The Missouri Questions and Affidavit Regarding Benefit Sources and Payments — Affidavit Form A is a document used by the Missouri Family Support Division (FSD) to determine the sources of income and the amount of money available to a family. This form is used as part of the process to establish eligibility for public assistance benefits in Missouri. The form includes questions about the amount of money received from sources such as Social Security, Supplemental Security Income (SSI), Pension, and other sources of income. It also includes questions about how the money is used and whether it is being used for basic needs such as food, rent, and medical expenses. The Affidavit Form A also includes a Sworn Statement that must be completed and signed by the applicant to verify their statements. There are three types of Missouri Questions and Affidavit Regarding Benefit Sources and Payments — Affidavit Form A available: Affidavit Form A for Families, Affidavit Form A for Households, and Affidavit Form A for Individuals.
Missouri Questions and Affidavit Regarding Benefit Sources and Payments - Affidavit Form A
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How to fill out Missouri Questions And Affidavit Regarding Benefit Sources And Payments - Affidavit Form A?
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FAQ
The Second Injury Fund compensates injured employees when a current work-related injury combines with a prior disability to create an increased combined disability. The Second Injury Fund is funded by a surcharge paid by employers.
Administrative Surcharge (authorized under Sec. 287.716) - 1.5 percent.
The application may be filed in person at the Division of Workers' Compensation's Jefferson City Office at 421 E Dunklin, or by mail: Tort Victims' Compensation Program, P.O. Box 58, Jefferson City, MO 65102. The eligible person filing a claim or application is called a claimant.
Generally your compensation rate will be equal to 2/3 of your average weekly wage at the time of the injury not to exceed a maximum rate which is presently 55% of the state average weekly wage (?SAWW?).
A claim against the second injury fund shall be filed within two years after the date of the injury or within one year after a claim is filed against an employer or insurer pursuant to this chapter, whichever is later.
The Tort Victims' Compensation Fund exists to help compensate those who have been injured due to the negligence or recklessness of another (such as in a motor vehicle collision or a hunting accident), and who have been unable to obtain full compensation because the party at fault (the tortfeasor) had no insurance, or
What Does the Second Injury Fund Do? The workers' comp Second Injury Fund assumes liability for compensation benefits attributable to prior injuries or illnesses. This happens when a worker subsequently becomes totally disabled because of a workplace injury.
