522 Mine Union Benefits All Programs
523 Other Union Benefits All Programs
524 Private Pensions All Programs
525 Hospital/Health Insurance All Programs
526 Other Insurance All Programs Specify under REMARKS.
531 Total declared income used by Healthy Start MPE provider. MPE Informational only. Not passed.
533 Net Unearned Income from Roomers and Boarders text revisedAABD For SNAP, use Item 90 code 534.
534 Net Income from Real Property All Programs
535 Other Cash Income - trust funds, annuities, etc. All Programs Specify under REMARKS.
538 Gross Income of a Person Included in the MANG Income Standard but Not in the Case All Medical Programs

Does not require an RIN.

Enter one of the following codes in the NO. column.

  • E - If income is earned, or
  • U - if income is from unemployment benefits

If the income is from a source other than earnings or unemployment, do not enter a code. If the person has earned income and unemployment, enter code E.

555 Income Diverted from Another Person in the Home All Programs Except SNAP
603 Budgetable Unearned Income of an Excluded Responsible Relative TANF Cash and All Kids (except S/P/R)