Veterans Benefits Retirement/Pension 1233 Income Verification Is any other income that may not have been listed? – → Requested None Additional Income: Total Reported Income: Source Amount 0.00 If reported income is greater than $2000, go to Income Trust script. If Income Trust script is not required, continue Application Script Do you have any deductions taken out of your check? Anything such 1233 Verification Requested → – as health/dental insurance premiums or taxes withheld? If you have If taxes are being withheld, you → have the option to ask whoever is medical deductions, we may be able to not count the premiums. paying the income to stop No Deductions Deductions (List all deductions) withholding taxes. Medicaid must use the full amount even if taxes are being deducted. Income Spouse or other dependent relative – Complete before call. Make any notes or corrections as necessary: 1233 Income Verification You listed the following income on your application: → – Requested Source Amount SSA/RRB Veterans Benefits Retirement/Pension Other: 1233 Income Verification Is any other income that may not have been listed? – → Requested None Additional Income: Source Amount Resources Complete on-line property Complete before call. Make any notes or corrections as
Veterans Benefits Retirement/Pension → Is any other income that may not have been listed? 1233 – Income Verification Requested Total Reported Income: 0.00 If reported income is greater than $2000, go to Income Trust script. If Income Trust script is not required, continue Application Script None Additional Income: Source Amount → Do you have any deductions taken out of your check? Anything such as health/dental insurance premiums or taxes withheld? If you have medical deductions, we may be able to not count the premiums. No Deductions Deductions (List all deductions) 1233 – Verification Requested → If taxes are being withheld, you have the option to ask whoever is paying the income to stop withholding taxes. Medicaid must use the full amount even if taxes are being deducted. Income – Spouse or other dependent relative Complete before call. Make any notes or corrections as necessary: → You listed the following income on your application: Source Amount SSA/RRB Veterans Benefits Retirement/Pension Other: 1233 – Income Verification Requested → Is any other income that may not have been listed? 1233 – Income Verification Requested None Additional Income: Source Amount Resources Complete on-line property Complete before call. Make any notes or corrections as
Chapter_105.docx