For AABD, QMB Only, SLIB Only, and QI-1 Only (Categories 01, 02, 03, 91, 92, and 93) cases and for P3-MA cases, enter the code and amount of assets owned by the client.
| ITEM 91 CODE |
Description |
| 701 |
Cash or Bank Account
Includes NH Personal Account |
| 702 |
Vehicles
Total equity value of all vehicles |
| 703 |
Investment
Total value of certificates of deposit, money market funds, mutual funds, IRA/Keough accounts, deferred compensation plans, pension/retirement funds, stocks, bonds, and  annuities counted as resources. |
| 704 |
Countable Asset Cash Value of Life Insurance
Total countable cash value of life insurance policies, except those that fund prepaid burial contracts. |
| 705 |
Non-homestead Property
Total equity value |
| 706 |
Burial Funds
Including those funded by life insurance (total value, including amount for burial space) |
| 707 |
Other
Total value of household goods/personal effects, safe deposit box contents, trust funds, fund-raisers, oil/coal/gas/mineral rights, non-EIC tax refund, and others to be specified in REMARKS |
| 709 |
Assets Protected Under an LTC Partnership Policy |
| 712 |
Earned Income Exemption |
| 715 |
Intended Amount to Transfer
Amount of resources the client intends to transfer to a community spouse. If zero, enter 0.00. |
| 716 |
Actual Amount of Transfer
Actual amount of resources the client transferred to a community spouse. If zero, enter 0.00. |
| 725 |
Life Insurance Face Value
Total face value of all insurance policies, except those that fund prepaid burial contracts. |
| 726 |
Countable Asset Amount of Burial Funds
Nonexempt part of burial funds. (Excludes P3-MA cases). |
| 730 |
Retirement Accounts
Protected under HBWD policy.
|
| 731 |
Medical Savings Accounts
Protected under HBWD policy.
|
| 732 |
Resources
Protected under HBWD policy.
|
