Information About Family Members


Information About Your Income and Assets


  1. Name, Address and telephone number of the employer.
  2. Current rate of regular pay, overtime pay and the number of hours normally worked.
  3. Information about any changes you expect to receive from employment such as tips, commissions, profit sharing, etc...
  1. Unemployment Compensation
  2. Social Security
  3. Supplemental Social Security
  4. Pension
  5. Disability Income
  6. Alimony
  7. Child Support
  8. Welfare or other Public Assistance
  9. Regular Support from Family Members or Friends

Expenses

  1. Medical expenses not covered by insurance. (Elderly, Handicapped or Disabled Families Only)

  2. Medical insurance premiums or amounts deducted from your pay for medical insurance. (Elderly, Handicapped or Disabled Families Only)

  3. child care expenses to care for your children while you work or go to school
  4. Expenses to care for a handicapped or disabled family member while you work