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.