A local health department or a Statewide academic health center shall use the following financial eligibility criteria for cancer treatment services under the Cancer Prevention, Education, Screening and Treatment Program: The basis for determining financial eligibility shall be the gross annual household income; An applicant with a gross annual household income above 250 percent of the federal poverty level is not eligible to receive cancer treatment services; Written documentation required for determination of the gross annual household income shall include: The household’s most recent federal income tax return; or If a household income tax return was not filed, the following: The most recent W-2 statement; Pay stubs from two consecutive pays; A Social Security entitlement letter; or A notarized letter from the applicant stating that the applicant is not working and does not have any income; The household income level for determining financial eligibility shall be based on the size of the family unit including the applicant and may include the following individuals as verified by the most recent tax return: The applicant’s spouse; Any financially dependent children; or Any financially dependent relative; and The type of written documentation that an applicant shall provide in order to document the size of the family unit includes the following: The most recent income tax return; A divorce decree, if applicable; or If a household income tax return was not filed, written documentation shall include the names, ages, and relationship to the applicant of individuals supported by the gross annual household income. A local health department or a Statewide academic health center may establish requirements for eligibility of cancer treatment services in addition to those cited in §A of this regulation.