(1) Any one of the following documents shall be considered sufficient evidence upon which to base the final determination of indigent status, when the income information is annualized as may be appropriate:

(a) A "W-2" withholding statement from all employers for the previous year;

(b) Pay stubs from all employers for the previous year;

(c) An income tax return from the most recently filed calendar year;

(d) Forms approving or denying eligibility for medicaid and/or state-funded medical assistance;

(e) Forms approving or denying unemployment compensation; or

(f) Written statements from all employers for the previous year or welfare agencies.

(2) In the event that the responsible party is not able to provide any of the documentation described above, the department shall rely upon written and signed declarations under penalty of perjury from the responsible party for making a final determination of eligibility for classification as an indigent person.

(3) Information requests, from the department to the responsible party, for the verification of income and family size shall be limited to that which is reasonably necessary to substantiate the responsible party's qualification for indigent status, and may not be used to discourage applications for such status. Only those facts relevant to eligibility may be verified.