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UNEARNED INCOME 20. Is anyone receiving, expect to receive, or applied for any type of income listed below?  Yes  No Check “Yes”, “No” or “Pending” (if awaiting approval) for each source of income. If “Yes” is checked, complete the information about the item. YES NO PEND- ING SOURCE OF INCOME PERSON WHO RECEIVES INCOME MONTHLY AMOUNT HOW OFTEN RECEIVED? (MONTHLY/WEEKLY) Social Security $ Supplemental Security Income (SSI) $ Assistance Payments from Another State $ Unemployment Benefits $ Housing Authority (HUD, Section 8), Energy Assistance $ Child Support, Alimony $ Money from friends, relatives, charities, contributions, gifts, etc. $ Blood/Plasma income $ Interest/Dividends/Royalties $ Veteran’s Benefits, Railroad Retirement, other Governmental Benefits $ Retirement/Pension, Profit Sharing, Annuity Pmts. $ Temporary Disability Insurance/Worker’s Compensation $ Training Allowance, Vocational Rehabilitation, JTPA $ Foster Care Payments $ Strike Pay $ Military Enlistment Bonus $ Military Allotment $ Money from land/building sales, rentals or leases (to include agreement of sales) $ Prizes, Cash, Gifts, Awards $ Lottery and/or Gaming Winnings $ Insurance Settlements $ Reapplication or Appeal of a Denied Benefit (such as SSI or Unemployment benefits, etc.) $ Other (Specify) $ DHS 1240 (REV 04/2024) Page 6 of 11 Attachment A-2, Page 8 of 18