Appendix C27 NAMES Survey Income Source Show Card

APPENDIX C27. NAMES SURVEY INCOME SOURCE SHOW CARD

National Assessment of Meal Eligibility and Services (NAMES) Study

Survey Income Source Show Card

OMB Number: 0584-XXXX

Expiration Date: XX/XX/XXXX

1. Paid Work or Salary (do not include business profit or loss)

2. Unemployment Compensation

3. Workers Compensation Benefits

4. Strike Benefits

5. Social Security or Railroad Retirement

6. Private Pension, Annuities, or Survivor’s Benefits

7. Military Cash Benefits

8. Veteran’s Benefits

9. Government Disability Benefits from Supplementary Security Income (SSI)

10. Private Disability Benefits

11. Alimony Payments

12. Child Support Payments

13. Interest and Dividends Income

14. Rental Income

15. Profit or Loss from Nonfarm Business/ Partnership/Professional Practice

16. Profit or Loss from a Farm

    

    According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-XXXX. The time required to complete this information collection is estimated to average 2 minutes per response, including the time to review instructions, search existing data sources, gather and maintain the data needed, and complete and review the collection of information.

17. Financial Aid to College Students
    
    
    

18. Regular Payments or Withdrawals from Large Awards or Settlements

19. Regular Contributions from Persons Outside the Household

20. Other Income, such as Net Royalties, Trust Income, 401K, Prize Winnings, or Bonuses

21. General Assistance Benefits

22. Housing Subsidy, do not include military housing subsidy

23. Black Lung Benefits

24. Other Public Benefits not including TANF or SNAP

25. Temporary Assistance to Needy Families or TANF

26. Supplemental Nutrition Assistance Program or SNAP or Food Stamps

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