A. Gross monthly earned income (if none, go to Step D) (Varying income)
B. Calculate 20% of A (A x .2) = B
C. Subtract B from A
D. Add all other income (SSI, AFDC, SSA, Unemployment) (Varying income)
E. Subtract deduction of $134 or $139 (household = 4), $162 (HH = 5) $186 (HH = 6)
F. SUM
G. For ELDERLY or DISABLED subtract monthly medical bills in excess of $35
[Total medical expenses] ________ - $35 = ______
H. Subtract monthly dependent care costs (kids or adults)
[Maximum deduction of $175/dependent/month or $200 for child 2 or younger]
I. Income Subtotal
J. Subtract excess shelter costs [maximum of deduction of $417/month
except elderly or disabled applicants, who have no max]
1. Give shelter costs (includes rent, mortgage, &/or utilities) $ _____
2. Figure shelter standard ( = 1/2 of I) $ _____
Subtract 2 from 1.
If 2 is larger than 1, then no deduction. = _____
K. SUM NET INCOME
K. Stamp amount = Max Stamp Allotment ($0 income) - [Net income (K) x .3]
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