Form Mc 175-3i.2r - Section 1931(B) Sneede V Kizer Net Nonexempt Income Determination And Mini Budget Unit (Mbu) Determination-Recipient Page 2
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1
2
3
4C.
NONEXEMPT EARNED INCOME
10. Source and amount of nonexempt earned income
(include TWC, SDI and earned IKI)
11. Section 1931(b) deduction from line 9
12. Remaining nonexempt earned income
(subtract line 11 from line 10)
13. 50% earned income deduction (one-half of line 12)
14. Child care deduction
15. Other deductions
16. Total deductions (add lines 13, 14, and 15)
17. Total net nonexempt earned income
(subtract line 16 from line 12)
D.
TOTAL COUNTABLE INCOME
18. Total countable nonexempt unearned income (line 5)
19. Total countable disability-based income (line 8)
20. Total countable nonexempt earned income (line 17)
21. Income allocated from LTC/B&C person to family
members at home (from MC 176W, Part B, or
from MC 175-7, line C.2)
22. Total countable income (add lines 18, 19, 20, and 21)
E.
TOTAL NET COUNTABLE INCOME
AFTER OTHER DEDUCTIONS
23. Court-ordered child support or alimony
24. Income used to determine PA eligibility
(see MC 175-6, Section B)
25. Other deductions:
26. Total deductions (add lines 23, 24, and 25)
27. Total net countable income (subtract line 26
from line 22) Enter this amount in Part 2 if
no parent in MFBU. If parent in MFBU, continue.
F.
PARENTAL/SPOUSAL (P/S) ALLOCATION
COMPUTATION (Skip if no parent in MFBU)
28. P/S (subtract $1 from MBSAC for one person or $1
from MBSAC for 2 or more if pregnant)
29. Total unearned in-kind income, income from PA, or
income allocated from LTC/B&C spouse
(add lines 3, 4, and 21)
30. Parent’s total net nonexempt income
(subtract line 29 from line 27)
31. Parent’s net nonexempt income less P/S own needs
(subtract line 28 from line 30); if negative, enter 0
32. Number of persons for whom Parent A is responsible
(MC 175-2, Section A) DO NOT COUNT PARENT A
33. Number of persons for whom Parent B is responsible
(MC 175-2, Section B) DO NOT COUNT PARENT B
34. Child’s natural/adoptive parent—check if Parent A
and/or B (see MC 175-2)
A
B
A
B
A
B
Page 2 of 4
MC 175-3I.2R (05/07) 1931 Group
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