Appendix B: The Prepopulated Semiannual Reporting Form

The SAR form (PA 564) is pre-populated with information the recipient must review. The chart below describes:

The information that is prepopulated; and
the eCIS screen where the information is found.

NOTE: It is very important to keep current employment, income, and resource information in eCIS at all times. If incorrect information in eCIS is prepopulated on the SAR forms, the recipient may receive a form listing income and resources that are no longer valid. Current information may not be listed due to limited space.

Question	Prepopulated information	Found in eCIS
1. These are the household members you last reported to be living in your household.	Line Number First Name M.I. Last Name Appellation Birth Date	Demographics
2. These are the household members you last reported to be working and where they worked.	Line Number First Name Employer Date Employment Began	Income-Employment/Wages
3. Provide proof of all work income any household member received in the month of:	Reporting Month	Based on SAR date
4. These are the household members you last reported to have income from a source other than work or public assistance.	Line Number First Name Type of Income Amount of last reported unearned income	Income-Unearned
6. This is the last reported amount of child support paid for children outside the household.	Total amount of support last reported paid	Income-Unearned
7. This is the information you last reported about childcare or for care of a sick or disabled person.	Line Number Provider of care Person paid for Total amount last reported	Expenses-Dependent Care
8. These are the household members you last reported to have resources, including vehicles.	Line Number First Name Resource Type Total Value Amount Owed Resource Description	Resources

Question #5 is not prepopulated. It asks for address and utility/shelter costs. The recipient will answer yes or no and may provide verification of changes.

The number of questions tracked and their placement on the form has changed. The CAO checks questions not answered and/or verified on the SAR form “incomplete.”

NOTE: If the recipient has established good cause for not completing or returning the SAR form, narrate the reason for granting good cause. There is not a Good Cause tracking line on the SAR form.

Recipients must answer all questions and list any changes from the information printed on the SAR form.

Updated September 23, 2026, replacing August 18, 2012