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CURRENT BENEFITS Complete below if applicable If any member of your household receives Food Assistance Program FAP Family Independence Program FIP or FDPIR provide the name and case number for the person who receives benefits. Monthly Payments from Pensions Retirement Social Security 4. Monthly Dividends or Interest on Savings 5. Gross Monthly Earnings Wages Salary Commissions None 2. Monthly Welfare Payments Child Support Alimony 3. IF ANY MEMBER OF YOUR HOUSEHOLD RECEIVES BENEFITS FROM...
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