27-91-01-b: AABD, QMB Only, SLIB Only, and QI-1 Only

For 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.