Section 13, Part B - Other Type of Insurance - Detailed Questions
Section 13, Part B collects detailed information on non-health insurance policies other than homeowner's insurance, life insurance, tenant's insurance, or vehicle insurance reported in Part A.
What is the name of the insurance company for "your (1st, 2nd, 3rd)" other type of insurance policy listed? [enter text] ____________________
* Enter name of insurance company, not the insurance agent.
What type of policy is this?
Briefly describe the other type of non-health insurance policy? [enter text] ______________
Briefly describe the other type of non-health insurance policy that you used to have? [enter text] ______________
Briefly describe the other type of non-health policy that you pay for someone outside your CU? [enter text] ______________
Are the policy premiums paid -
Are any premiums paid through payroll deductions?
How often are premiums on this policy paid?
* Specify: [enter text] ___________
Since the first of the reference month, what was your or your CU total expense for this insurance policy? [enter value] ______________
* Enter the actual amount the CU paid. Do not include any expenses paid for the CU by others
How much was paid this month? [enter value] ______________
End of Section 13B Other Type of Insurance
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Last Modified Date: November 29, 2005