Entitlement to the Guaranteed Income Supplement (GIS) or the Allowance is based on the income for the preceding calendar year calculated in accordance with the Income Tax Act.

If you have any questions, please contact your nearest Human Resources Development Canada (HRDC) office. If you live in Canada or the United States, call us free of charge at 1 800 277-9914. For people with speech or hearing impairments using a teletypewriter device (TDD/TTY), call 1 800 255-4786. Our lines are busiest at the beginning and end of each month, so if your business can wait, it's best to call at other times. Please have your Social Insurance Number ready.

For general information on Income Security Programs, you can also visit our Internet site at:
http://www.hrdc-drhc.gc.ca/isp (English)
http://www.hrdc-drhc.gc.ca/psr (French)

Sections A and B -- This information is essential. Make sure that your address and telephone number are correct; please correct and write your Social Insurance Number if necessary.

Sections C, D, E, and F -- If you are married and applying for the Supplement for the first time, please submit an original or a certified copy of the marriage certificate. If you are in a common-law union, you must submit a "Statutory Declaration of Common-law Union" form and additional documentation. Please contact us to obtain this form and a list of documentation required.

If you are separated, please let us know whether your separation is voluntary or involuntary. You are involuntarily separated if you and your spouse or common-law partner are living in separate dwellings for reasons beyond your control. For example, you or your spouse or common-law partner are confined to a hospital or nursing home. If you reunite you also must tell us.

A spouse is a person of the opposite sex to whom you are legally married. A common-law partner is a person of the opposite sex or same sex who has been living with you in a conjugal relationship for at least one year.

Note: A photocopy of a document may be accepted if it is certified as a true copy of the original. The following persons are authorized to certify the document: an Accountant, Chiropractor, Dentist, Doctor, Employee of a Federal or Provincial Department or one of its agencies, Funeral Director, Justice of the Peace, Lawyer, Magistrate, Manager of Financial Institutions, Member of a Provincial Legislature (or their staff),Member of Parliament (or their staff), Minister of Religion, Municipal Clerk, Notary, Official of a country with which Canada has a reciprocal Social Security Agreement, Official of an Embassy, Consulate or High Commission, Pharmacist, Police Officer, Postmaster, Professional Engineer, Social Worker and Teacher.

People who certify photocopies have to compare the original document to the photocopy and must state their official position or title, sign and print their name, provide their phone number and include the date they certified the document(s). They also have to write the following statement on the photocopy: "This photocopy is a true copy of the original document which has not been altered in any way". It should be noted that the applicant or his/her relative cannot certify his/her own documents. All Human Resources Development Canada offices will provide this service free of charge.

ISP 3020-3037-3038-3039-C (01-02) E

Section G -- Report all of your income for the year 2001 from the sources stated below. Do not include the Canadian Old Age Security pension, Guaranteed Income Supplement or Allowance payments. Use the information slips issued to you for income tax purposes in order to declare, accurately, all of the year 2001 sources of income listed. Failure to provide us with correct information could result in an overpayment which will have to be recovered. If you are married or living in a common-law union, your spouse or common-law partner must also complete a statement of income in the column provided on your form or on a separate form. Indicate negative amounts (losses) by circling them.

Canada Pension Plan or Quebec Pension Plan Benefits (Block 1)
Report the amount shown in Box 20 of your Canada Pension Plan T4A (P) slip or Box C of Statement 2 from Quebec Pension Plan. If you have received a CPP/QPP back payment, please include the full amount in Block 1 of your application. Do not include any Lump-sum Death Benefits from these sources.
Use the following grid to calculate the amount to report in Block 1.

Step 1) Add the amount(s) shown in Box 20 of all your T4A (P) slips or Box C of all your Statement 2. Enter the total here	1) __________
Step 2) Add the amount(s) shown in Box 18 of all your T4A (P) slips or Box E of all your Statement 2. Enter the total here	2) __________
Step 2) Subtract the amount in Step 2 from the amount in Step 1. Enter the total here	3) __________ Report this amount in Block 1 of your form.

Other Pension Income (Block 2)
Report the source and GROSS amount of all income, as reported on line 115 of your Federal Income Tax Report.

From Canadian sources: Report your income from pensions, Registered Retirement Income Fund (RRIF), superannuation, retirement plan payments, taxable annuities or other payments as reported to Canada Customs and Revenue Agency. Do not include any payments received under the Canadian Old Age Security, Guaranteed Income Supplement, Allowance, War Veteran's Allowances, Veteran's Disability or dependents Pension Payments programs. Do not include any benefits from provincial or municipal supplement programs, or the Goods and Services Tax Credit (GST Credit).

From another country: You must report total benefits if they are income for Canadian income tax purposes, even if the income is exempt from taxation under an income tax treaty. These payments would include all employment pensions, social security benefits and war service pensions. Please list the sources, all back payments, and report the amounts in Canadian dollars. If the amount is given in foreign currency (specify), the conversion will be made by using the average buying rate of exchange for the year as provided by a Canadian Chartered Bank or by the Bank of Canada. Foreign pension stubs are accepted as proof of declared amounts.

Note: Foreign pension income must be reported whether it is paid in Canada or abroad.

	Box 14 of all your T4E - Statement of Employment Insurance benefits paid; (line 119 on your Federal Income Tax Report) and/or
	Box 10 of all your T5007 slip - Statement of Benefits (line 144 of your Federal Income Tax Report).

Bank, Trust Company, Bond, Foreign Dividends and Other Interest (Block 4)
Report the total net interest received from a bank, trust company, credit union, bonds, mortgage(s) and any foreign dividends or other interest received as reported on line 121 of your Federal Income Tax Report. You must report bond interest at least every three years. All interest amounts reported here should be in accordance with the method used for income tax purposes. All interest received in the year 2001 must be declared.

Dividends and/or Capital Gains (Block 5)
Report the taxable amount of dividends from taxable Canadian Corporations (as reported on line 120 of your Federal Income Tax Report). Report the taxable portion of the capital gains. The capital gains deduction permitted for income tax purposes is not an allowable deduction for Guaranteed Income Supplement or Allowance purposes.

Note: You may deduct capital losses for a year from the total capital gains for that year to arrive at a net capital gain for that year. If the loss is greater than the gain, then report "zero" on your form.

Note: If you have received or are expecting to receive income from a mutual life insurance company which has demutualized, please contact us at 1 800 277-9914. We will provide you with an information sheet explaining how your GIS amount may be affected. You can also visit our web site at http://www.hrdc-drhc.gc.ca/isp for additional information on demutualization and how it can affect OAS and GIS benefits.

Total Net Rental Income (Rooms, Apartments, Buildings, Land, etc.) (Block 6)
Total your rental income and deduct the expenses as you would for income tax purposes (line 126 of your Federal Income Tax Report), i.e. property taxes, insurance, capital cost allowance and repairs and maintenance costs that apply only to the rented portions. The balance will be your net rental income. If you have suffered a net loss, circle that amount and attach a Profit and Loss Statement with your Statement of Income.

Total Net Earnings from Employment (Block 7)
Total of your employment income (line 101) and other employment income (line 104) of your Federal Income Tax Report, minus allowable deductions. The following deductions are allowed:

Employment income is calculated using Box 14 of your T4 slip(s). If you received any housing allowance as a cleric, and it is included in Box 14 of your T4 slip, then you should subtract this amount from your employment income in the same manner as you do on your Federal Income Tax Report before calculating your employment expenses.

See Block 9 for instructions on how to claim other allowable deductions.

Net Income from Self-Employment (Block 8)
If you operate a business of any kind, or if you are a farmer or a person who fishes for a living, state your net profit for the year in the same way you calculate it for income tax purposes less contributions to the Canada Pension Plan or Quebec Pension Plan. (Add lines 135 to 143 of your Federal Income Tax Report then subtract lines 222, 231 and line 310). Also, you may subtract any housing allowance you receive as a cleric. If you suffered a net loss last year, circle that amount and provide a Profit and Loss Statement. Income averaging is not allowed for supplement purposes. If you are a professional person, state the net amount of professional fees you earned in the year 2001.

Total Gross Income from Other Sources (Block 9)
Report any other income that you received in the year 2001 that was not reported in other sections. In addition, other deductions allowed by the tax system that were not claimed elsewhere may be included here. Do Not Include: Child Tax Benefit payments, assistance payments from a municipal, provincial or the Canadian Federal Government, support or gifts from relatives, registered charities or other organizations and municipal tax rebates.

Add your income as indicated on your Federal Income Tax Report, from the following sources:
Net Partnership Income (line 122), Support Payments Received (line 128), RRSP Income (line 129), Other Income (line 130). This includes such income as supplementary employment insurance benefits, amounts received from sickness, accident, disability or income insurance plans, interest income from an estate or trust, severance pay, lump-sums for pensions, and other items as reported on the Federal Income Tax Report.

Add your deductions, as indicated on your Federal Income Tax Report, from the following sources:
Registered pension plan deduction (line 207), RRSP deduction (line 208), Annual union, professional dues (line 212), Child care expenses (line 214), Attendant care expenses (line 215), Business investment loss (line 217), Moving expenses (line 219), Support payments made (line 220), Carrying charges and interest expenses (line 221), Exploration and development expenses (line 224), Other deductions (line 232). Subtract the total deductions from the total income. Report this amount in Block 9 on your application form. If contributions were made to an RRSP, please provide confirmation (i.e. receipt).

Total Income for the year 2001 (Block 0)
Add up the figures and enter the total. Circle the amount if negative.

Sections H and I -- If you complete either of these sections, you will receive a special form, at the time of the event, on which you may estimate the income you expect to receive. The amount of the Supplement may be calculated based on your estimated total income for the current calendar year, if this is to your advantage.

Sections J and K -- The application is not complete until it is signed by the applicant (and spouse or common-law partner) or the person receiving the pension as a trustee. If the applicant (or the spouse or common-law partner) is unable to sign the form, a mark signature is acceptable if it is witnessed and the witness completes section K.

Important Notes
Relatives or friends may help you complete your application. If this applies to you, make sure that you, not the person assisting you, sign the application. HRDC staff are also at your service free of charge.

Payment outside Canada -- Your Guaranteed Income Supplement or Allowance may be paid outside Canada for the month of departure and for six more months only. If you or your spouse or common-law partner will be outside Canada for more than six months, contact, free of charge, your nearest HRDC office at 1 800 277-9914 (calls from Canada and USA).

Protection of Personal Information
The information requested is required under the Old Age Security (OAS) Act. We may not be able to give you a benefit if you do not give us all the information we need. We will keep this information in the Personal Information Bank HRDC PPU 116. Your personal information is governed by the Privacy Act and we may disclose it where we are authorized to do so under the OAS Act.

Under the OAS Act and the Privacy Act you have the right to look at the personal information about you in your file. You can ask to see your file by contacting a HRDC office. To find out how to get your personal information through the Access to Information Coordinator's office, see the Info Source, a directory that lists all the information banks and the information they contain. Copies of the Info Source are available in all HRDC offices.