Fillable Form 90r - Oregon Elderly Rental Assistance

Line instructions

Other income

Instructions are for lines not fully explained on

12. Department of Human Services (DHS) ben‑

efits. Fill in the total amount of public assis-

the form.

tance you received. Include amounts received

Note: You must round off cents to the nearest

from Seniors and People with Disabilities.

dollar. For example, $12.49 becomes $12.

Also include Temporary Assistance for Needy

Families (TANF). You should have received an

Work and investment income

Assistance Summary statement that shows the

amount you received. Don’t include:

Fill in the total amount received during the year.

• Special Shelter Allowance portion of TANF.

2. Interest and dividends. Fill in your total taxable

and nontaxable interest and dividends. Don’t

• Amounts for food stamps or surplus foods.

include “return of capital” dividends or insur-

• Payments for medical care, drugs, medical

ance policy “return of premium” dividends.

supplies, and services related to medical care

Note for lines 3, 4, and 6:

for which you received no direct payment.

• In-home services approved by the Oregon

• If you had a net loss, it is limited to $1,000.

Department of Human Services.

• Include income from part nerships and S

corporations.

• Reimbursement of expenses from participat-

• Do not reduce these items by net operating loss

ing in work or training programs.

carryovers and carrybacks.

If you receive public assistance benefits for your

• Limit the combined total of your depreciation,

nursing home costs, include 23 percent of that

depletion, and amortization deductions to $5,000.

payment as public assistance income. Generally,

23 percent of the payment is rent plus utilities

5. Total gain on property sales. Fill in your total

and fuel (see “Special living places” on page 2).

gain from any property sales: stocks, bonds,

Don’t include payments to your nursing home

land, or other property. If you had a net loss,

for medical care, drugs, or medical supplies.

you can subtract up to $1,000. Don’t include any

gain you deferred or excluded from the sale of

14. Veteran’s and military benefits. Fill in your

your house.

total taxable and nontaxable veteran’s benefits,

GI Bill benefits, family allowances, and educa-

Retirement income

tional allowances.

15. Family support, gifts, and grants. Add all the

For each of the following, fill in the total amount

gifts, grants, and scholarships you received.

you received during the year.

Include any amounts you received from others

9. Social Security, Supplemental Security

to help pay your expenses. You can exclude up

Income (SSI), Social Security Disability

to $500 from household income. Don’t include

Insurance (SSDI), and railroad retirement.

federal grants to improve your home.

Fill in the total taxable and nontaxable Social

16. Other sources. See the household income

Security, SSI, SSDI, and Railroad Retirement

checklist on page 4.

Board benefits you received in 2014. Include

21. Household assets.

Social Security before any Medicare premium

deductions. Do not include reimbursed medical

Single or married/RDP—living apart. Com-

expenses. Include any amounts you received in

plete the household assets list on the back

your name from Social Security for the benefit

of your Form 90R. If the total value of your

of a minor child.

household assets is more than $25,000 you don’t

qualify for ERA.

10. Pensions and annuities. Fill in the total pen-

Married/RDP—living together. Complete the

sion and annuity income you received in 2014.

household assets list on the back of your Form

Federal pensions: Be sure to include your total

90R. If the total value of both your household

taxable and nontaxable pension income. Don’t

include your contribution to the plan. Include

lump-sum distributions and death benefits.

150-545-002 (Rev. 12-14)

Form 90r - Oregon Elderly Rental Assistance - 2014 Page 3

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