Fillable Form 90r - Oregon Elderly Rental Assistance

Sign and mail Form 90R

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

qualify for ERA. Include property you own

Before you mail Form 90R, check for the following:

together and separately.

Were you or your spouse/RDP age 58 or older on

Note: Examples of items not to include are: TVs,

December 31? Did you fill in your date of birth

computers, cars, furniture, appliances, jewelry,

and your spouse’s/RDP’s date of birth?

and bicycles. (This is not intended to be a com-

Did you and your spouse/RDP sign and date

plete list.)

Form 90R?

Did you complete the entire form? An incomplete

Qualifying rent

claim could delay your assistance until next year.

22. Total Oregon rent you paid during 2014.

Remember—You must file Form 90R by July 1,

2015 so we can process and issue your payment in

Include all Oregon rent you paid for each resi-

November 2015.

dence you rented in 2014. Rent doesn’t include

advance rent or deposits for keys, cleaning, or

Have questions? Need help?

security. Keep your rent receipts for at least

three years.

General tax information .......

Salem ...................................................... 503-378-4988

If the property you rented was partially exempt

Toll-free from an Oregon prefix ...1-800-356-4222

from property taxes, or you lived in a nursing

home, retirement/rest home or center, group

Asistencia en español:

home, or pay room and board, only a portion is

En Salem o fuera de Oregon ........... 503-378-4988

qualifying rent. See “Special living places” on

Gratis de prefijo de Oregon .........1-800-356-4222

page 2.

TTY (hearing or speech impaired; machine only):

Salem area or outside Oregon .........503-945-8617

23. Special Shelter Allowance (TANF). Did you

Toll-free from an Oregon prefix ... 1-800-886-7204

receive TANF? If you did, the Assistance Sum-

mary statement you received shows the amount

Americans with Disabilities Act (ADA): Call one of

of your TANF. Fill in the amount from the

the help numbers above for information in alterna-

notice on this line. This allowance is an advance

tive formats.

payment of ERA and will reduce the amount of

Household income checklist

your assistance.

24. Fuel and utilities. Include the amount you paid

Use this list to decide if an item must be included

during 2014 for lights, water, garbage, sewer, and

in total household income.

heating while living in Oregon. Don’t include

Alimony and separate maintenance .......... Yes

amounts for telephone, cable, or internet.

Annuities and pensions (reduced by

If the total of lines 22 and 24 is 20 percent or less

cost recovery) .................................................. Yes

of your total household income on line 20, then

Business income (reduced by

you don’t qualify.

expenses) (losses limited to $1,000) ............. Yes

If you lived in a nursing home, retirement/rest

Cafeteria plan benefits ........................................ No

home or center, group home, or paid room and

board, see “Special living places” on page 2.

Capital loss carryover .......................................... No

25. Nursing home, retirement/care home or facil‑

Capital losses (in year determined)

ity, or group home. Check the box that applies.

(losses limited to $1,000) ................................ Yes

Generally, a nursing home provides medical

Child support ................................................. Yes

care, but retirement/care homes or centers and

group homes don’t.

Child support included in

public assistance ............................................... Yes

ERA payment. We will figure your assistance

amount for you. Remember your assistance pay-

Clergy’s rental or housing allowance,

ment will be reduced by any TANF you received

in excess of expenses claimed to

in 2014.

determine federal AGI ................................. Yes

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

Form 90r - Oregon Elderly Rental Assistance - 2014 Page 4

Related Articles

Related forms

Related Categories