Claimant Statement About Loan of Food or Shelter

Claimant Statement About Loan of Food or Shelter; Statement about Food or Shelter Provided to Another

MSSICS Screen Shot 5062-5063--2009 pkg

Claimant Statement About Loan of Food or Shelter

OMB: 0960-0529

Document [doc]
Download: doc | pdf

The attached MSSICS “LHID” screen establishes whether a bona fide loan of ISM (food or shelter) exists. The information is collected during the interviewing process. Form SSA-5062 (“Claimant’s Statement About Loan of Food or Shelter”) collects additional information necessary to support the claimant’s statement that he or she has a bona fide loan of ISM. The SSA-L5063-F3 (“Statement About Food or Shelter Provided to Another”) collects information from the lender to verify that the claimant has a bona fide loan of ISM.



__________________________________________________________________________________________________

MSSICS                 HOUSEHOLD INCOME DATA                  LHID

                                [1-D]                      [2-O]

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

            [3-M]

            ALL PUBLIC ASSISTANCE HOUSEHOLD (Y/N): X

            [4-C]

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

                  [5-C]

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

                    [6-C]

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

                            [7-C]

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

                [8-O]

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

                                                                [9-O]

                                                                REMARKS(Y): X


File Typeapplication/msword
File TitleThe attached MSSICS screen establishes whether or not a Loan of ISM exists
Author497351
Last Modified ByLarwood, Debbie
File Modified2010-01-07
File Created2010-01-07

© 2024 OMB.report | Privacy Policy