Mssics Household Income Data Screen

FACSIMILIE OF MSSICS HOUSEHOLD INCOME DATA SCREEN (LHID)

MSSICS                 HOUSEHOLD INCOME DATA                  LHID

SSS-SS-SSSS  SSSSS SSSSSSSSSS   PERIOD BEGAN: SS/SS/SSSS   TRANSFER TO:  XXXX

           

            ALL PUBLIC ASSISTANCE HOUSEHOLD (Y/N): X

           

          PUBLIC ASSISTANCE WITH AFDC PAYMENT CAP HOUSEHOLD (Y/N) : X

                 

                  LOAN AGREEMENT REGARDING HOUSEHOLD EXPENSES  (Y/N): X

                

                    IF YES, BONA FIDE LOAN EXISTS (Y/N): X

                       

                            IF YES, ASSUMED TO COVER PRO RATA SHARE (Y/N): X

              

                DEVELOPMENT OF INSIDE ISM/UNSTATED INCOME NECESSARY (Y/N) : X

                                                              

                                                                REMARKS(Y): X