Form Mc 326 A - Supplemental Security Income (Ssi) Methodology Adult Income Eligibility Work Sheet Page 2
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1
2INSTRUCTIONS
SUPPLEMENTAL SECURITY INCOME (SSI) METHODOLOGY ADULT
ELIGIBILITY WORK SHEET MC 326 A
(Individual or couple, applicant with an ineligible spouse)
PART I.
INELIGIBLE SPOUSE’S UNEARNED INCOME
Do not include ineligible spouse’s income if he/she receives any public assistance (PA).
Line
I.1.
Enter the ineligible spouse’s unearned income.
Line
I.2.
(If there are no children, enter zero on line 2.c.) Enter each ineligible child’s first name in boxes provided on line 2.a., enter the
standard SSI allocation for any ineligible child(ren) not on PA or applying for or eligible for this program. On line 2.b., enter any
income for each of the children excluding $400 per month, up to $1,260 per year of student income. On line 2.c., enter the
remainder for each child and total the allocation for each child.
Line
I.3.
Subtract line I.2.c. from line I.1. (unearned income) and enter the difference. This is the remaining unearned income amount unless
the allocation amount (line I.2.c.) exceeds line I.1. (countable unearned income). In the latter case, the negative figure on line I.3. is
carried over to line II.2. (unused portion of allocation).
PART II. INELIGIBLE SPOUSE’S EARNED INCOME
Line
II.1.
Enter the ineligible spouse’s gross earned income.
Line
II.2.
Enter the amount of any allocation for ineligible children that is not offset by countable unearned income (line I.2.c. minus line I.3.).
If line I.1. is equal to or greater than line I.2.c., enter zero in line II.2.
Line
Il.3.
Subtract the allocation amount on line II.2. from line II.1. (gross earned income) and enter the difference.
PART III. INELIGIBLE SPOUSE’S TOTAL INCOME AFTER ALLOCATIONS
Add the amounts in lines I.3. and II.3. to determine the total income after allocations.
NOTE: If, at this point (after the allocation for ineligible children), the total earned and unearned income amount is less than the standard SSI allocation (the
difference between the Federal Benefits Rate [FBR] for a couple and the FBR for an individual), there is no income available for deeming to the applicant. In
this case, use only the applicant’s income in Part IV and the current SSI/SSP payment level for an individual in Part V. If there is combined earned and/or
unearned income remaining in excess of the standard SSI allocation, use the amounts from lines I.3. and II.3. in Part IV and the current SSI/SSP payment
level for a couple in Part V.
PART IV. COMBINED INCOME
Line
IV.1.
Enter the applicant’s or potentially eligible couple’s unearned income.
Line
IV.2.
Enter the ineligible spouse’s unearned income from line I.3. unless there is no deeming according to Part III.
Line
IV.3.
Enter combined unearned income of applicant(s) (line IV.1.) and/or ineligible spouse (line IV.2.).
Line
IV.4.
Enter the $20 any income exclusion.
Line
IV.5.
Subtract line IV.4. from IV.3. and enter the difference. (If line IV.3. is less than $20, enter zero in line IV.5.)
Line
IV.6.
Enter combined earned income of the ineligible spouse (unless there is no deeming from the ineligible spouse according to Part IV.)
and the applicant(s). Use line II.3. for ineligible spouse’s income. If there is no deeming, enter only the applicant’s earned income.
Line
IV.7.
Enter unused portion of the $20 any income exclusion not offset by unearned income.
Line
IV.8.
Subtract line IV.7. from IV.6. and enter the difference.
Line
IV.9.
$65 work expense exclusion.
Line IV.10.
Subtract line IV.9. from IV.8. and enter the difference.
Line IV.11.
Enter half of the amount of line IV.10.
Line IV.12.
Subtract line IV.12. from line IV.11.
Line IV.13.
Subtract line IV.11. from line IV.10. and enter the difference.
Line IV.14.
Add line IV.5. and IV.13. and enter total. This is the amount of income to be considered in determining SSI eligibility. Enter on
line V.2.
Do not allow deductions for other health insurance premiums.
PART V. SSI ELIGIBILITY CALCULATION
Line
V.1.
Enter the current, applicable SSI/SSP payment level. If income is deemed from the ineligible spouse, use the SSI/SSP payment
level for a couple. Otherwise use the SSI/SSP payment level for an individual.
Line
V.2.
Enter total countable income from line IV.14.
If line V.2. (total countable income) is less than or equal to the current SSI/SSP payment level, the applicant(s) is/are income
eligible for this program.
In a situation where there is a potentially eligible child and parent with an ineligible spouse, first determine the eligible parent’s SSI
income eligibility using this work sheet. If the parent is eligible, determine the child’s financial eligibility using only the eligible child’s
countable income.
MC 326 A (05/07)
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