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497 Check "YES" on Question 3 (Y shown if applicable. Otherwise, position 293 will be blank if N or N/A applicable) PIC X(01) The code in this field will tell you whether the beneficiary completed the entire application or stopped at question 3, self- screening himself/herself out of eligibility for Extra Help because his/her resources are too high.

If there is a Y the beneficiary stopped at question 3.

The field will be blank if the entire application was completed.

Values:

Y (Yes) or Blank Spaces (No or N/A) 498-502 Resources PIC S9(06) V99 Bank Account - This field will display the sum total of resources in a bank account, before the burial exclusion is applied. 503-507 Resources PIC S9(06) V99 Stocks, Bonds or Other Investments - This field will display the sum total of stocks, bonds or other investments, before the burial exclusion is applied. 508-512 Resources PIC S9(06) V99 Cash - This field will display the sum total of resources, before the burial exclusion. 513-517 Resources PIC S9(06) V99 Real Estate - This field will display the sum total of real estate other than the beneficiary’s home, before the burial exclusion is applied. 518-519 Household Size PIC 9(02) Amount of other relatives (1 thru 99) living in the household - Not including the beneficiary and spouse. Zeros in this space will represent no other relatives in the household.

520-524 Income Not from Work

PIC S9(06) V99 This is the income other than from work. The income shown is the full monthly amount of the benefit. This does not display the net check amounts which are after deductions from premiums, overpayments, etc.

525-529 Income Not from Work

PIC S9(06) V99