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Routine: EASEC102

Package: Enrollment Application System

Routine: EASEC102


Information

EASEC102 ;ALB/BRM - Print 1010EC LTC Enrollment form ; 9/20/01 12:25pm

Source Information

Source file <EASEC102.m>

Entry Points

Name Comments DBIA/ICR reference
PAGE2(EALNE,EAINFO,EASDFN) ;Print page 2
SIGN ;print disclaimer and signature block to refuse income data
SEC4 ; print section 4 - Fixed Assets (Veteran and Spouse)
SEC5 ; print section 5 - Liquid Assets (Veteran and Spouse)

Interaction Calls

Name Line Occurrences
Function Call: WRITE
  • Prompt: !,"I do not wish to provide my detailed financial information. "
  • Line Location: SIGN+2
Function Call: WRITE
  • Prompt: "I understand that I will be assessed the maximum copayment amount for"
  • Line Location: SIGN+3
Function Call: WRITE
  • Prompt: !,"extended care services and agree to pay the applicable VA copayment as required by law.",?131,$C(13)
  • Line Location: SIGN+4
Function Call: WRITE
  • Prompt: !,"Signature",?100,"| Date",!?100,"|",?131,$C(13)
  • Line Location: SIGN+5
Function Call: WRITE
  • Prompt: !?23,"SECTION IV - FIXED ASSETS (VETERAN AND SPOUSE)",?100,"|",?113,"VALUE",!,EALNE("D")
  • Line Location: SEC4+3
Function Call: WRITE
  • Prompt: !,"1. Residence (Market value minus any outstanding mortgage or "
  • Line Location: SEC4+5
Function Call: WRITE
  • Prompt: "lien - exclude if veteran",?100,"|",?105,"$",$J(@EAS4@(1),12,2)
  • Line Location: SEC4+6
Function Call: WRITE
  • Prompt: !?3,"receiving only non-institutional services or spouse or "
  • Line Location: SEC4+7
Function Call: WRITE
  • Prompt: "dependent residing in community).",?100,"|",?131,$C(13)
  • Line Location: SEC4+8
Function Call: WRITE
  • Prompt: !,"2. Other Residences/Land/Farm or Ranch (Market value minus any "
  • Line Location: SEC4+10
Function Call: WRITE
  • Prompt: "outstanding mortgage or lien)",?100,"|",?105,"$",$J(@EAS4@(2),12,2),?131,$C(13)
  • Line Location: SEC4+11
Function Call: WRITE
  • Prompt: !,"3. Vehicle(s)* (Value minus any outstanding lien - exclude if veteran is "
  • Line Location: SEC4+13
Function Call: WRITE
  • Prompt: "receiving only",?100,"|",?105,"$",$J(@EAS4@(3),12,2)
  • Line Location: SEC4+14
Function Call: WRITE
  • Prompt: !?3,"non-institutional services or spouse or dependent residing in community).",?100,"|",?131,$C(13)
  • Line Location: SEC4+15
Function Call: WRITE
  • Prompt: !?62,"| SUBTOTAL (Sum of lines 1 through 3)",?100,"|",?105,"$",$J(@EAS4@(4),12,2),?131,$C(13)
  • Line Location: SEC4+17
Function Call: WRITE
  • Prompt: !?23,"SECTION V - LIQUID ASSETS (VETERAN AND SPOUSE)",?100,"|",?113,"VALUE",!,EALNE("D")
  • Line Location: SEC5+3
Function Call: WRITE
  • Prompt: !,"1. Cash, e.g., interest, dividends from IRA, 401K's and other "
  • Line Location: SEC5+5
Function Call: WRITE
  • Prompt: "tax deferred annuities ",?100,"|",?105,"$",$J(@EAS5@(1),12,2)
  • Line Location: SEC5+6
Function Call: WRITE
  • Prompt: !?3,"(including checking, savings, money market, etc.)"
  • Line Location: SEC5+7
Function Call: WRITE
  • Prompt: ?100,"|",?131,$C(13)
  • Line Location: SEC5+8
Function Call: WRITE
  • Prompt: !,"2. Stocks, bonds, mutual funds, SEP's, and other retirement "
  • Line Location: SEC5+10
Function Call: WRITE
  • Prompt: "accounts (e.g., IRA, 401K,",?100,"|",?105,"$",$J(@EAS5@(2),12,2)
  • Line Location: SEC5+11
Function Call: WRITE
  • Prompt: !?3,"annuities, self-employed person)",?100,"|",?131,$C(13)
  • Line Location: SEC5+12
Function Call: WRITE
  • Prompt: !,"3. Other Liquid Assets (Includes such items as stamp or coin "
  • Line Location: SEC5+14
Function Call: WRITE
  • Prompt: "collections, art work, collectibles",?100,"|"
  • Line Location: SEC5+15
Function Call: WRITE
  • Prompt: !?3,"household furniture and other household goods, clothing, jewelry, and "
  • Line Location: SEC5+16
Function Call: WRITE
  • Prompt: "personal items",?100,"|",?105,"$",$J(@EAS5@(3),12,2)
  • Line Location: SEC5+17
Function Call: WRITE
  • Prompt: !?3,"minus amount owed).",?100,"|",?131,$C(13)
  • Line Location: SEC5+18
Function Call: WRITE
  • Prompt: !?62,"| SUBTOTAL (Sum of lines 1 through 3)",?100,"|",?105,"$",$J(@EAS5@(4),12,2),?131,$C(13)
  • Line Location: SEC5+20
Function Call: WRITE
  • Prompt: !,"SUM OF ALL LINES FIXED AND LIQUID ASSETS",?62,"|"
  • Line Location: SEC5+22
Function Call: WRITE
  • Prompt: ?83,"TOTAL ASSETS",?100,"|",?105,"$",$J(@EAS5@(5),12,2),?131,$C(13)
  • Line Location: SEC5+23
Function Call: WRITE
  • Prompt: !?45,"CATEGORY",?97,"|",?102,"VETERAN",?113,"|",?119,"SPOUSE",?131,$C(13)
  • Line Location: SEC5+25
Function Call: WRITE
  • Prompt: !,"Current income, e.g. gross income (including, but not limited "
  • Line Location: SEC5+27
Function Call: WRITE
  • Prompt: "to, wages and income from",?97,"| $",$J(@EAS5@(6),10,2),?113,"| $",$J(@EAS5@(7),10,2)
  • Line Location: SEC5+28
Function Call: WRITE
  • Prompt: !,"a business, bonuses, tips, severance pay, accrued benefits, "
  • Line Location: SEC5+29
Function Call: WRITE
  • Prompt: "cash gifts)",?97,"|",?113,"|",?131,$C(13)
  • Line Location: SEC5+30
Function Call: WRITE
  • Prompt: !,"Social Security Retirement/Disability",?97,"| $",$J(@EAS5@(8),10,2),?113,"| $",$J(@EAS5@(9),10,2),?131,$C(13)
  • Line Location: SEC5+32
Function Call: WRITE
  • Prompt: !,"Interest/Dividends (i.e., interest income, standard dividend "
  • Line Location: SEC5+34
Function Call: WRITE
  • Prompt: "income from non tax deferred",?97,"| $",$J(@EAS5@(10),10,2),?113,"| $",$J(@EAS5@(11),10,2)
  • Line Location: SEC5+35
Function Call: WRITE
  • Prompt: !,"annuities)",?97,"|",?113,"|",?131,$C(13)
  • Line Location: SEC5+36
Function Call: WRITE
  • Prompt: !,"Retirement and Pension income",?97,"| $",$J(@EAS5@(12),10,2),?113,"| $",$J(@EAS5@(13),10,2),?131,$C(13)
  • Line Location: SEC5+38
Function Call: WRITE
  • Prompt: !,"Civil Service Retirement",?97,"| $",$J(@EAS5@(14),10,2),?113,"| $",$J(@EAS5@(15),10,2),?131,$C(13)
  • Line Location: SEC5+40
Function Call: WRITE
  • Prompt: !,"US Railroad Retirement",?97,"| $",$J(@EAS5@(16),10,2),?113,"| $",$J(@EAS5@(17),10,2),?131,$C(13)
  • Line Location: SEC5+42
Function Call: WRITE
  • Prompt: !,"VA Pension",?97,"| $",$J(@EAS5@(18),10,2),?113,"| $",$J(@EAS5@(19),10,2),?131,$C(13)
  • Line Location: SEC5+44
Function Call: WRITE
  • Prompt: !,"Spouse VA disability/compensation",?97,"| $",$J(@EAS5@(20),10,2),?113,"| $",$J(@EAS5@(21),10,2),?131,$C(13)
  • Line Location: SEC5+46
Function Call: WRITE
  • Prompt: !,"Unemployment Benefits/Compensation",?97,"| $",$J(@EAS5@(22),10,2),?113,"| $",$J(@EAS5@(23),10,2),?131,$C(13)
  • Line Location: SEC5+48
Function Call: WRITE
  • Prompt: !,"Other compensation, e.g. Workers Compensation and Black Lung",?97,"| $",$J(@EAS5@(24),10,2),?113,"| $",$J(@EAS5@(25),10,2),?131,$C(13)
  • Line Location: SEC5+50
Function Call: WRITE
  • Prompt: !,"Military Retirement",?97,"| $",$J(@EAS5@(26),10,2),?113,"| $",$J(@EAS5@(27),10,2),?131,$C(13)
  • Line Location: SEC5+52
Function Call: WRITE
  • Prompt: !,"Other Retirement",?97,"| $",$J(@EAS5@(28),10,2),?113,"| $",$J(@EAS5@(29),10,2),?131,$C(13)
  • Line Location: SEC5+54
Function Call: WRITE
  • Prompt: !,"Court Mandated (e.g. alimony, child support) (Veteran and Spouse)",?97,"| $",$J(@EAS5@(30),10,2),?113,"| $",$J(@EAS5@(31),10,2),?131,$C(13)
  • Line Location: SEC5+56
Function Call: WRITE
  • Prompt: !,"Other Income (i.e., inheritance amounts, tort settlement "
  • Line Location: SEC5+58
Function Call: WRITE
  • Prompt: "payments)",?97,"| $",$J(@EAS5@(32),10,2),?113,"| $",$J(@EAS5@(33),10,2),?131,$C(13)
  • Line Location: SEC5+59
Function Call: WRITE
  • Prompt: !,?82,"| TOTALS",?97,"| $",$J(@EAS5@(34),10,2),?113,"| $",$J(@EAS5@(35),10,2)
  • Line Location: SEC5+60
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