AU
COMPOSITION
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INCOMES/DEDUCTIONS Do you or does anyone else in your home have any: wages, self-employment, commissions/tip, JTPA, Job Corps, training allowances, rental income, or income from a roomer/boarder? Do you or does anyone else in your home receive: Social Security, SSI, child support, contributions, VA, Railroad Retirement, Worker's Compensation, Unemployment, sick pay, interest, dividends, educational loans or income, or striker benefits? Do you pay child care? Do you or does anyone in your home pay child support to someone? Explain Lump Sum policy to the A/R. |
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MEDICAL EXPENSES
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SHELTER
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WORK REGISTRATION/EXEMPTION |