Statement required to obtain public assistance.

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(a) The name of the individual, address, date and place of birth, residence, family relationships, and the composition of the household in which the individual lives;

(b) The financial circumstances of the individual and means of and ability for support of the individual and other individuals, including but not limited to information concerning:

(A) The employment of the individual and the nature and amount of the income of the individual, from whatever source derived;

(B) The tangible and intangible assets of the individual, property and resources of any nature including, but not limited to, money, real and personal property, rights and expectancies as an heir, devisee, legatee, trustee or cestui que trust, and any rights, benefits, claims or choses in action, whether arising in tort or based upon statute, contract or judgment; and

(C) Other information as may be required by the department pursuant to state or federal laws applicable to general assistance or public assistance.

(2) All applications for general assistance or public assistance and all statements referred to in subsection (1) of this section shall be upon forms prescribed and furnished by the department. Each statement shall be subscribed by each individual who executes or joins in the execution of the statement.

(3) The spouse of any individual who applies for or receives general assistance or public assistance may be required by the department to join in the execution of, or separately to execute, any statement referred to in subsection (1) of this section, under oath or affirmation, except during any period in which it appears to the department that:

(a) The individual and the spouse of the individual are estranged and are living apart;

(b) The spouse is absent from this state or the whereabouts of the spouse is unknown; or

(c) The spouse is physically or mentally incapable of executing the statement or of providing any information referred to in subsection (1) of this section. [Formerly 411.650; 2011 c.720 §97; 2013 c.688 §37]

Note: 411.087 was added to and made a part of ORS chapter 411 by legislative action but was not added to any smaller series therein. See Preface to Oregon Revised Statutes for further explanation.


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