Section 13, Part B - Other Type of Insurance - Detailed Questions

Section 13, Part B collects detailed information on non-health insurance policies other than long term insurance, homeowner's insurance, life insurance, tenant's insurance, or vehicle insurance reported in Part A.1.

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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.

Briefly describe the other type of non-health insurance policy? [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 21, 2006