Form 90r - Oregon Elderly Rental Assistance Program - 2011 Page 6
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10Savings accounts ......................................... Yes
Surplus food ....................................................... No
Tax-exempt interest ..................................... Yes
Temporary assistance to needy families ... Yes
U.S. Savings Bonds ...................................... Yes
Women, Infants, and Children
Losses on sales (to extent used in
program (WIC) .................................................. No
determining AGI) (limited to $1,000) ......... Yes
Railroad Retirement Board benefits ......... Yes
From sales of real or personal
property (nonbusiness) ................................... No
Refunds
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
Rental allowances paid to ministers
Family allowances....................................... Yes
not included in federal AGI ........................ Yes
Pensions ........................................................ Yes
Rental and royalty income (reduced by
Net operating loss carryback and carryover ... No
expenses) (losses limited to $1,000) ............. Yes
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
Social Security)
used in determining federal AGI .............. Yes
Scholarships (totaling more than $500) .... Yes
Pensions and annuities (taxable and
nontaxable) (reduced by cost
Sick pay ........................................................... Yes
recovered in the current year) ..................... Yes
Social Security (taxable and nontaxable) ... Yes
Prizes and awards ......................................... Yes
Children’s benefits paid to parent ............ Yes
Public assistance benefits ............................ Yes
Children’s benefits paid to your child ............. No
Aid to blind and disabled .......................... Yes
Disability pension ....................................... Yes
Child care payments ................................... Yes
Medicare payments of medical expenses ....... No
Child support included in public
Medicare premiums deducted from
assistance ..................................................... Yes
Social Security ............................................ Yes
Direct payments to nursing home ................... No
Old-age benefits ........................................... Yes
Food stamps (or cash payments in lieu
Social Security Disability Insurance
of food stamps) .................................................. No
(SSDI) ........................................................... Yes
Fuel assistance .................................................... No
In-home services approved by the
Supplemental Security Income (SSI) ........ Yes
Department of Human Services ..................... No
Survivor benefits ......................................... Yes
Medical payments to doctors ........................... No
Stipends (totaling more than $500) ........... Yes
Oregon Supplemental Income
Program (OSIP) .......................................... Yes
Strike benefits ............................................... Yes
Payments for medical care, drugs,
Support from parents who don’t live
medical supplies, and services for
in your household ......................................... Yes
which no direct payment is received ............. No
Reimbursements of expenses paid or
Trust income ................................................... Yes
incurred by participants in work
Unemployment compensation .................... Yes
or training programs ........................................ No
Special Shelter Allowance ................................ No
Wages ............................................................... Yes
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150-545-002 (Rev. 12-11)
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Parent category: Business