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Form Dhcs 7029 - California Disregard Computation Worksheet - Health And Human Services Agency Page 2

INSTRUCTIONS FOR DISREGARD COMPUTATION WORKSHEET

(DHCS 7029)

The PICKLE DISREGARD COMPUTATION WORKSHEET (DHCS 7029) must be completed and

filed with the Screening Worksheet (DHCS 7020) in each case with potential Pickle eligibility.

TO COMPLETE THE DHCS 7029:

1. Determine the section to be used for each person (A, B, or C).

Situation:

(a) Disabled child and parent(s):

Use Section A for the child.

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The parents are not in any section because there is no disregard for the parents’

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RSDI COLAs.

(b) ABD couple and both are potential Pickle, i.e., both passed screening:

Use Section A for one spouse with potential Pickle eligibility.

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Use Section B for the other spouse with potential Pickle eligibility.

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spouse who did not pass screening. Both spouses have RSDI:

Use Section A for the spouse who passed screening.

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Use Section C for the ineligible spouse who did not pass screening.

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2. Determine the current RSDI benefit amount and enter on line 1 for each person.

3. If Part A or Part A and Part B are being used: Determine the date when the individual was

last eligible for and received SSI/SSP check, enter the month and the year on line 2.

If Part C is being used: Either determine the date the potential Pickle person’s SSI was

discontinued or the date when the ineligible spouse started receiving RSDI, whichever is

later.

To determine the multiplier, refer to the DHCS’ current year All County Welfare Directors

letter titled “January (appropriate year) Social Security Title II and Title XVI Cost of

Living Adjustments (COLA) and Related Issues.” Enter the multiplier also on line 2.

4. Multiply line 1 by line 2 and enter the amount on line 3.

(Round to nearest dollar and enter under “Disregard Amount.”)

EXAMPLE: Current RSDI benefit amount is $655. Applicant last received SSI/SSP in

12/90. Multiply $655 by 0.1342. Result is $87.90. Rounded to nearest dollar,

the disregard amount is $88. The multiplier will change each year with the

RSDI COLA.

DHCS 7029 (06/07)

Form Dhcs 7029 - California Disregard Computation Worksheet - Health And Human Services Agency Page 2