The Benefit Bank: QuickCheck

Welcome to QuickCheck!

QuickCheck is a screening tool of The Benefit Bank that estimates eligibility for benefits. You will be asked a few questions about yourself and your household. Based on your answers, you will see a results page with program information and a rough estimate of your household's eligibility for various benefits, as well as tax credits. Keep in mind that the result is an estimate, not an actual eligibility decision.

We encourage you to apply using The Benefit Bank to receive a complete assessment, regardless of your QuickCheck result.

Let's get started with some basic information about your household.

* Which state do you live in?

* Which county do you live in?

You

We need some basic information about each person in your household.

The first person we need to know about is you.

* First name

* Last name

* Age

* Do you plan to file a YEAR tax return? Yes No

* Will you be claimed as a dependent on someone else's YEAR tax return? Yes No

Why are you asking me tax questions?

* How many other people are in your household?

How many people do not live in your household but are claimed as dependents on your tax return?

Medical Details

Does anyone have a physical, mental, or emotional condition that causes limitations in activities (such as dressing, bathing, or other daily activities?) Yes No

Is anyone pregnant? Yes No

Household Expenses

Monthly shelter costs

Rent

$

Or

Mortgage

$

Utilities

$

Does someone in your household own the home you live in? Yes No

Does your household pay for telephone? Yes No

Does your household pay for the heating and cooling costs of your residence? Yes No

Does your household receive HEAP? Yes No

Household Members

Tell us about each person in your household.

Add another household member

Individual Income

For the sections below, please tell us monthly amounts. If your income and expenses change each month, enter monthly averages.

Individual Expenses

Additional Relationships

PERSON_00

Check the box next to anyone who is also a parent of CHILD:

Check the box next to anyone who is the spouse of PERSON_00:

Individual Details

For each person listed below, check all that apply. Each check box below is an additional way to qualify for a benefit or tax credit.

Welcome to QuickCheck!

You

Medical Details

Household Expenses

Monthly shelter costs

Household Members

Individual Income

PERSON_00

Individual Expenses

PERSON_00

Additional Relationships

PERSON_00

Individual Details

PERSON_00

Program Eligibility Summary