Form Soc 811 - In-Home Supportive Services (Ihss) - Sponsor To Alien Deeming Worksheet
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1STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES (IHSS)
SPONSOR TO ALIEN DEEMING WORKSHEET
(20 CFR 416.1166a)
INCOME
1.
Enter Gross Income (earned and unearned) of the sponsor(s) and the
sponsor's spouse.
$ _________________
2.
Enter Allocation for Sponsor(s). Each sponsor's allocation is equal to
the federal SSI rate [not including the SSP rate] for an individual ($545
as of January 2002).
If the co-sponsors are married, the total
- $ ________________
allocation is two times the federal SSI rate.
________________
3.
Subtract the Allocation for Sponsor(s) from Gross Income and enter
= $ ________________
result.
4.
Enter Allocation for Dependent(s) of the sponsor (other than the alien-
applicant). Deduction of one-half of the federal SSI only rate for an
individual for each dependent (a spouse who is not a co-sponsor
receives the dependent allocation).
- $ ________________
________________
5.
Subtract Allocation for Dependent(s) from Line 3 and enter result
(zero, if a negative number). The amount is deemed to the immigrant.
Enter on line A.1.a - c. of the IHSS Income Eligibility worksheet.
= $ ________________
RESOURCES
1.
Enter Total Countable Resources of the sponsor(s) and sponsor's
spouse (if living together).
$ ________________
2.
Enter Allocation for Sponsor(s). Each sponsor's allocation is equal to
the SSI resource limit of $2,000 for an individual, or $3,000 for a couple
when both members of the couple are living together and one member
is not a co-sponsor. If both members of the couple are co-sponsors,
the allocation is twice the individual resource limit.
- $ ________________
________________
3.
Subtract Allocation for Sponsor(s) from Total Countable Resources
and enter result (zero, if a negative number). This amount is deemed
to the immigrant and should be added to the recipient's own resources
to determine eligibility.
= $ ________________
SUPERVISOR’S SIGNATURE
DATE
WORKER
DATE
SOC 811 (4/02)
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