TN 5 (03-12)
Complete question 50(a) for all claimants. A "YES" or "NO" indication is required
for each item in (a). For any "YES" answer to (a), complete (b).
Record cash gifts, foreign pensions, interest, and other income not previously captured
under "Other income".
NOTE: We cover wages, sick pay and self-employment income in questions 53 and 54.
Enter the frequency that the claimant receives income. He or she may not receive all
If income is expected to continue, write "Continuing" in the "To" portion of the "Dates
Expected or Received" block.
In the "Identifying Number" block enter the appropriate number or write Unknown, or
N/A (not applicable).
SI 00830.001 through SI 00830.880 Unearned Income
SI 00810.600 through SI 00810.620 Verifying and Estimating Income
SI 00830.115 Garnishment or Other Withholding
SI 00830.175 Assistance Based on Need (ABON)
SI 00830.520C.4 Gift of Cash
SI 00830.105 Payments in Foreign Currency
SI 00810.035 Unstated Income
SI 00830.225 Railroad Retirement Payments
MSOM MSSICS 014.002 Income Menu (IMEN)