File INDIVIDUAL_ANNUAL_INCOME(408.21) Data List
| YEAR |
PATIENT RELATION |
RETIREMENT AND PENSION |
VA PENSION |
SOCIAL SECURITY (NOT SSI) |
U.S. CIVIL SERVICE |
U.S. RAILROAD RETIREMENT |
MILITARY RETIREMENT |
UNEMPLOYMENT COMPENSATION |
OTHER RETIREMENT |
TOTAL INCOME FROM EMPLOYMENT |
INTEREST, DIVIDEND, OR ANNUITY |
WORKERS COMP. OR BLACK LUNG |
ALL OTHER INCOME |
COPIED DATA |
SPOUSE VA DISABILITY/COMP |
COURT MANDATED |
YEARS ESTIMATED TAXABLE INCOME |
ADJUSTED MEDICAL EXPENSES |
FUNERAL AND BURIAL EXPENSES |
EDUCATIONAL EXPENSES |
RENT/MORTGAGE |
UTILITIES |
CAR PAYMENT |
FOOD |
COURT-ORDERED PAYMENTS |
INSURANCE |
TAXES |
TAXES (PROPERTY,PERSONAL) |
GROSS MEDICAL EXPENSES |
ENTERED BY |
ENTERED ON |
LAST EDITED BY |
LAST EDITED ON |
CASH, AMOUNTS IN BANK ACCOUNTS |
STOCKS AND BONDS |
REAL PROPERTY |
OTHER PROPERTY OR ASSETS |
DEBTS |
RESIDENCE |
OTHER RESIDENCES/LAND/FARM |
VEHICLE(S) |
OTHER LIQUID ASSETS |
*ANNUAL MEANS TEST |
TOTAL SPOUSE INCOME |
TOTAL SPOUSE NET WORTH |
TOTAL CHILDREN INCOME |
TOTAL CHILDREN NET WORTH |
TOTAL VETERAN STOCKS, BONDS |