* = Required Field
What source(s) of income has/have been received in the household?
This would include everyone in the household, including those 17 and under. Check all that applies below.
If your entire household has received no income/monies of any kind for the months of October 2021, November 2021, or December 2021, then check the box below. Otherwise enter all income received for these months in the table below.
|Type Of Income||October 2021||November 2021||December 2021|
|Earned income (gross)|
(not taxed at the time received)
(taxed at the time received)
|Child support (received)|
|Child support (paid out)|
(taxed at the time rec'd)
(not taxed at the time rec'd)
If you continue beyond this point you authorize Lower Columbia CAP staff to verify income for all household members.