When individuals in Pennsylvania apply for or receive public assistance benefits, the Commonwealth of Pennsylvania's Department of Public Welfare, through its Office of Income Maintenance, plays a crucial role in ensuring that the benefits are accurately distributed. This process involves verifying the financial information of applicants or beneficiaries to maintain integrity and fairness in the distribution of public assistance funds. The Pa 162Vr form serves as a vital communication tool in this verification process. It is sent to those whose social security numbers, including those of household members, have provided financial information that either wasn't reported during the application process or conflicts with previously provided information. This form outlines the sources of the unreported or conflicting financial data, type and amount of income received, payee details, relevant periods, and the frequency of the income received. Recipients of this form are required to provide additional verification to clear up any discrepancies. Verification can vary but must be provided either by mail by a specified deadline or in person, with the form giving clear instructions on how to do so, including a deadline for submission, and where to send or bring the required documentation. Additionally, the form provides contact information for assistance, highlighting the department's commitment to keeping applicants informed and engaged in the maintenance of their eligibility for public assistance benefits. This thorough process ensures that assistance is provided fairly and to those who genuinely qualify, making forms like the Pa 162Vr an essential component of the welfare system in Pennsylvania.
Question | Answer |
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Form Name | Form Pa 162Vr |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | form 162, 162vr, pa 162vr pdf, pa162 vr |
COMMONWEALTHOFPENNSYLVANIA
DEPARTMENTOFPUBLICWELFARE
OFFICE OF INCOME MAINTENANCE
Dear
Because you have applied for/or receive PUBLIC ASSISTANCE benefits, your social security number and the social security numbers of the people in your household have been used to obtain information from other government agencies.
The information we have received follows:
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INCOMETYPE |
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AMOUNT: $ |
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PAIDTO: |
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PERIOD: |
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SOCIALSECURITYNUMBER: |
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PAID BY: |
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FREQUENCY: |
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CONTINUED ON BACK |
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This information was not reported when you applied for public assistance or it conflicts with information you gave to your eligibility worker. In order for us to determine if this information is correct and/or affects your public assistance benefits, you must provide additional verification. Verification which may be acceptable includes
Be sure to put your name, address and record number on the information you provide.
Please mail this information by |
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to the office shown above. |
Attention
Please bring this information to the COUNTYASSISTANCE OFFICE at the above address on
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This information is required |
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determine |
your continued eligibility for benefits. If |
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you have any questions concerning |
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request, |
or need |
help to get verification, please call your |
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eligibility worker immediately at |
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. Thank you. |
Worker’s Signature |
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RECORD NO. |
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DIST
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CLIENT |
CASE RECORD |
PA162VR - 12/07 |
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AMOUNT: $ |
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PAIDTO: |
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PERIOD: |
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SOCIALSECURITYNUMBER: |
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PAID BY: |
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FREQUENCY: |
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INCOMETYPE |
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AMOUNT: $ |
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PAIDTO: |
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PERIOD: |
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SOCIALSECURITYNUMBER: |
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PAID BY: |
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AMOUNT: $ |
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PAIDTO: |
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PERIOD: |
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SOCIALSECURITYNUMBER: |
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AMOUNT: $ |
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SOCIALSECURITYNUMBER: |
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AMOUNT: $ |
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PERIOD: |
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SOCIALSECURITYNUMBER: |
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PAID BY: |
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FREQUENCY: |
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COMMENTS: |
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