Paragraph SAD001

Let us know if (1) have enough money to get food and shelter. If this happens, we may change the way we count certain income and property of (2) when we figure the amount of (3) SSI checks.

Also let us know if:

• •

  (4) sponsor dies;

• •

  (5) a U.S. citizen; or

• •

  You think (6) may have 40 qualifying quarters of work.

  According to SSA records, you now have (7) qualifying quarters. If (8) spouse or parent has qualifying quarters, we also may be able to count them. We cannot count any quarter acquired after December 31, 1996 if (9) received certain types of federally funded assistance during that quarter.

Normally, we will stop counting the income and property of (10) if (11) a U.S. citizen or (12) 40 qualifying quarters of work. But we will count any income or assistance (13) (14) (15)

Fill-ins:

1. 1. 

   Choice 1: you don't

   Choice 2: (name of beneficiary) doesn't

2. 2. 

   Choice 1: your sponsor

   Choice 2: his sponsor

   Choice 3: her sponsor

   Choice 4: your sponsor and the sponsor's spouse

   Choice 5: his sponsor and the sponsor's spouse

   Choice 6: her sponsor and the sponsor's spouse

3. 3. 

   Choice 1: your

   Choice 2: his

   Choice 3: her

4. 4. 

   Choice 1: your

   Choice 2: his

   Choice 3: her

5. 5. 

   Choice 1: you become

   Choice 2: he becomes

   Choice 3: she becomes

6. 6. 

   Choice 1: you

   Choice 2: he

   Choice 3: she

7. 7. 

   Number of quarters earned by the individual. Do not include any quarters earned by his or her parent or spouse.

8. 8. 

   Choice 1: your

   Choice 2: his

   Choice 3: her

9. 9. 

   Choice 1: you or your parent or spouse

   Choice 2: (name of beneficiary) or his spouse or parent

   Choice 3: (name of beneficiary) or her spouse or parent

10. 10. 

    Choice 1: your sponsor

    Choice 2: his sponsor

    Choice 3: her sponsor

    Choice 4: your sponsor and the sponsor's spouse

    Choice 5: his sponsor and the sponsor's spouse

    Choice 6: her sponsor and the sponsor's spouse

11. 11. 

    Choice 1: you become

    Choice 2: he becomes

    Choice 3: she becomes

12. 12. 

    Choice 1: have

    Choice 2: has

13. 13. 

    Choice 1: your sponsor actually gives

    Choice 2: his sponsor actually gives

    Choice 3: her sponsor actually gives

    Choice 4: your sponsor and the sponsor's spouse actually give

    Choice 5: his sponsor and the sponsor's spouse actually give

    Choice 6: her sponsor and the sponsor's spouse actually give

14. 14. 

    Choice 1: you

    Choice 2: him

    Choice 3: her

15. 15. 

    Choice 1: We also count certain income and property of your spouse. Since your sponsor is also your spouse, we will continue to count that income.

    Choice 2: We also count certain income and property of his spouse. Since his sponsor is also his spouse, we will continue to count that income.

    Choice 3: We also count certain income and property of her spouse. Since her sponsor is also her spouse, we will continue to count that income.

    Choice 4: We also count certain income and property of your parent and your parent's spouse. Since your sponsor is also your parent, we will continue to count that income.

    Choice 5: We also count certain income and property of his parent and his parent's spouse. Since his sponsor is also his parent, we will continue to count that income.

    Choice 6: We also count certain income and property of her parent and her parent's spouse. Since her sponsor is also her parent, we will continue to count that income.

    Choice 7: (Null)

Paragraph SAD002

Usually, we count certain income and property of (1) as if they were (2) income and property. However, (3) have enough money to get food and shelter. So, we will only count the money or support (4) actually gives (5) until (6) . That date is 12 months from when (7) didn't have enough money for food and shelter.

You must tell us if the amount of money or support (8) from (9) or from anyone else changes. Also, if (10) know where (11) sponsor is living, you must let us know if (12) out.

Fill-ins:

1. 1. 

   Choice 1: your sponsor

   Choice 2: (name of beneficiary, possessive) sponsor

   Choice 3: your sponsor and the sponsor's spouse

   Choice 4: (name of beneficiary, possessive) sponsor and the sponsor's spouse

2. 2. 

   Choice 1: your

   Choice 2: his

   Choice 3: her

3. 3. 

   Choice 1: you don't

   Choice 2: he doesn't

   Choice 3: she doesn't

4. 4. 

   Choice 1: your sponsor

   Choice 2: his sponsor

   Choice 3: her sponsor

   Choice 4: your sponsor and the sponsor's spouse

   Choice 5: his sponsor and the sponsor's spouse

   Choice 6: her sponsor and the sponsor's spouse

5. 5. 

   Choice 1: you

   Choice 2: him

   Choice 3: her

6. 6. 

   MM/YY (end of exception period)

7. 7. 

   Choice 1: you

   Choice 2: he

   Choice 3: she

8. 8. 

   Choice 1: you get

   Choice 2: he gets

   Choice 3: she gets

9. 9. 

   Choice 1: your sponsor

   Choice 2: his sponsor

   Choice 3: her sponsor

   Choice 4: your sponsor and the sponsor's spouse

   Choice 5: his sponsor and the sponsor's spouse

   Choice 6: her sponsor and the sponsor's spouse

10. 10. 

    Choice 1: you don't

    Choice 2: he doesn't

    Choice 3: she doesn't

11. 11. 

    Choice 1: your

    Choice 2: his

    Choice 3: her

12. 12. 

    Choice 1: you find

    Choice 2: he finds

    Choice 3: she finds

Paragraph SAD003

For 12 months, when (1) didn't have enough money to get food and shelter, we only counted the income and property of (2) that (3) actually received. The 12-month period has ended. We must start counting certain income and property of (4) as if they were (5) beginning in (6) . Let us know if (7) unable to get food and shelter.

Fill-ins:

1. 1. 

   Choice 1: you

   Choice 2: (name of beneficiary)

2. 2. 

   Choice 1: your sponsor

   Choice 2: his sponsor

   Choice 3: her sponsor

   Choice 4: your sponsor and the sponsor's spouse

   Choice 5: his sponsor and the sponsor's spouse

   Choice 6: her sponsor and the sponsor's spouse

3. 3. 

   Choice 1: you

   Choice 2: (name of beneficiary, possessive)

4. 4. 

   Choice 1: your sponsor

   Choice 2: his sponsor

   Choice 3: her sponsor

   Choice 4: your sponsor and the sponsor's spouse

   Choice 5: his sponsor and the sponsor's spouse

   Choice 6: her sponsor and the sponsor's spouse

5. 5. 

   Choice 1: yours

   Choice 2: (name of beneficiary, possessive)

6. 6. 

   MM/YY (date deeming resumed)

7. 7. 

   Choice 1: you become

   Choice 2: he becomes

   Choice 3: she becomes