Form Dhs-2 - Application Forassistance - Rhode Island Department Of Human Services Page 16
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38DHS-2 Rev. 10-14
Page 12
Questions 14-19 b ask about resources-- money and things you own.
IF YOU ARE APPLYING FOR SNAP ONLY, DO NOT FILL OUT QUESTIONS 14-19b UNLESS OTHERWISE
INSTRUCTED BY YOUR DHS WORKER DURING YOUR INTERVIEW. PLEASE CONTINUE TO QUESTION 20.
Do you, your spouse, or anyone in the household have any cash? Yes
14
No
If yes, complete the boxes below about each person with cash.
C A S H
Last Name
First Name
Mid dle
Amount
Last Name
First Name
Mid dle
Amount
$
$_____________
Initial
Initial
Do you, your spouse, or anyone in the household have his/her
15
Yes
name on any accounts such as the type listed below?
No
EXAMPLES:
Checking account
Credit union account
Savings certificate
IRA
Mutual Funds
Savings account
Money market account
Certificate of deposit
Annuity
Trust
Burial Set Aside
If yes, complete the boxes below for each account.
B A N K
Last Name
First Name
Mid dle Initial
Type of account
Account number
Amount
$
Co-owner name
Financial Institution
Address
Address
Last Name
First Name
Mid dle Initial
Type of account
Account number
Amount
$
Co-owner name
Financial Institution
Address
Address
Last Name
First Name
Mid dle Initial
Type of account
Account number
Amount
$
Co-owner name
Financial Institution
Address
Address
Last Name
First Name
Mid dle Initial
Type of account
Account number
Amount
$
Co-owner name
Financial Institution
Address
Address
Last Name
First Name
Mid dle Initial
Type of account
Account number
Amount
$
Co-owner name
Financial Institution
Address
Address
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