Temporary Assistance Budget Worksheet Template Page 2
ADVERTISEMENT
1
2PAYMENT DETERMINATION
EARNED INCOME
Gross Wages
$ ___________
Adjusted Gross Self-
Employment Earnings
+
$ ___________
In-Kind Earnings
+
$ ____________
Total Gross Earned Income
= $_____________
$150 + _____ %
-
$_____________
Child Care Deduction
-
$_____________
A. NET EARNED INCOME
= $_____________
B. UNEARNED INCOME
+ $_____________
-
C. CHILD SUPPORT PAID
$ _____________
D. NET DEEMED INCOME
+ $_____________
NET COUNTABLE INCOME (A+B-C+D)
= $ _____________
PAYMENT CALCULATION
Family's Need Standard
$ _____________
Penalty Amount
-
$ _____________
Penalty amount may vary depending on penalty type
and length of penalty period. See TA MS 723-4.
Maximum Shelter Allowance
$ ____________
(30% of Need Standard)
Shelter Costs
-
$ ____________
Shelter Allowance Adjustment
-
$ _____________
Adjusted Need
= $ _____________
Net Countable Income
-
$ _____________
Amount of Need
= $ _____________
Percent of Need Payable (100% minus Ratable Reduction)
X
_____________
This percentage changes January 1 each year.
PAYMENT AMOUNT
= $ _____________
If the payment amount is less than $10, no payment is made.
Initial Month Proration Percentage
X
_____________
Days remaining in month (including date of receipt) divided by total days in the month
See Chapter 780 for policy on initial month payment.
Prorated Payment (month of application only)
= $ _____________
For July/August/September, payments for 2-parent households are multiplied by .50
Page 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial