Fillable Form 90r - Oregon Elderly Rental Assistance

U.S. Savings Bonds ...................................... Yes

Women, Infants, and Children

program (WIC) .................................................. No

Losses on sales (to extent used in

determining AGI) (limited to $1,000) ......... Yes

Railroad Retirement Board benefits ......... Yes

From sales of real or personal

Refunds

property (nonbusiness) ................................... No

Earned income credit ........................................ No

Lottery winnings .......................................... Yes

Federal tax ........................................................... No

Lump‑sum distribution (less cost

Property tax ........................................................ No

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

Oregon income tax ............................................. No

Military and veteran’s benefits

Other states’ income tax (if in federal AGI) ...Yes

(taxable and nontaxable)

Prior-year rental assistance payment .............. No

Combat pay .................................................. Yes

Disability pensions ..................................... Yes

Reimbursements (in excess of expenses) ... Yes

Educational benefits (GI Bill) ..................... Yes

Family allowances....................................... Yes

Rental allowances paid to ministers

Pensions ........................................................ Yes

not included in federal AGI ........................ Yes

Net operating loss carryback and carryover ... No

Rental and royalty income (reduced by

Partnership income (reduced by

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

Residence sales (see gains on sales) .......... Yes

Parsonage (rental value) or housing

Retirement benefits (see pensions and

allowance in excess of expenses

used in determining federal AGI .............. Yes

Social Security)

Pensions and annuities (taxable and

Scholarships (totaling more than $500) .... Yes

nontaxable) (reduced by cost

Sick pay ........................................................... Yes

recovered in the current year) ..................... Yes

Prizes and awards ......................................... Yes

Social Security (taxable and nontaxable) ... Yes

Children’s benefits paid to parent ............ Yes

Public assistance benefits ............................ Yes

Aid to blind and disabled .......................... Yes

Children’s benefits paid to your child ............. No

Child care payments ................................... Yes

Disability pension ....................................... Yes

Child support included in public

Medicare payments of medical expenses ....... No

assistance ..................................................... Yes

Medicare premiums deducted from

Direct payments to nursing home ................... No

Social Security ............................................ Yes

Food stamps (or cash payments in lieu

of food stamps) .................................................. No

Old-age benefits ........................................... Yes

Fuel assistance .................................................... No

Social Security Disability Insurance

In-home services approved by the

(SSDI) ........................................................... Yes

Department of Human Services ..................... No

Supplemental Security Income (SSI) ........ Yes

Medical payments to doctors ........................... No

Survivor benefits ......................................... Yes

Oregon Supplemental Income

Program (OSIP) .......................................... Yes

Stipends (totaling more than $500) ........... Yes

Payments for medical care, drugs,

Strike benefits ............................................... Yes

medical supplies, and services for

which no direct payment is received ............. No

Support from parents who don’t live

Reimbursements of expenses paid or

in your household ......................................... Yes

incurred by participants in work

or training programs ........................................ No

Trust income ................................................... Yes

Special Shelter Allowance ................................ No

Unemployment compensation .................... Yes

Surplus food ....................................................... No

Temporary assistance to needy families ... Yes

Wages ............................................................... Yes

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

Form 90r - Oregon Elderly Rental Assistance - 2012 Page 6

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