected caseworker(s) for processing. Select all relevant caseworkers.

Personal Information

Please provide your personal details for verification.

Name *

Date of Birth *

Email *

Employment Information

Provide details about your current employment.

Job Title *

Employer *

Length of Employment *

Please specify how long you have been employed with your current employer.

Supervisor Information

Provide your supervisor's contact information for verification purposes.

Supervisor's Name *

Supervisor's Phone *

Supervisor's E-mail *

Supporting Documentation

Please describe the supporting documents you are providing with this form.

Required Documentation: Please attach recent pay stubs and W2 forms to support this income verification. Describe the documents you are providing in the fields below.

Pay Stub Description *

Please provide details about the pay stub including date and amounts shown.

W2 Form Description *

Please provide details about the W2 form including tax year and wage information.

Additional Information

Provide any additional information that may be relevant to your income verification.

Additional Notes (Optional)

This field is optional but can be used to provide context or clarification about your employment situation.