We’re asking this question to find out how much money the people in your home receive from places other than a job. If you don’t know the exact answer to these money questions,give the best answer you can. Keep in mind that by giving us more accurate information, we can give you a more accurate answer. To answer the question, please type in the amounts each person in your home receives from any of these sources:

The most important thing to keep in mind is that we need to know the amount each person receives before any taxes or other deductions are taken out. This amount is called "gross amount".

Supplemental Security Income (SSI) - SSI is a monthly payment for people with very low incomes who are at least 65 or blind or disabled. SSI is not a retirement benefit and it is not the same as Social Security.

Social Security - By Social Security, we mean retirement payments and some disability payments. Don’t include SSI income in this box.

Child Support - Child support is the money that you or your children receive from a parent who is not living in your home.

Unemployment payments - Unemployment payments are payments you may receive from the state if you have recently lost your job.

Other sources -

• Countable: Some examples are workers’compensation, veterans’ benefits, pensions, any regular money given to any member of your household,interest or dividends.
• Non-Countable: Some sources of money don’t count at all. If someone receives income from one of these sources, you don’t have to tell us about it:
  • Income from a loan
  • One-time payments such as an income tax refund, a one-time insurance settlement, a security deposit refund,or an emergency assistance payment
  • Heating assistance payments
  Keep in mind that there are many other kinds of income that may not count. If you receive a type of income that isn’t listed here, it’s a good idea to ask your caseworker about it when you apply for benefits.