Form Mc 338 B - 250 Percent And Ssi/ssp Income Test Work Sheet For The 250 Percent Working Disabled Program-Child Applying With Or Without Ineligible Parent(S) Page 2
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1
2II.
Parental Allocation to Minor Child(ren) from Ineligible Parent(s). Do not allocate to children on SSI/SSP or children eligible for
the 250 percent program. (Use additional sheets if more than three children.)
(a)
(b)
(c)
Child One
Child Two
Child Three
1. Name
2. Standard SSI allocation
3. Enter ineligible minor child’s
gross income. Evaluate for
student deduction.
Allow
student a $400 per month
income disregard from earned
income, up to $1,620 per year.
4. Subtract line 3 from line 2 to
determine the allocation to
each child.
Enter zero if
minus.
5. Add columns 4a, 4b, and 4c to get allocation to ineligible children. Enter in Section I, line 5.
III.
Determine Whether Child Meets 250 Percent Test and SSI/SSP Test
A. Child’s Net Nonexempt Unearned Income
Child
1. This is the allocation from ineligible parent(s) from Section I, line 17.
2. Enter child’s social security income (do NOT include social security disability income).
3. Enter other unearned income, excluding any other disability income.
4. Add lines 1 through 3.
$20
5. Any income deduction.
6. Subtract line 5 from line 4. If a minus, enter amount without minus in instruction box line 9 and zero
on this line. Amount on line 6 is net nonexempt unearned income. Enter on line 12 and line 17.
B. Child’s Net Nonexempt Earned Income
Child
7. Child’s gross earned income.
8. Subtract dollar amount of IRWE and student deduction.
9. Add $65 and
of the unused portion of the $20 any income deduction.
10. Subtract line 9 from line 8. If a minus, enter zero.
11. Divide line 10 by 2 to get net nonexempt earned income.
12. Net nonexempt unearned income from line 6.
13. Add line 11 and line 12 to get total net nonexempt income.
14. List 250 percent of the current federal poverty level for one.
C. 250 Percent Test
15. If line 13 is less than line 14, the child meets the 250 percent income test.
D. SSI/SSP Test—Note: Child’s earnings are exempt.
16. Enter the SSI/SSP payment level for one.
17. Net nonexempt unearned income from line 6.
18. If line 17 is less than line 16, the child meets the SSI/SSP income test.
Eligibility Worker signature
Worker number
Computation date
County Use
MC 338 B (05/07)
Page 2 of 2
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