man changeFor AABD, QMB Only, SLIB Only, and QI-1 Only (Categories 01, 02, 03, 91, 92, and 93) cases, enter the code and amount of assets owned by the customer.

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 customer intends to transfer to a community spouse. If zero, enter 0.00.
716 Actual Amount of Transfer
Actual amount of resources the customer 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.
730

Retirement Accounts

Protected under HBWD policy.

731

Medical Savings Accounts

Protected under HBWD policy.

732

Resources

Protected under HBWD policy.