Form MC604 IPS ARM "Additional Income and Property Information Needed for Medi-Cal" - California (Armenian)

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This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California.

The document is provided in Armenian. As of today, no separate filing guidelines for the form are provided by the issuing department.

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  • Released on May 1, 2014;
  • The latest edition provided by the California Department of Health Care Services;
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State of California Health and Human Services Agency
Department of Health Care Services
§MEDI-CAL¦-ÆÜ ²ÜÐð²ÄºÞî Èð²òàôòÆâ îºÔºÎàôÂÚàôÜܺð
ºÎ²ØàôîÆ ºì êºö²Î²ÜàôÂÚ²Ü Ø²êÆÜ
Ø»Ýù ¹»é ·Ý³Ñ³ïáõÙ »Ýù §Medi-Cal¦-Ç Ò»ñ Çñ³í³ëáõÃÛáõÝÁ, ¨ Ù»½ Éñ³óáõóÇã ï»Õ»ÏáõÃÛáõÝÝ»ñ »Ý ³ÝÑñ³Å»ßï:
ÊݹñáõÙ »Ýù å³ï³ëË³Ý»É ëïáñ¨ ïñí³Í ѳñó»ñÇÝ` Ò»ñ ÁÝï³ÝÇùÇ ³Ý¹³Ù ѳݹÇë³óáÕ Ûáõñ³ù³ÝãÛáõñ ³ÝÓÇ
Ù³ëÇÝ: ¸³ Ý»ñ³éáõÙ ¿ Ò»½, Ò»ñ ÏÝáçÁ ϳ٠³ÙáõëÝáõÝ ¨ Ò»½ Ñ»ï µÝ³ÏíáÕ ÙÇÝ㨠21 ï³ñ»Ï³Ý »ñ»Ë³Ý»ñÇÝ Ï³Ù
ÁÝï³ÝÇùÇ áñ¨¿ ³ÛÉ ³Ý¹³ÙÇ, áñÁ ųٳݳϳíáñ³å»ë Ò»ñ ï³ÝÁ ãÇ µÝ³ÏíáõÙ, ûñÇݳÏ` ¹åñáóáõÙ ¿, ³ß˳ï³ÝùÇ
µ»ñáõÙáí µ³ó³Ï³ÛáõÙ ¿ ϳ٠ÑÇí³Ý¹³ÝáóáõÙ ¿ ·ïÝíáõÙ:
¶áñÍÇ ³ÝáõÝÁ`
¶áñÍÇ Ñ³Ù³ñÁ`
²ß˳ïáÕÇ ³ÝáõÝÁ`
²ß˳ïáÕÇ Ñ»é³ËáëÇ Ñ³Ù³ñÁ`
àõÕ³ñÏ»Éáõ ³Ùë³ÃÇíÁ`
ì»ñ³¹³ñÓñ»ù ³Ûë ûñÃÇÏÁ ÙÇÝã¨`
ÀÝï³ÝÇùÇ Ù³ëÇÝ å³Ñ³ÝçíáÕ Éñ³óáõóÇã ï»Õ»ÏáõÃÛáõÝÝ»ñ
лï¨Û³É Éñ³óáõóÇã ï»Õ»ÏáõÃÛáõÝÝ»ñÝ ³ÝÑñ³Å»ßï »Ý: ä³ï³ë˳ݻù ÙdzÛÝ ³ÛÝ ¹»åùáõÙ, »Ã» ³Ûë ¿çáõÙ Ýßí³Í
ѳñó»ñÁ í»ñ³µ»ñáõÙ »Ý Ò»½ ϳ٠һñ ÁÝï³ÝÇùÇ áñ¨¿ ³Ý¹³ÙÇ:
ÊݹñáõÙ »Ýù Ýß³Ý ¹Ý»É ³Ûëï»Õ, »Ã» ¸áõù ϳ٠һñ ÁÝï³ÝÇùÇ áñ¨¿ ³Ý¹³Ù å³ßïáݳå»ë ³Ùáõëݳó³Í ¿, µ³Ûó
Ý»ñϳÛáõÙë ÏÝáçÇó ϳ٠³ÙáõëÝáõó ³é³ÝÓÇÝ ¿ ³åñáõÙ:
ºÃ» Ýß³Ý »ù ¹ñ»É í³Ý¹³ÏáõÙ, ËݹñáõÙ »Ýù Ýß»É Ò»ñ ÁÝï³ÝÇùÇ ³ÛÝ ³Ý¹³ÙÇ ³ÝáõÝÁ, áñÝ Çñ ÏÝáçÇó ϳÙ
³ÙáõëÝáõó ³é³ÝÓÇÝ ¿ ³åñáõÙ:
ÊݹñáõÙ »Ýù Ýß³Ý ¹Ý»É ³Ûëï»Õ, »Ã» ¸áõù ϳ٠һñ ÁÝï³ÝÇùÇ áñ¨¿ ³Ý¹³Ù Ëáñà ÍÝáÕ ¿:
ºÃ» Ýß³Ý »ù ¹ñ»É ³Ûë í³Ý¹³ÏáõÙ, ËݹáõÙ »Ýù Ýß»É`
Ëáñà ÍÝáÕÇ ³ÝáõÝÁ`
³Û¹ Ëáñà ÍÝáÕÇ »ñ»Ë³Ý»ñÇÝ`
ÊݹñáõÙ »Ýù Ýß³Ý ¹Ý»É ³Ûëï»Õ, »Ã» Ò»ñ ÁÝï³ÝÇùÇ áñ¨¿ ³Ý¹³Ù »ñ»Ë³ ¿, áñÇÝ ËݳÙáõÙ ¿ á°ã û ÍÝáÕÁ, ³ÛÉ Ò»ñ
ï³ÝÁ µÝ³ÏíáÕ áñ¨¿ ³½·³Ï³Ý:
ºÃ» Ýß³Ý »ù ¹ñ»É ³Ûë í³Ý¹³ÏáõÙ, ËݹáõÙ »Ýù Ýß»É`
ËݳÙáÕ ³½·³Ï³ÝÇ ³ÝáõÝÁ`
ËݳÙíáÕ »ñ»Ë³Ý»ñÁ`
Page 1 of 7
MC 604 IPS ARM (5/14)
State of California Health and Human Services Agency
Department of Health Care Services
§MEDI-CAL¦-ÆÜ ²ÜÐð²ÄºÞî Èð²òàôòÆâ îºÔºÎàôÂÚàôÜܺð
ºÎ²ØàôîÆ ºì êºö²Î²ÜàôÂÚ²Ü Ø²êÆÜ
Ø»Ýù ¹»é ·Ý³Ñ³ïáõÙ »Ýù §Medi-Cal¦-Ç Ò»ñ Çñ³í³ëáõÃÛáõÝÁ, ¨ Ù»½ Éñ³óáõóÇã ï»Õ»ÏáõÃÛáõÝÝ»ñ »Ý ³ÝÑñ³Å»ßï:
ÊݹñáõÙ »Ýù å³ï³ëË³Ý»É ëïáñ¨ ïñí³Í ѳñó»ñÇÝ` Ò»ñ ÁÝï³ÝÇùÇ ³Ý¹³Ù ѳݹÇë³óáÕ Ûáõñ³ù³ÝãÛáõñ ³ÝÓÇ
Ù³ëÇÝ: ¸³ Ý»ñ³éáõÙ ¿ Ò»½, Ò»ñ ÏÝáçÁ ϳ٠³ÙáõëÝáõÝ ¨ Ò»½ Ñ»ï µÝ³ÏíáÕ ÙÇÝ㨠21 ï³ñ»Ï³Ý »ñ»Ë³Ý»ñÇÝ Ï³Ù
ÁÝï³ÝÇùÇ áñ¨¿ ³ÛÉ ³Ý¹³ÙÇ, áñÁ ųٳݳϳíáñ³å»ë Ò»ñ ï³ÝÁ ãÇ µÝ³ÏíáõÙ, ûñÇݳÏ` ¹åñáóáõÙ ¿, ³ß˳ï³ÝùÇ
µ»ñáõÙáí µ³ó³Ï³ÛáõÙ ¿ ϳ٠ÑÇí³Ý¹³ÝáóáõÙ ¿ ·ïÝíáõÙ:
¶áñÍÇ ³ÝáõÝÁ`
¶áñÍÇ Ñ³Ù³ñÁ`
²ß˳ïáÕÇ ³ÝáõÝÁ`
²ß˳ïáÕÇ Ñ»é³ËáëÇ Ñ³Ù³ñÁ`
àõÕ³ñÏ»Éáõ ³Ùë³ÃÇíÁ`
ì»ñ³¹³ñÓñ»ù ³Ûë ûñÃÇÏÁ ÙÇÝã¨`
ÀÝï³ÝÇùÇ Ù³ëÇÝ å³Ñ³ÝçíáÕ Éñ³óáõóÇã ï»Õ»ÏáõÃÛáõÝÝ»ñ
лï¨Û³É Éñ³óáõóÇã ï»Õ»ÏáõÃÛáõÝÝ»ñÝ ³ÝÑñ³Å»ßï »Ý: ä³ï³ë˳ݻù ÙdzÛÝ ³ÛÝ ¹»åùáõÙ, »Ã» ³Ûë ¿çáõÙ Ýßí³Í
ѳñó»ñÁ í»ñ³µ»ñáõÙ »Ý Ò»½ ϳ٠һñ ÁÝï³ÝÇùÇ áñ¨¿ ³Ý¹³ÙÇ:
ÊݹñáõÙ »Ýù Ýß³Ý ¹Ý»É ³Ûëï»Õ, »Ã» ¸áõù ϳ٠һñ ÁÝï³ÝÇùÇ áñ¨¿ ³Ý¹³Ù å³ßïáݳå»ë ³Ùáõëݳó³Í ¿, µ³Ûó
Ý»ñϳÛáõÙë ÏÝáçÇó ϳ٠³ÙáõëÝáõó ³é³ÝÓÇÝ ¿ ³åñáõÙ:
ºÃ» Ýß³Ý »ù ¹ñ»É í³Ý¹³ÏáõÙ, ËݹñáõÙ »Ýù Ýß»É Ò»ñ ÁÝï³ÝÇùÇ ³ÛÝ ³Ý¹³ÙÇ ³ÝáõÝÁ, áñÝ Çñ ÏÝáçÇó ϳÙ
³ÙáõëÝáõó ³é³ÝÓÇÝ ¿ ³åñáõÙ:
ÊݹñáõÙ »Ýù Ýß³Ý ¹Ý»É ³Ûëï»Õ, »Ã» ¸áõù ϳ٠һñ ÁÝï³ÝÇùÇ áñ¨¿ ³Ý¹³Ù Ëáñà ÍÝáÕ ¿:
ºÃ» Ýß³Ý »ù ¹ñ»É ³Ûë í³Ý¹³ÏáõÙ, ËݹáõÙ »Ýù Ýß»É`
Ëáñà ÍÝáÕÇ ³ÝáõÝÁ`
³Û¹ Ëáñà ÍÝáÕÇ »ñ»Ë³Ý»ñÇÝ`
ÊݹñáõÙ »Ýù Ýß³Ý ¹Ý»É ³Ûëï»Õ, »Ã» Ò»ñ ÁÝï³ÝÇùÇ áñ¨¿ ³Ý¹³Ù »ñ»Ë³ ¿, áñÇÝ ËݳÙáõÙ ¿ á°ã û ÍÝáÕÁ, ³ÛÉ Ò»ñ
ï³ÝÁ µÝ³ÏíáÕ áñ¨¿ ³½·³Ï³Ý:
ºÃ» Ýß³Ý »ù ¹ñ»É ³Ûë í³Ý¹³ÏáõÙ, ËݹáõÙ »Ýù Ýß»É`
ËݳÙáÕ ³½·³Ï³ÝÇ ³ÝáõÝÁ`
ËݳÙíáÕ »ñ»Ë³Ý»ñÁ`
Page 1 of 7
MC 604 IPS ARM (5/14)
Ø»½ ï»Õ»ÏáõÃÛáõÝÝ»ñ ïñ³Ù³¹ñ»ù Ò»ñ »Ï³ÙáõïÇ ¨ ͳËë»ñÇ Ù³ëÇÝ
Ø»½ ï»Õ»ÏáõÃÛáõÝÝ»ñ ïñ³Ù³¹ñ»ù Ò»ñ »Ï³ÙáõïÇ ¨ ͳËë»ñÇ Ù³ëÇÝ, áñáÝù ϳåí³Í »Ý Ò»½, Ò»ñ ÏÝáç ϳÙ
³ÙáõëÝáõ ¨ Ò»½ Ñ»ï µÝ³ÏíáÕ ÙÇÝ㨠21 ï³ñ»Ï³Ý »ñ»Ë³Ý»ñÇ Ï³Ù ÁÝï³ÝÇùÇ áñ¨¿ ³ÛÉ ³Ý¹³ÙÇ Ñ»ï, áñÁ
ųٳݳϳíáñ³å»ë Ò»ñ ï³ÝÁ ãÇ µÝ³ÏíáõÙ, ûñÇݳÏ` ¹åñáó ѳ׳˻Éáõ, ³ß˳ï³ÝùÇ Ï³Ù ÑÇí³Ý¹³ÝáóáõÙ
·ïÝí»Éáõ å³ï׳éáí:
ºÏ³ÙáõïÁ
ÊݹñáõÙ »Ýù Ýß³Ý ¹Ý»É ²Ûá ϳ٠àã í³Ý¹³ÏáõÙ, »Ã» Ò»ñ ÁÝï³ÝÇùÇ ³Ý¹³ÙÝ»ñÇó áñ¨¿ Ù»ÏÁ ëïáñ¨ Ýßí³Í
ï»ë³ÏÇ »Ï³Ùáõï ¿ ëï³ÝáõÙ:
Üß³Ý ¹ñ»ù »Ï³ÙáõïÇ Ûáõñ³ù³ÝãÛáõñ ï»ë³ÏÇ ¹ÇÙ³óÇ í³Ý¹³ÏáõÙ:
²Ý³ß˳ïáõݳÏáõÃÛ³Ý Ýå³ëïÝ»ñ
²Ûá
àã
ì»ï»ñ³ÝÝ»ñÇ Ýå³ëïÝ»ñ
²Ûá
àã
ºñ»Ë³ÛÇ ³åñáõëï³¹ñ³Ù
²Ûá
àã
Üí»ñÝ»ñ
²Ûá
àã
ºÃ» í»ñÁ Ýßí³ÍÝ»ñÇó áñ¨¿ Ù»ÏÇÝ ²Ûá »ù å³ï³ë˳ݻÉ, ËݹñáõÙ »Ýù ³Ûë ûñÃÇÏÇ Ñ»ï »Ï³ÙáõïÇ ³å³óáõÛó
áõÕ³ñÏ»É: ²å³óáõÛó ϳñáÕ »Ý ѳݹÇë³Ý³É Ñ»ï¨Û³É ÷³ëï³ÃÕûñÁ. §Social Security Administration¦-Çó, §Veteran’s
Administration¦-Çó §Employment Development Department¦-Çó ëï³ó³Í ݳٳÏÝ»ñÁ ϳ٠ѳÛï³ñ³ñáõÃÛáõÝÝ»ñÁ,
»ñ»Ë³ÛÇ ³åñáõëï³¹ñ³ÙÇ í»ñ³µ»ñÛ³É ¹³ï³ñ³ÝÇ áñáßáõÙÝ»ñÁ ¨ ïíÛ³É »Ï³ÙáõïÇ Ù³ëÇÝ ÏáÝÏñ»ï
ï»Õ»ÏáõÃÛáõÝÝ»ñ å³ñáõݳÏáÕ ³ÛÉ ·ñ³íáñ ÷³ëï³ÃÕûñ:
̳Ëë»ñÁ
ÊݹñáõÙ »Ýù Ýß³Ý ¹Ý»É ²Ûá ϳ٠àã í³Ý¹³ÏáõÙ, »Ã» Ò»ñ ÁÝï³ÝÇùÇ ³Ý¹³ÙÝ»ñÇó áñ¨¿ Ù»ÏÁ ϳñáÕ ¿ ëïáñ¨
Ýßí³Í ï»ë³ÏÇ Í³Ëë»ñÁ ϳï³ñ»É:
Üß³Ý ¹ñ»ù Ûáõñ³ù³ÝãÛáõñ ï»ë³ÏÇ Í³ËëÇ ¹ÇÙ³óÇ í³Ý¹³ÏáõÙ:
ºñ»Ë³Ý»ñÇ ³åñáõëï³¹ñ³ÙÇ í׳ñáõÙ
²Ûá
àã
²ÛÉ Ï³ñ·Ç ³å³Ñáí³·ÝÇ ÙáõÍáõÙÝ»ñ
²Ûá
àã
§Medicare¦-Ç ³å³Ñáí³·ÝÇ ÙáõÍáõÙÝ»ñ
²Ûá
àã
ºñ»Ë³ÛÇ ËݳÙùÇ Ñ»ï ϳåí³Í ͳËë»ñ
²Ûá
àã
â³÷³Ñ³ë ³ÝÓÇ ËݳÙùÇ Ñ»ï ϳåí³Í ͳËë»ñ
²Ûá
àã
ÎñÃ³Ï³Ý Í³Ëë»ñ
²Ûá
àã
ºÃ» í»ñÁ Ýßí³ÍÝ»ñÇó áñ¨¿ Ù»ÏÇÝ ²Ûá »ù å³ï³ë˳ݻÉ, ËݹñáõÙ »Ýù ³Ûë ûñÃÇÏÇ Ñ»ï ïíÛ³É Í³ËëÇ ³å³óáõÛó
áõÕ³ñÏ»É: ²å³óáõÛó ϳñáÕ »Ý ѳݹÇë³Ý³É Ñ»ï¨Û³É ÷³ëï³ÃÕûñÁ. »ñ»Ë³ÛÇ ³åñáõëï³¹ñ³ÙÇ í»ñ³µ»ñÛ³É
¹³ï³ñ³ÝÇ áñáßáõÙÝ»ñÁ, áõëÙ³Ý í³ñÓÇ Ù³ëÇÝ Í³ÝáõóáõÙÝ»ñÁ, §Medicare¦-Ç Ï³Ù ³ÛÉ ³å³Ñáí³·ñ³Ï³Ý
ÁÝÏ»ñáõÃÛ³Ý ÏáÕÙÇó áõÕ³ñÏí³Í ݳٳÏÝ»ñÁ, ³åñ³Ýù³·ñ»ñÁ ϳ٠ëï³ó³Ï³ÝÝ»ñÁ ¨ ïíÛ³É Í³ËëÇ Ù³ëÇÝ
ÏáÝÏñ»ï ï»Õ»ÏáõÃÛáõÝÝ»ñ å³ñáõݳÏáÕ ³ÛÉ ·ñ³íáñ ÷³ëï³ÃÕûñ:
Page 2 of 7
MC 604 IPS ARM (5/14)
Ø»½ ï»Õ»ÏáõÃÛáõÝÝ»ñ ïñ³Ù³¹ñ»ù Ò»ñ ë»÷³Ï³ÝáõÃÛ³Ý ¨ ·áõÛùÇ Ù³ëÇÝ
ÊݹñáõÙ »Ýù Ýß³Ý ¹Ý»É ²Ûá ϳ٠àã í³Ý¹³ÏáõÙ, »Ã» Ò»ñ ÁÝï³ÝÇùÇ ³Ý¹³ÙÝ»ñÇó áñ¨¿ Ù»ÏÁ ëïáñ¨ Ýßí³Í
ï»ë³ÏÇ ë»÷³Ï³ÝáõÃÛáõÝ áõÝÇ: гñϳíáñ ¿ Ýß³Ý ¹Ý»É ëïáñ¨ Ýßí³Í 1, 2 ¨ 3 ïáÕ»ñÇó Ûáõñ³ù³ÝãÛáõñÇ ¹ÇÙ³ó:
´²ÄÆÜ 1
1. γÝËÇÏ ·áõÙ³ñ ϳ٠ãϳÝËÇϳóí³Í í׳ñ³·ñ»ñ
²Ûá
àã
ºÃ» ²Ûá, ³Ûëï»Õ Ýß»ù ·áõÙ³ñÁ $
2. ÀÝóóÇÏ Ñ³ßÇí ϳ٠ËݳÛáÕ³Ï³Ý Ñ³ßÇí
²Ûá
àã
ºÃ» ²Ûá, áõÕ³ñÏ»ù ѳßíÇ ù³Õí³ÍùÝ»ñÇ ûñÇݳÏÝ»ñÁ, áñáÝù óáõÛó »Ý ï³ÉÇë
Ý»ñϳ ѳßí»ÏßÇéÁ:
3. ¸áõù ϳ٠һñ ÁÝï³ÝÇùÇ áñ¨¿ ³Ý¹³Ù Ù»ÏÇó ³í»ÉÇ ÷á˳¹ñ³ÙÇçáó áõÝDZ
(³íïáÙáµÇÉ, ÙáïáóÇÏÉ, µ»éݳï³ñ):
²Ûá
àã
4. ¸áõù ϳ٠һñ ÁÝï³ÝÇùÇ áñ¨¿ ³Ý¹³Ù áõÝDZ ݳí³Ï, ׳ݳå³ñÑáñ¹³Ï³Ý Ïó³ë³ÛÉ
ϳ٠Ïóáñ¹:
²Ûá
àã
ºÃ» 3-ñ¹ ϳ٠4-ñ¹ ѳñóÇÝ ²Ûá »ù å³ï³ë˳ݻÉ, ËݹñáõÙ »Ýù áõÕ³ñÏ»É ë»÷³Ï³ÝáõÃÛ³Ý
ϳ٠·ñ³ÝóÙ³Ý ÷³ëï³ÃÕûñÇ, ³éùáõí³×³éùÇ å³Ûٳݳ·ñ»ñÇ, í³×³éùÇ ëï³ó³Ï³ÝÝ»ñÇ
ϳ٠·Ý³Ñ³ïÙ³Ý ÷³ëï³ÃÕûñÇ å³ï×»ÝÝ»ñÁ:
5. ÊݹñáõÙ »Ýù ͳÝáÃ³Ý³É ë»÷³Ï³ÝáõÃÛ³Ý ëïáñ¨ µ»ñí³Í óáõó³ÏÇÝ:
Üß³Ý ¹ñ»ù ³Ûë í³Ý¹³ÏáõÙ, »Ã» Ò»ñ ÁÝï³ÝÇùÇ áñ¨¿ ³Ý¹³ÙÇ å³ïϳÝáõÙ ¿ ϳ٠»Ã» ݳ Çñ ³Ýí³Ùµ
·ñ³Ýó³Í áõÝÇ Ñ»ï¨Û³É ³é³ñϳݻñÇó Ù»ÏÁ ϳ٠ٻÏÇó ³í»ÉÇÝ:
²Ýß³ñÅ ·áõÛù` µ³óÇ ³ÛÝ ïÝÇó, áñáõÙ ¸áõù µÝ³ÏíáõÙ »ù (³é³ÝÓݳïÝ»ñ, µÝ³Ï³ñ³ÝÝ»ñ` µ³½Ù³µÝ³Ï³ñ³Ý
ß»ÝùáõÙ, ßÇÝáõÃÛáõÝÝ»ñ, ß³ñÅ³Ï³Ý ïÝ»ñ, óÏÛ³Ýë ·áõÛù (life estates), ѳٳï»Õ û·ï³·áñÍíáÕ ³Ù³é³ÝáóÝ»ñ),
µ³ÅÝ»ïáÙë»ñ, ÷á˳¹³ñÓ ÑÇÙݳ¹ñ³ÙÝ»ñ, §Individual Retirement Account¦-Ý»ñ (IRA-Ý»ñ), §Keogh¦-Ý»ñ ϳÙ
³ß˳ï³ÝùÇ Ñ»ï ϳåí³Í Ï»Ýë³Ãáß³Ï, ËݳٳéáõÃÛáõÝÝ»ñ, ³ñ·»É³÷³Ïí³Í ѳßÇíÝ»ñ (áñáÝó íñ³ ·áõÙ³ñ
ϳ٠·áõÛù ¿ å³ÑíáõÙ` ï³ÝÁ µÝ³ÏíáÕ` ÁÝï³ÝÇùÇ áñ¨¿ ³Ý¹³ÙÇ û·ïÇÝ), ¹³ï³í×éáí ß³Ñ³Í ·áõÙ³ñÝ»ñ,
å³ñïùÇ Ù³ñÙ³Ý å³Ûٳݳ·ñ»ñ, ³åñáõëï³¹ñ³ÙÇ Ù³ëÇÝ ¹³ï³ñ³ÝÇ áñáßáõÙÝ»ñ, ÙÇÝã³ÙáõëݳϳÝ
¨ Ñ»ï³ÙáõëÝ³Ï³Ý å³Ûٳݳ·ñ»ñ, ÙáõñѳÏÝ»ñ, ÑÇåáûÏÝ»ñ ϳ٠Ëݳٳ·ñ»ñ, ³é¨ïñ³ÛÇÝ Ñ³ßÇíÝ»ñ,
³é¨ïñ³ÛÇÝ ë»÷³Ï³ÝáõÃÛáõÝ, ݳíÃÇ ¨ ѳݳÍáÝ»ñÇ Çñ³íáõÝùÝ»ñ, $100.00-Çó ³í»ÉÇ ³ñÅáÕáõÃÛ³Ùµ
óÝϳñÅ»ù Çñ»ñ (µ³Ûó á°ã ³ÙáõëÝ³Ï³Ý Ï³Ù Ý߳ݳ¹ñáõÃÛ³Ý Ù³ï³ÝÇÝ»ñ ϳ٠ïáÑÙ³Ï³Ý Ã³ÝϳñÅ»ù Çñ»ñ)
ϳ٠$500 ϳ٠³í»ÉÇ ³ñÅáÕáõÃÛ³Ùµ ó³Ýϳó³Í ³ÛÉ ³Ýß³ñÅ ·áõÛù, ³ÝÓÝ³Ï³Ý Çñ ϳ٠ë»÷³Ï³ÝáõÃÛáõÝ:
ºÃ» ¸áõù Ýß³Ý ºø ¹ñ»É í³Ý¹³ÏáõÙ, ËݹñáõÙ »Ýù ³ÝóÝ»É 2-ñ¹ ´²ÄÜÆÜ (ëïáñ¨):
ºÃ» ¸áõù Ýß³Ý âºø ¹ñ»É ³Ûë í³Ý¹³ÏáõÙ, ËݹñáõÙ »Ýù ³ÝóÝ»É 3-ñ¹ ´²ÄÜÆÜ` 6-ñ¹ ¿çáõÙ:
´²ÄÆÜ 2
ºÃ» ¸áõù Ýß³Ý »ù ¹ñ»É í»ñÁ` 5-ñ¹ ѳٳñÇ ï³Ï ·ïÝíáÕ í³Ý¹³ÏáõÙ, ËݹñáõÙ »Ýù Éñ³óÝ»É ³Ûë µ³ÅÇÝÁ ¨
å³ï³ëË³Ý»É ´àÈàð ѳñó»ñÇÝ: ÊݹñáõÙ »Ýù ³Ûë ûñÃÇÏÇ Ñ»ï ·ñ³íáñ ÷³ëï³ÃÕûñ ïñ³Ù³¹ñ»É ëïáñ¨ Ýßí³Í
µáÉáñ ³ÛÝ ËÙµ»ñÇ Ñ³Ù³ñ, áñáÝó ²Ûá »ù å³ï³ë˳ݻÉ: ÜÙ³Ý ÷³ëï³ÃÕûñÇ ûñÇݳÏÝ»ñ »Ý` ³å³Ñáí³·ñ»ñÁ,
å³Ûٳݳ·ñ»ñÁ, Ëݳٳ·ñ»ñÁ, ³éùáõí³×³éùÇ å³Ûٳݳ·ñ»ñÁ, ¹³ï³ñ³ÝÇ áñáßáõÙÝ»ñÁ, å³ñïùÇ Ù³ñÙ³Ý
å³Ûٳݳ·ñ»ñÁ, ýÇݳÝë³Ï³Ý ѳÛï³ñ³ñ³·ñ»ñÁ, ³é¨ïñ³ÛÇÝ Ñ³ñϳ·ñ»ñÁ, ³åñ³Ýù³·ñ»ñÁ, ëï³ó³Ï³ÝÝ»ñÁ,
ÃáõÛɳïñ³·ñ»ñÁ, ß³ÑáõÛÃÇ ¨ íݳëÇ ï»Õ»Ï³·ñ»ñÁ, ÇÝãå»ë ݳ¨ ë»÷³Ï³ÝáõÃÛ³Ý Çñ³íáõÝùÁ ϳ٠ûñÇݳϳÝ
ß³ÑÁ óáõÛó ïíáÕ ³ÛÉ ÷³ëï³ÃÕûñ:
6. ´³ÅÝ»ïáÙë»ñ ϳ٠÷á˳¹³ñÓ ÑÇÙݳ¹ñ³ÙÝ»ñ
ºÃ» ²Ûá, ËݹñáõÙ »Ýù áõÕ³ñÏ»É ù³Õí³ÍùÝ»ñÇ å³ï×»ÝÝ»ñÁ ϳ٠³ñÅ»ïáÙë»ñÇ Ï³Ù
÷á˳¹³ñÓ ÑÇÙݳ¹ñ³ÙÇ Ñ³í³ëï³·ñ»ñÇ å³ï×»ÝÝ»ñÁ, áñáÝó íñ³ Ýßí³Í
¿ µ³ÅÝ»ïáÙë»ñÇ ÃÇíÁ:
²Ûá
àã
Page 3 of 7
MC 604 IPS ARM (5/14)
7. §Individual Retirement Account¦-Ý»ñ (IRA-Ý»ñ), §Keogh¦-Ý»ñ, ³ß˳ï³ÝùÇ Ñ»ï ϳåí³Í
Ï»Ýë³Ãáß³Ï Ï³Ù Ï»Ýë³Ãá߳ϳÛÇÝ Ñ³ßÇíÝ»ñ, ûñÇݳÏ` 401k ϳ٠457 ѳßÇíÝ»ñ
²Ûá
àã
ºÃ» ²Ûá, ËݹñáõÙ »Ýù áõÕ³ñÏ»É Ò»ñ ·áñͳïáõÇ, ýÇݳÝë³Ï³Ý ѳëï³ïáõÃÛ³Ý Ï³Ù
í³×³é³ÙÇçÝáñ¹Ç ÏáÕÙÇó ïñí³Í ³Ù»Ý³í»ñçÇÝ ù³Õí³ÍùÝ»ñÁ, áñáÝó íñ³ Ýßí³Í
¿ ÑÇÙݳ·áõÙ³ñÁ ¨ ß³ÑÁ, áñÁ ëï³ÝáõÙ »ù, ϳ٠ѳßíÇ Ï³ÝËÇÏ ·ÇÝÁ (·áõÙ³ñÁ
í³Õ³Å³Ù ѳݻÉáõ ¹»åùáõ٠ݳ˳ï»ëí³Í ïáõ·³ÝùÇó Ñ»ïá):
8. î³ñ»í׳ñÝ»ñ ϳ٠ÏÛ³ÝùÇ ³å³Ñáí³·ñáõÃÛáõÝ
²Ûá
àã
9. ¶»ñ»½Ù³ÝÇ ï»Õ»ñ, ËݳٳéáõÃÛáõÝÝ»ñ, óÕÙ³Ý å³Ûٳݳ·ñ»ñ,
óÕÙ³Ý ³å³Ñáí³·ñáõÃÛáõÝ
²Ûá
àã
10. ÊݳٳéáõÃÛáõÝÝ»ñ, ³ñ·»É³÷³Ïí³Í ѳßÇíÝ»ñ (áñáÝó íñ³ ·áõÙ³ñ ϳ٠·áõÛù
¿ å³ÑíáõÙ` ï³ÝÁ µÝ³ÏíáÕ` ÁÝï³ÝÇùÇ áñ¨¿ ³Ý¹³ÙÇ û·ïÇÝ)
²Ûá
àã
11. ¸³ï³í×éáí ß³Ñ³Í ·áõÙ³ñÝ»ñ, å³ñïùÇ Ù³ñÙ³Ý å³Ûٳݳ·ñ»ñ, ³åñáõëï³¹ñ³ÙÇ
Ù³ëÇÝ ¹³ï³ñ³ÝÇ áñáßáõÙÝ»ñ, ÙÇÝã³ÙáõëÝ³Ï³Ý ¨ Ñ»ï³ÙáõëÝ³Ï³Ý å³Ûٳݳ·ñ»ñ
²Ûá
àã
12. ØáõñѳÏÝ»ñ, ÑÇåáûÏÝ»ñ ϳ٠Ëݳٳ·ñ»ñ
²Ûá
àã
ºÃ» ¸áõù ²Ûá »ù å³ï³ëË³Ý»É 6-Çó ÙÇÝ㨠12-ñ¹ ѳñó»ñÇó áñ¨¿ Ù»ÏÇÝ (í»ñÁ), ËݹñáõÙ »Ýù
ïñ³Ù³¹ñ»É Ù»½ ³å³Ñáí³·ñ»ñÇ, å³Ûٳݳ·ñ»ñÇ, Ëݳٳ·ñ»ñÇ, ³éùáõí³×³éùÇ
å³Ûٳݳ·ñ»ñÇ, ¹³ï³ñ³ÝÇ áñáßáõÙÝ»ñÇ, å³ñïùÇ Ù³ñÙ³Ý å³Ûٳݳ·ñ»ñÇ Ï³Ù Ñ³ßíÇ
í»ñ³µ»ñÛ³É ÷³ëï³ÃÕûñÇ å³ï×»ÝÝ»ñÁ, áñáÝù óáõÛó »Ý ï³ÉÇë í׳ñáõÙÝ»ñÁ, Ý»ñϳ
ßáõÏ³Û³Ï³Ý ³ñÅ»ùÝ»ñÁ, Ñ»ï·ÝÙ³Ý Ï³ÝËÇÏ ·áõÙ³ñÁ, ѳßí»ÏßÇéÝ»ñÁ, Ý»ñ¹ñáõÙÝ»ñÁ
¨ µ³ßËáõÙÝ»ñÁ:
13. $100.00-Çó ³í»ÉÇ ³ñÅáÕáõÃÛ³Ùµ óÝϳñÅ»ù Çñ»ñ (µ³Ûó á°ã ³ÙáõëÝ³Ï³Ý Ï³Ù
Ý߳ݳ¹ñáõÃÛ³Ý Ù³ï³ÝÇÝ»ñ ϳ٠ïáÑÙ³Ï³Ý Ã³ÝϳñÅ»ù Çñ»ñ)
²Ûá
àã
ºÃ» ²Ûá, ËݹñáõÙ »Ýù áõÕ³ñÏ»É í³×³éùÇ ëï³ó³Ï³ÝÝ»ñÇ, ·Ý³Ñ³ïáõÙÝ»ñÇ,
³ñÅ»ùÇ Ñ³ßí³ñÏÇ Ï³Ù ³å³Ñáí³·ñÙ³Ý ÷³ëï³ÃÕûñÇ å³ï×»ÝÝ»ñÁ:
14. ²é¨ïñ³ÛÇÝ Ñ³ßÇíÝ»ñ ¨ ë»÷³Ï³ÝáõÃÛáõÝ
²Ûá
àã
ºÃ» ²Ûá, ËݹñáõÙ »Ýù áõÕ³ñÏ»É Ñ³ñϳ·ñ»ñÁ, ³åñ³Ýù³·ñ»ñÁ, ëï³ó³Ï³ÝÝ»ñÁ,
ÃáõÛɳïñ³·ñ»ñÁ, ß³ÑáõÛÃÇ ¨ íݳëÇ ï»Õ»Ï³·ñ»ñÁ, ϳ٠ë»÷³Ï³ÝáõÃÛ³Ý Çñ³íáõÝùÁ,
»Ï³ÙáõïÁ ¨/ϳ٠ͳËë»ñÁ óáõÛó ïíáÕ ³ÛÉ ÷³ëï³ÃÕûñ:
15. Ü»ñϳÛáõÙë ¸áõù` áñå»ë ë»÷³Ï³ÝáõÃÛáõÝ, áõÝ»±ù ³é³ÝÓݳïáõÝ, µÝ³Ï³ñ³Ý`
µ³½Ù³µÝ³Ï³ñ³Ý ϳ٠ѳٳïÇñ³Ï³Ý ß»ÝùáõÙ, ³·³ñ³Ï, ÑáÕ³Ù³ë, ß³ñÅ³Ï³Ý ïáõÝ
ϳ٠óÏÛ³Ýë ·áõÛù (life estate) (û·ï³·áñÍÙ³Ý Çñ³íáõÝù) ÙÇ ï³ÝÁ, áñÁ Ý»ñϳÛáõÙë Ò»ñ
ïáõÝÝ ¿ ϳ٠³ÝóÛ³ÉáõÙ Ò»ñ ïáõÝÝ ¿ »Õ»É:
²Ûá
àã
ºÃ» ²Ûá, ¸áõù ³ÛÅÙ ³Û¹ ï³±ÝÝ »ù µÝ³ÏíáõÙ:
ºÃ» ²Ûá, ËݹñáõÙ »Ýù ³Û¹ ï³Ý ѳëó»Ý Ýᯐ ³Ûëï»Õ ¨ ³ÝóÝ»É 16-ñ¹ ѳñóÇÝ:
ºÃ» ¸áõù Ý»ñϳÛáõÙë ³Û¹ ï³ÝÁ ã»ù µÝ³ÏíáõÙ, ³ÝóÛ³ÉáõÙ ³åñ»±É »ù ¹ñ³ÝáõÙ ¨ ÑáõÛë
áõÝ»±ù ³å³·³ÛáõÙ »ñµ¨¿ ϵݳÏí»ù ¹ñ³ÝáõÙ` áñå»ë Ò»ñ ï³ÝÁ:
²Ûá
àã
ºÃ» ²Ûá »ù å³ï³ë˳ݻÉ, ³Ýó»ù 16-ñ¹ ѳñóÇÝ:
Page 4 of 7
MC 604 IPS ARM (5/14)
ºÃ» àã »ù å³ï³ë˳ݻÉ, Ò»ñ ÁÝï³ÝÇùÇ ëïáñ¨ Ýßí³Í ³Ý¹³ÙÝ»ñÇó áñ¨¿ Ù»ÏÁ ϳ٠ÙÇ
ù³ÝÇëÁ Ý»ñϳÛáõÙë ³åñáõ±Ù »Ý ³Û¹ ï³ÝÁ:
• Ò»ñ ÏÇÝÁ ϳ٠³ÙáõëÇÝÁ.
• ÙÇÝ㨠21 ï³ñ»Ï³Ý »ñ»Ë³Ý.
• ѳßٳݹ³Ù áñ¹ÇÝ Ï³Ù ¹áõëïñÁ.
• ËݳÙÛ³É ³½·³Ï³ÝÁ, áñÁ ÝßíáõÙ ¿ ѳñϳ·ñÇ íñ³` áñå»ë ËݳÙÛ³É.
• ѳñ³½³ï ùáõÛñÁ ϳ٠»Õµ³ÛñÁ, áñÁ ÝáõÛÝå»ë ѳݹÇë³ÝáõÙ ¿ ï³Ý ë»÷³Ï³Ý³ï»ñ
¨ Ò»ñ Í»ñ³Ýáó ÷á˳¹ñí»Éáõó ³é³ç ³éÝí³½Ý Ù»Ï ï³ñÇ µÝ³Ïí»É ¿ ¹ñ³ÝáõÙ.
• Ò»ñ Í»ñ³Ýáó ÷á˳¹ñí»Éáõó ³ÝÙÇç³å»ë ³é³ç` ³éÝí³½Ý »ñÏáõ ï³ñÇ Ò»½ ËݳٻÉáõ
Ýå³ï³Ïáí` Ò»½ Ñ»ï ³Û¹ ï³ÝÁ µÝ³Ïí³Í` ÁÝï³ÝÇùÇ áñ¨¿ ³ÛÉ ³Ý¹³Ù, áñå»ë½Ç ¸áõù
Ç íÇ׳ÏÇ ÉÇÝ»ù ï³ÝÝ ³åñ»É:
²Ûá
àã
ºÃ» ²Ûá »ù å³ï³ë˳ݻÉ, ³Ýó»ù 16-ñ¹ ѳñóÇÝ:
ºÃ» àã »ù å³ï³ë˳ݻÉ, ËݹñáõÙ »Ýù áõÕ³ñÏ»É ·áõÛù³Ñ³ñÏÇ ³Ù»Ý³í»ñçÇÝ Ñ³ßí³ñÏÇ
ϳ٠³Ýß³ñÅ ·áõÛùÇ Ñ³Ù³å³ï³ëË³Ý áñ³Ï³íáñáõÙ áõÝ»óáÕ ·Ý³Ñ³ïáÕÇ ÏáÕÙÇó
ϳï³ñí³Í ·Ý³Ñ³ïÙ³Ý ûñÇݳÏÁ: Ø»Ýù Ïû·ï³·áñÍ»Ýù ·áõÛùÇ ³Ù»Ý³ó³Íñ ³ñÅ»ùÁ:
16. ²ÛÉ ³Ýß³ñÅ ·áõÛù, áñÁ å³ïϳÝáõÙ ¿ Ò»½, µ³Ûó áñáõÙ ¸áõù ã»ù µÝ³ÏíáõÙ (ûñÇݳÏ`
µÝ³Ï³ñ³ÝÝ»ñ` µ³½Ù³µÝ³Ï³ñ³Ý ß»ÝùáõÙ, ßÇÝáõÃÛáõÝÝ»ñ, ß³ñÅ³Ï³Ý ïÝ»ñ, óÏÛ³Ýë
·áõÛù (life estates), ѳٳï»Õ û·ï³·áñÍíáÕ ³Ù³é³ÝáóÝ»ñ)
²Ûá
àã
ºÃ» ²Ûá, ³å³ ³Û¹ ³Ýß³ñÅ ·áõÛù»ñÇó áñ¨¿ Ù»ÏÁ »Ï³Ùáõï µ»ñáõ±Ù ¿:
ºÃ» ²Ûá, ËݹñáõÙ »Ýù áõÕ³ñÏ»É ³Ù»Ý³í»ñçÇÝ í³ñÓ³í׳ñÇ ëï³ó³Ï³ÝÝ»ñÇ ¨ ÏáÙáõݳÉ
ͳé³ÛáõÃÛáõÝÝ»ñÇ, ·áõÛù³Ñ³ñÏÇ, ³å³Ñáí³·ñáõÃÛ³Ý, ëå³ë³ñÏÙ³Ý ¨ í»ñ³Ýáñá·Ù³Ý
ѳٳñ Ý»ñϳ۳óí³Í ѳßÇíÝ»ñÇ å³ï×»ÝÝ»ñÁ:
17. ܳíÃÇ ¨ ѳݳÍáÝ»ñÇ Çñ³íáõÝùÝ»ñ
²Ûá
àã
ºÃ» ¸áõù ²Ûá »ù å³ï³ëË³Ý»É 15-ñ¹, 16-ñ¹ ϳ٠17-ñ¹ ѳñó»ñÇÝ, ËݹñáõÙ »Ýù áõÕ³ñÏ»É
ÑÇåáûÏÇ ÷³ëï³ÃÕûñÇ, ·áõÛù³Ñ³ñÏÇ ³Ù»Ý³í»ñçÇÝ Ñ³ßí³ñÏÇ, ·ñ³ÝóÙ³Ý ¨
ë»÷³Ï³ÝáõÃÛ³Ý ÷³ëï³ÃÕûñÇ å³ï×»ÝÝ»ñÁ:
18. $500 ϳ٠³í»ÉÇ ³ñÅáÕáõÃÛ³Ùµ ó³Ýϳó³Í ³ÛÉ ³Ýß³ñÅ ·áõÛù, ³ÝÓÝ³Ï³Ý Çñ
ϳ٠ë»÷³Ï³ÝáõÃÛáõÝ:
²Ûá
àã
ºÃ» ²Ûá, ËݹñáõÙ »Ýù ѳÛï³ñ³ñ³·ñ»ñ áõÕ³ñÏ»É ·áõÛùÇ ¨ ¹ñ³ ³ñÅ»ùÇ Ù³ëÇÝ:
19. ì»ñÁ` 2-Çó 18-ñ¹ ѳñó»ñáõÙ Ýßí³Í ·áõÛùÇ Ï³Ù ³é³ñϳݻñÇ Ù»ç ϳ±Ý ³ÛÝåÇëÇù, áñáÝó
û·ÝáõÃÛ³Ùµ ýÇݳÝë³íáñí»É »Ý µÅßÏ³Ï³Ý Í³é³ÛáõÃÛáõÝÝ»ñÁ ϳ٠»ñ³ß˳íáñí»É ¹ñ³Ýó
í׳ñáõÙÁ:
²Ûá
àã
ºÃ» ²Ûá, ËݹñáõÙ »Ýù ³Ûë ûñÃÇÏÇ í»ñçáõÙ ·ïÝíáÕ §Èñ³óáõóÇã ¹ÇïáÕáõÃÛáõÝÝ»ñÇ Ï³Ù
ï»Õ»ÏáõÃÛáõÝÝ»ñ¦ µ³ÅÝáõÙ, µ³ó³ïñ»É ¨ áñå»ë ³å³óáõÛó` Ïó»É ·ñ³í³¹ñÙ³Ý,
÷á˳éáõÃÛ³Ý Ï³Ù ³å³ÑáíÙ³Ý ÷³ëï³ÃÕûñÇ å³ï×»ÝÝ»ñÁ:
²Ûá
àã
20. ì»ñÁ` 2-Çó 18-ñ¹ ѳñó»ñáõÙ Ãí³ñÏí³ÍÝ»ñÇ Ù»ç ϳ±Ý ³ÛÝåÇëÇù, áñáÝó ѳٳñ
¸áõù ·áõÙ³ñ »ù å³ñïù:
²Ûá
àã
ºÃ» ²Ûá, ËݹñáõÙ »Ýù áõÕ³ñÏ»É ·ñ³í³¹ñÙ³Ý, ÷á˳éáõÃÛ³Ý Ï³Ù ³å³ÑáíÙ³Ý
÷³ëï³ÃÕûñÇ å³ï×»ÝÝ»ñÁ:
21. гí³ëï³·ñí³Í §ºñϳñ³ï¨ ËݳÙùÇ Ñ³ñóáõ٠γÉÇýáéÝdzÛÇ Ñ³Ù³·áñͳÏóáõÃÛáõݦ
(California Partnership for Long-Term Care) ³å³Ñáí³·Çñ
²Ûá
àã
ºÃ» ²Ûá, ËݹñáõÙ »Ýù áõÕ³ñÏ»É Ò»ñ ³å³Ñáí³·ñÇ å³ï×»ÝÁ: ºÃ» ¸áõù í»ñÁ Ýßí³Í
³å³Ñáí³·ñáí Ýå³ëïÝ»ñ »ù ëï³ó»É, ËݹñáõÙ »Ýù áõÕ³ñÏ»É Ò»ñ ëï³ó³Í ³Ù»Ý³í»ñçÇÝ
§Üå³ëïÝ»ñÇ µ³ó³ïñáõÃ۳ݦ å³ï×»ÝÁ:
Page 5 of 7
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