| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | year(+) | 0;1 | DATE-TIME | B | Enter in this field the year the income information is being collected for. | |
| .02 | patient relation(+) | 0;2 | POINTER | 408.12 | C | Enter in this field the patient or relation whose annual income information is being collected. |
| .06 | retirement and pension | 0;6 | NUMERIC | Enter in this field the annual amount of Retirement and Pension received during the current calendar year. A monthly amount can be entered with an '*' after it. | ||
| .07 | va pension | 0;7 | NUMERIC | Enter in this field the annual amount of VA Pension received during the current calendar year. A monthly amount can be entered with an '*' after it. | ||
| .08 | social security (not ssi) | 0;8 | NUMERIC | |||
| .09 | u.s. civil service | 0;9 | NUMERIC | Enter in this field the annual amount of U.S. Civil Service received during the previous calendar year. A monthly amount can be entered with an '*' after it. | ||
| .1 | u.s. railroad retirement | 0;10 | NUMERIC | Enter in this field the annual amount of U.S. Railroad Retirement received during the previous calendar year. A monthly amount can be entered with an '*' after it. | ||
| .11 | military retirement | 0;11 | NUMERIC | Enter in this field the annual amount of Military Retirement received during the previous calendar year. A monthly amount can be entered with an '*' after it. | ||
| .12 | unemployment compensation | 0;12 | NUMERIC | Enter in this field the annual amount of Unemployment Compensation received during the previous calendar year. A monthly amount can be entered with an '*' after it. | ||
| .13 | other retirement | 0;13 | NUMERIC | Enter in this field the annual amount of Other Retirement received during the previous calendar year. This includes company, state, local, etc. A monthly amount can be entered with an '*' after it. | ||
| .14 | total income from employment | 0;14 | NUMERIC | |||
| .15 | interest, dividend, or annuity | 0;15 | NUMERIC | Enter in this field the annual amount of Interest, Dividend, or Annuity Income received during the previous calendar year. A monthly amount can be entered with an '*' after it. | ||
| .16 | workers comp. or black lung | 0;16 | NUMERIC | Enter in this field the annual amount of Workers Compensation or Black Lung Benefits received during the previous calendar year. A monthly amount can be entered with an '*' after it. | ||
| .17 | all other income | 0;17 | NUMERIC | Enter in this field the annual amount of all other income received during the previous calendar year. A monthly amount can be entered with an '*' after it. | ||
| .18 | copied data | 0;18 | BOOLEAN | 1:YES 0:NO | This field is used to track the use of the Income Screen COPY function. NULL = COPY function has never been used on this record YES = COPY function has been used and no editing has been done NO = COPY function has been used but record was selected for editing | |
| .19 | spouse va disability/comp | 0;19 | NUMERIC | Enter in this field the annual amount for Spouse VA Disability and Compensation received during the current calendar year. A monthly amount can be entered with an '*' after it. | ||
| .2 | court mandated | 0;20 | NUMERIC | Enter in this field the annual amount of Court Mandated income (such as alimony or child support) received during the current calendar year. A monthly amount can be entered with an '*' after it. | ||
| .21 | years estimated taxable income | 0;21 | NUMERIC | Last Year's Estimated "Household" Taxable Income which will be used to make preliminary prima facie financial eligibility determinations. | ||
| 1.01 | adjusted medical expenses | 1;1 | NUMERIC | Enter in this field the total amount of unreimbursed medical expenses paid by the veteran during the previous calendar year. The expenses can be for the veteran or for members of the veteran's family. Reportable medical expenses include amounts paid for the following: fees of physicians, dentists, and other providers of health services; hospital and nursing home fees; medical insurance premiums (including the Medicare premium); drugs and medicines; eyeglasses; any other expenses that are reasonable related to medical care. The expenses must actually have been paid by the veteran. Do not list expenses which have not been paid or which have been paid by someone other than the veteran. Do not list expenses which the veteran has paid if the veteran expects to receive reimbursement from insurance or some other source. | ||
| 1.02 | funeral and burial expenses | 1;2 | NUMERIC | |||
| 1.03 | educational expenses | 1;3 | NUMERIC | Enter amounts paid by the veteran during the previous calendar year for educational expenses. | ||
| 1.04 | rent/mortgage | 1;4 | NUMERIC | Enter in this field the annual amount paid for Rent or Mortgage during the current calendar year. A monthly amount can be entered with an '*' after it. | ||
| 1.05 | utilities | 1;5 | NUMERIC | Enter in this field the annual amount paid for Utilities during the current calendar year. A monthly amount can be entered with an '*' after it. | ||
| 1.06 | car payment | 1;6 | NUMERIC | Enter in this field the annual amount paid for Car Payments during the current calendar year. This amount excludes gas, insurance, and parking fees. A monthly amount can be entered with an '*' after it. | ||
| 1.07 | food | 1;7 | NUMERIC | Enter in this field the annual amount paid for Food during the current calendar year. A monthly amount can be entered with an '*' after it. | ||
| 1.08 | court-ordered payments | 1;8 | NUMERIC | Enter in this field the annual amount paid for Court-Ordered Payments during this current calendar year. A monthly amount can be entered with an '*' after it. | ||
| 1.09 | insurance | 1;9 | NUMERIC | Enter in this field the annual amount paid for Insurance during the current calendar year. This amount should exclude life insurance. A monthly amount can be entered with an '*' after it. | ||
| 1.1 | taxes | 1;10 | NUMERIC | Enter in this field the annual amount paid for Taxes during the current calendar year. This includes income tax, property and personal tax. A monthly amount can be entered with an '*' after it. | ||
| 1.11 | taxes (property,personal) | 1;11 | NUMERIC | Enter in this field the total amount of Taxes (personal, property) paid during the current calendar year. A monthly amount can be entered with an '*' after it. | ||
| 1.12 | gross medical expenses | 1;12 | NUMERIC | |||
| 2.01 | cash, amounts in bank accounts | 2;1 | NUMERIC | |||
| 2.02 | stocks and bonds | 2;2 | NUMERIC | Enter in this field stocks, bonds, and similar assets. The reportable value of the stock or bond is the amount of money that the asset would bring if it were cashed out today. | ||
| 2.03 | real property | 2;3 | NUMERIC | |||
| 2.04 | other property or assets | 2;4 | NUMERIC | |||
| 2.05 | debts | 2;5 | NUMERIC | Enter in this field debts that will reduce the value of the property listed in 'OTHER PROPERTY OR ASSETS'. It cannot exceed the 'OTHER PROPERTY OR ASSETS'. DO NOT ENTER ANY CREDIT CARD DEBTS. | ||
| 2.06 | residence | 2;6 | NUMERIC | Enter in this field the current market value, minus any outstanding mortgage or lien, of the veteran's primary residence. Do not enter an amount in this field if the veteran is receiving only non-institutional services, or there is a spouse or dependent residing in the community. | ||
| 2.07 | other residences/land/farm | 2;7 | NUMERIC | Enter in this field the current market value, minus any outstanding mortgages or liens, of the veteran's other residence(s), land, farm or ranch. Exclude the value of burial plots. | ||
| 2.08 | vehicle(s) | 2;8 | NUMERIC | Enter in this field the current value, minus any outstanding liens, of any vehicle(s) owned by the veteran. Exclude the value of one vehicle if the veteran is receiving only non-institutional care, or there is a spouse or dependent residing in the community. | ||
| 2.09 | other liquid assets | 2;9 | NUMERIC | Enter in this field the current value of such items as stamp or coin collections, art work, and collectibles minus any amount owed. Exclude from this amount the value of household furniture and other household goods, clothing, jewelry, and personal items if the veteran is receiving only non-institutional care, or there is a spouse or dependent residing in the community. | ||
| 31 | *annual means test | MT;1 | POINTER | 408.31 | AM | This field is filled in by the system. It contains the financial test associated with this individual annual income. It is not required; since all income records will not necessarily be associated with a financial test. |
| 91 | total spouse income | TOT;1 | NUMERIC | This field contains the total income for a spouse prior to moving to the new income structure in MAS v5.2. | ||
| 92 | total spouse net worth | TOT;2 | NUMERIC | This field contains the total net worth for a spouse prior to moving to the new income structure in MAS v5.2. | ||
| 93 | total children income | TOT;3 | NUMERIC | This field contains the total income for children prior to moving to the new income structure in MAS v5.2. | ||
| 94 | total children net worth | TOT;4 | NUMERIC | This field contains the total net worth for children prior to moving to the new income structure in MAS v5.2. With the new version net worth will no longer be collected for children. | ||
| 95 | total veteran stocks, bonds | TOT;5 | NUMERIC | This field contains the veteran's stocks and bonds prior to moving to the new income structure in MAS v5.2. With the new version cash has been combined with the stocks and bonds. | ||
| 101 | entered by(+) | USR;1 | POINTER | 200 | This field contains the user who entered the income information. | |
| 102 | entered on(+) | USR;2 | DATE-TIME | This field contains the date/time the income information was entered. | ||
| 103 | last edited by(+) | USR;3 | POINTER | 200 | This field contains the last user to edit the income information. | |
| 104 | last edited on(+) | USR;4 | DATE-TIME | This field contains the last date/time the income information was edited. |