TN 1 (10-89)
Ask the person making the statement whether he/she received any other income while
receiving the PIM payments shown in question 1.
If the answer to question 2(a) is “No,” do not complete questions 3-5. Go to question 6 (except for an ineligible child;
skip to question 17).
If the answer to question 2(a) is “Yes,” and
When the person received no PIM payments for some months in the period being covered,
and alleges no other income, explain in the “Remarks” section. Unstated income may be an issue.
If the person making the statement does not expect the PIM payments to continue, explain
in“Remarks” section and show any expected income for the next 14 months in questions 3, 4, and
5. Remind the person to report when his /her income actually changes.
Deeming other income while receiving PIM payments, SI 01320.141.