Pennsylvania residents who are age 62 or older may soon be required to file a new form with the state, Form Pa 162Vr. This form will be used to track individuals' income and estate information, and it is expected that the information collected on this form will help the state better assess and levy taxes on residents' estates. The deadline for filing this form is December 31st of each year. Residents who do not file this form by the deadline may face penalties. More information about Form Pa 162Vr can be found on the Pennsylvania Department of Revenue's website.
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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we can |
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
CS LD
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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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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AMOUNT: $ |
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PERIOD: |
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SOCIALSECURITYNUMBER: |
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AMOUNT: $ |
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SOCIALSECURITYNUMBER: |
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PAID BY: |
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AMOUNT: $ |
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PAID BY: |
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FREQUENCY: |
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COMMENTS: |
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