Form Mc 327 A - Supplemental Security Income (Ssi) Program Property Work Sheet - Adult

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State of California—Health and Welfare Agency
Department of Health Care Services
SUPPLEMENTAL SECURITY INCOME (SSI) PROGRAM
PROPERTY WORK SHEET
ADULT
(18 Years of Age and Older or Married)
Name
Case number
Month
STEP I
Determine net nonexempt property in accordance with Article 9.
STEP II
A. Only consider the net nonexempt property of the SSI applicant (and spouse); do not consider the
property of any other family members in the home.
B. Net nonexempt property of SSI applicant (and spouse) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$_____________
C. Property limit for one person (or two persons if there is a spouse) . . . . . . . . . . . . . . . . . . . . . . . . . . .
$_____________
D. Is line II.B. less than or equal to line II.C.?
Yes, SSI property requirement met.
No, ineligible due to excess property.
___________________________________________________________________________________________
_______________________________________________
Eligibility Worker signature
Worker number
MC 327 A (05/07) Adult

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