Income Type Frequency of Payment Amount #1 Amount #2 Amount #3 Amount #4 Total Average Annual Total
Income Source #1 - Gross Earnings $0.00 $0.00
Income Source #2 - Gross Earnings $0.00 $0.00
Income Source #3 - Gross Earnings $0.00 $0.00
TANF / AFDC $0.00 $0.00
Child Support $0.00 $0.00
Unemployment $0.00 $0.00
SSI / SSDI $0.00 $0.00
Pension $0.00 $0.00
Worker's Comp $0.00 $0.00
WIC Benefits $0.00 $0.00
SNAP / Food Stamps $0.00 $0.00
Non-Cash Benefits $0.00 $0.00
Other $0.00 $0.00
Yearly Gross Income $0.00
Monthly Average Income $0.00