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LIHEAP MANUAL JANUARY 2022 83

12. Primary Source of Income

13. Applicant Date of Birth

13a. Applicant Age

14. Sex

15. Number of Elderly in Household

16. Number of Disabled in Household

1. Social Security or Railroad Retirement Wages 2. Supplemental Social Security Income (SSI) 3. TANF or other Public Assistance 4. Self Employed 5. Unemployment Insurance 6. Pension or Veteran Benefits 7. No Income 8. Other ( Specify)

FOR REPORTING PURPOSES

- enter the applicant Date of Birth enter the age of the applicant as two digits. Example: If the applicant is 47 years old, enter 47.

- enter the appropriate letter M or F to indicate whether the applicant is male or female.

- enter the number of people 60 years or older, including the applicant, living in the household. If none, enter 0, if more than nine, enter a i-

- enter the number of disabled people living in the household. If none, enter a ,Q; if more than nine, enter ai.