Enter the applicant's/recipient's name and SSN and the computation month in the appropriate blocks.

Enter the parent's unearned income less any exclusions which may apply.

Enter the allocation for any ineligible children and/or any eligible noncitizens sponsored by the parent(s) in the boxes next to “Allocation.”

Enter the ineligible child's/eligible noncitizen's unexcluded income in the boxes next to “Subtract Child's/Noncitizen's income.”

1. a. 

   Total Allocation

Subtract each child's/noncitizen's income from their allocation and enter the remainder for each below the boxes on line a. Total the allocations and enter the total in the appropriate column (“Eligibility”' or “Payment”).

1. b. 

   Remaining Unearned Income

Subtract the total allocation on line 2.a. from the parent's unearned income (line 1.) and enter the remainder on line 2.b. If the total allocation exceeds the unearned income amount, enter the excess amount on line 3.a.

Enter the parent's earned income on line 3.

1. a. 

   Enter the excess of the child's/noncitizen's allocation on line 3.a. (as in 3.b. above). Subtract line 3.a. from line 3.

2. b. 

   Enter the result of 3.a. above on line 3.b.

Complete the column headed “4. All Remaining Income.”

1. a. 

   Enter the parent's remaining unearned income. From this, subtract the general income exclusion of $20.

2. b. 

   Enter the parent's remaining earned income. From this, subtract any amount remaining from the general income exclusion, the $65.00 earned income exclusion, any impairment related work expenses (IRWEs), 1/2 the remainder, and any blind work expenses (BWEs).

3. c. 

   To the remainder of b. above add any remaining unearned income.

4. d. 

   From this, subtract an allocation for the parent(s): for one parent subtract the individual FBR and for two parents, the couple's FBR. The result of this step is the amount of the parent(s) income to be deemed.

5. e. 

   If there are more than one eligible child in the household, divide the result of d. above equally among them as deemed income (SI 01320.500B.6.). Carry over the entry on the last line of the column ("Individual's Deemed Income").

1. a. 

   Enter the deemed income. Always treat deemed income as unearned income.

2. b. 

   To a. above, add the individual's own income.

3. c. 

   From the total of a. and b. above, subtract the general income exclusion ($20).

4. d. 

   To the total from c. above, add any countable earned income the child has after applying the $65 earned income exclusion, any IRWEs, 1/2 the remainder, and any BWEs.

5. e. 

   From the total of d. above, subtract any amount approved for a plan for achieving self-support.

6. f. 

   Add the value of the one-third reduction (VTR) to the result of e. above.

7. g. 

   Subtract the result of f. above from the FBR including State supplement (where applicable). This is the payment amount.