Applicant Personal Information
Suffix
Jr.
Sr.
I
II
III
IV
V
State*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Time at Current Residence
Years
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Months
0
1
2
3
4
5
6
7
8
9
10
11
Residence Type
Own home w/ mortgage
Own home w/o mortgage
Rent
Live with relative
Other
Applicant Employment Information
Income Interval
Weekly
Bi-Weekly
Monthly
Employment Status
Contract
Full Time
N/A
Part Time
Retired
Seasonal
Self-Employed
Temporary
Employment Type
Auto Worker
Clerical
Craftman
Executive / Municipal
Farmer
Fisherman
Government
Homemaker
Other
Professional
Sales/Advertisement
Semi-Skilled Labor
Skilled Labor
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Years
0
1
2
3
4
5
6
7
8
9
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Applicant Additional Income Information
Income interval
Weekly
Bi-Weekly
Monthly
Applicant Personal Friend Information
Suffix
Jr.
Sr.
I
II
III
IV
V
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Applicant Relative Personal Information
Suffix
Jr.
Sr.
I
II
III
IV
V
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Applicant Military Information
Branch
Army
Air Force
Navy
Coast Guard
Marines
Paygrade
E-1
E-2
E-3
E-4
E-5
E-6
E-7
E-8
E-9
O-1
O-2
O-3
O-4
O-5
O-6
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Applicant Survey
Applicant Personal Information
Suffix
Jr.
Sr.
I
II
III
IV
V
State*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Time at Current Residence
Years
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Months
0
1
2
3
4
5
6
7
8
9
10
11
Residence Type
Own home w/ mortgage
Own home w/o mortgage
Rent
Live with relative
Other
Applicant Employment Information
Income Interval
Weekly
Bi-Weekly
Monthly
Employment Status
Contract
Full Time
N/A
Part Time
Retired
Seasonal
Self-Employed
Temporary
Employment Type
Auto Worker
Clerical
Craftman
Executive / Municipal
Farmer
Fisherman
Government
Homemaker
Other
Professional
Sales/Advertisement
Semi-Skilled Labor
Skilled Labor
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Years
0
1
2
3
4
5
6
7
8
9
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Applicant Additional Income Information
Income interval
Weekly
Bi-Weekly
Monthly
Applicant Personal Friend Information
Suffix
Jr.
Sr.
I
II
III
IV
V
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Applicant Relative Personal Information
Suffix
Jr.
Sr.
I
II
III
IV
V
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Applicant Military Information
Branch
Army
Air Force
Navy
Coast Guard
Marines
Paygrade
E-1
E-2
E-3
E-4
E-5
E-6
E-7
E-8
E-9
O-1
O-2
O-3
O-4
O-5
O-6
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Applicant Survey