1. Social Security benefits – as paid after deduction for Medicare premium

2. Pension – as paid

3. Veterans Administration Pension – as paid

4. U.S. Railroad Retirement Benefits – as paid

5. Wages – net amount after deductions for taxes and FICA

6. Senior Community Service Employment – net amount after deductions for taxes and FICA

7. Interest/Dividends – gross amount

8. Capital Gains – gross amount from capital gains on stocks, mutual funds, bonds.

9. Credit Life or Credit Disability Insurance Payments – as paid

10. Alimony – as paid

11. Rental Income from entire dwelling – gross rent paid minus standard deduction of 20% for expenses

12. Roomer/Boarder Income – gross room/board paid minus standard deduction of 10% for expenses

13. Self Employment – countable income as reported to Internal Revenue Service (IRS)

14. Unemployment Compensation - as paid