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ALIMONY/CHILD SUPPORT EXPENSES 32. Does anyone pay alimony, child support, or make payments for those whom you claim as tax dependents and do not live in your home? Yes No If Yes, complete the following: TYPE OF PAYMENT AMOUNT HOW OFTEN PAID NAME OF PERSON PAID $ $ DEPENDENT CARE EXPENSES 33. Does anyone pay or is anyone billed for the care of a child or disabled adult so someone can work, attend school or training, or look for work?  Yes  No If Yes, complete the following: NAME OF PERSON RECEIVING CARE NAME OF PERSON PAYING CARE BILLING NAME AND ADDRESS OF PERSON PROVIDING CARE YOUR SHARE MONTHLY TOTAL DUE MONTHLY MEDICAL EXPENSES 34. MEDICAL EXPENSES. List current medical bills and estimate for anticipated medical expenses for the next 12 months for members of your household who are: (1) age 60 or older, (2) receiving Supplemental Security Income (SSI), Social Security Disability or Blindness payments, Railroad Retirement or other government disability payments, (3) entitled to, but not receiving SSI or Social Security Disability or Blindness Benefits, (4) a disabled veteran, or (5) a disabled spouse or a child of a deceased Veteran. Medical bills/expenses include Medicare premiums, health and hospitalization insurance premiums, prescription drugs, doctor and dental bills, medical transportation costs, glasses, dentures, hearing aids, service of a nurse, or attendant, etc. NAME OF PERSON THE EXPENSE IS FOR ACTUAL AMT. BILLED ESTIMATED EXPENSE HOW OFTEN BILLED (MONTHLY, WEEKLY) NAME OF DOCTOR, HOSPITAL PHARMACY, INSURANCE COMPANY $ $ $ $ $ $ $ $ $ $ $ $ $ $ DHS 1240 (REV 04/2024) Page 9 of 11 Attachment A-2, Page 11 of 18