Questionnaire Text

Questionnaire form view entire document:  text  image
M. Answer questions 42a - f if this person worked in the past 5 years. Otherwise, skip to question 43.

44. What was this person's total income during the past 12 months?

Add entries in questions 43a to 43h; subtract any losses. If net income was a loss, enter the amount and mark (X) the "Loss" box next to the dollar amount.

[] None or
$_ _,_ _ _,_ _ _.00 (Total amount for past 12 months)
[] Loss
Questionnaire instructions view entire document:  text  image
Person questions 43-44

P44. Add the total entries (subtracting losses) for 43a through 43h for the past 12 months and enter that number in the space provided. Mark the "loss" box if there is a loss. Print the total amount in dollars.

Include:

  • Recurring payments such as income from unemployment compensation or unemployment insurance cash benefits

Do not include:

  • Noncash benefits such as food stamps or benefits from SNAP or rental assistance.