Instructions: Check this box to indicate if anyone in the household has any sort of income.

Instructions: Enter the household member’s employer name. You can enter more than one employer for any household member. Entering multiple employers will cause a scrollbar to appear in that field.
To add a new employer, press the INSERT key while the cursor is placed in the employer field.

To delete an employer that was entered by mistake, left click or tab into the employer field, select “action” from the menu bar and then select “delete row”.

Do not delete or type over previous employers (they are needed for case history). Always enter a new line for a new employer.

Instructions: Enter the address that corresponds with the given employer.

Instructions: Enter the phone number that corresponds with the given employer.

Instructions: Enter the gross monthly income of the household member for this employer. This is the client reported amount. This field is not input to PS2.

Instructions: Indicate whether or not this employed household member receives tips. In some situations tips may be included in the earned income. Some common types of employment where tips are generally received are:

• Regular employment: waiter/waitress, bartender, hostess, car hop, cosmetologist, nail tech, hotel courtesy clerk, massage therapist, valet, cab driver, shuttle driver, bingo caller or runner, delivery person, etc..
• Seasonal (these employees often get tips around Christmas): tutor, instructor, mail carrier, gardener, lawn service, teacher, and housekeeper.

Instructions: Indicate the declared amount of tips received in the month.

Instructions: Enter the date the employment began. Don’t assume employment didn’t overlap. Ask the client

Instructions: Enter the date this employment ended. This should be the last day the client worked or the last day they were employed, whichever is later.

Instructions: Indicate the household member’s declared self-employment gross income for the previous year. This is the client reported amount. This field is not input to PS2.

Instructions: Indicate the household member’s declared self-employment business expenses for the previous year. This is the client reported amount. This field is not input to PS2.

Instructions: Indicate the source of the terminated income.

Instructions: Indicate the household member’s final pay amount. This is the client reported amount. This field is not input to PS2.

Instructions: Indicate the date the household member received their final payment from the terminated income source.

Instructions: Enter the reported amount of RSDI benefits. This is the client reported amount and is not saved as countable income to PS2. This field is the information that will print on the FSS-1.

Instructions: Enter the reported amount of SSI benefits. This is the client reported amount and is not saved as countable income to PS2. This field is the information that will print on the FSS-1.

Instructions: Enter the reported amount of Veteran’s benefits. This is the client reported amount is not saved as countable income to PS2. This field is the information that will print on the FSS-1.

Instructions: Enter the reported amount of child support. This is the client reported amount and is not saved as countable income to PS2. This field is the information that will print on the FSS-1.

Instructions: Enter the declared amount of any other type of unearned income. This is the client reported amount and is not saved as countable income to PS2.

This field is the information that will print on the FSS-1. Use the Other 2 block if the client has 2 types of other unearned income.

If the client has three or more types of other unearned income, add them together until you are down to 2 entries. Use the indicator that is most appropriate for the largest type of income and document your actions in case actions.

Instructions: Enter the reported amount of Tribal TANF. This is the client reported amount and is not saved as countable income to PS2. This field is the information that will print on the FSS-1.

Instructions: The default frequency for RSDI payments is monthly. You cannot change this frequency. The system will ignore all frequencies except monthly.

Instructions: The default frequency for SSI payments is monthly. You cannot change this frequency. The system will ignore all frequencies except monthly.

Instructions: Select the frequency for payment of Veteran’s benefits. If the client receives their benefits more often than once a month it may be helpful to make dates of receipt on a calendar to determine how frequently they get the benefit.

Instructions: Enter the frequency of child support payments received for this child. If the client gets their child support in several payments per month it may be helpful to mark the dates on a calendar to determine the frequency.

Instructions: Enter the frequency of the Other income. If the client gets other income in several payments per month it may be helpful to mark the dates on a calendar to determine the frequency.

Instructions: Enter the frequency of Tribal TANF for this client.

Instructions: Select the appropriate box to indicate if RSDI has only been applied for or if it is already being received.

Instructions: Select the appropriate box to indicate if SSI has only been applied for or if it is already received.

Instructions: Select the appropriate box to indicate if Veteran’s benefits have only been applied for or if they are already being received.

Instructions: Select the appropriate box to indicate if child support has only been applied for or if it is already being received.

Instructions: Select the appropriate to indicate if other unearned income has only been applied for or if it is already being received

Instructions: Select the appropriate box to indicate if Tribal TANF has only been applied for or if it is already being received.