A | List all months affected by the adjusted type "'W” or “G” income. If the windfall offset computation is out of balance (an excess or negative offset applies), then list all months in the windfall period. |
NOTE: Columns B - D2 = SSI Eligibility Computation |
B | Use amount of title II income remaining, if any, as shown in column D on the SSA-2894. |
C | If the Federal living arrangement is B and there is no corresponding J income in the UMIH segment of the SSID (usually a record not in RIC G), include the VTR. |
| If column B equals zero, then column C equals the total of the UMC and the ENC from the CMPH segment of the SSID. |
| If column B equals the type W income in the UMIH segment of the SSID for the same month, then column C equals the total of the WUM and the WEN from the WCMP segment of the SSID. |
| If column B is greater than zero but less than the corresponding type W entry in the UMIH segment of the SSID, then column C equals the total of the UMC and the ENC from the CMPH segment of the SSID plus the total* from column B. |
| *Determine whether any or all of the $20 general income exclusion can be used to reduce the total in column B. |
| This is the new FCI based on the attorney fee adjustment. |
X | The Federal payment amount for Federal living arrangement A, based on the date in column A. |
D1 | Compare the amount in column C with the amount in column X. If eligible, enter “E.” If ineligible, enter “N” in this column and zero in the FAM (column E3). |
D2 | If ineligible, enter zero in the SAM (column E6). |
NOTE: Column D3 - E6 = SSI Payment Computation |
D3 | If eligible, enter the budget month (BM). |
| If column B equals zero then the BM is the same as the BM in the CMPH segment of the SSID. |
E1 | FBR for the month in column A or, if the Federal living arrangement is D, enter $30 (or $25 for months before 7/88) in column E1. |
| If there is no OS for this variation, enter zero in column E6. |
E2 | If the amount is available for the BM in column C, enter the amount from column C. Otherwise, obtain it from the SSID. |
| Consider COLA coordination (SI 02005.015) if title II income is received. |
E3 | Enter the remainder of column E1 minus column E2. |
E5 | Enter the remainder, if any, of column E2 minus column E1. |
E6 | Enter the remainder of column E4 minus column E5. |
NOTE: Columns F1 - F6 = Computation of the underpayment to be paid by one-time payment (OTP). |
F1 | Enter the amount from column E3 unless proration is involved (pre-September 1996). If proration applies and column B equals zero, then the FAM equals the FAM in the CMPH segment of the SSID. Otherwise, determine the prorated amount per SI 02005.005. |
F2 | If offset is automated, enter the WFA from the WCMP segment of the SSID. If offset is manual, enter the new FAM from the SSA-4346 offset worksheet. This is the amount the recipient would have been due if title II had NOT been adjusted for attorney fees and had been paid when it was due. |
F3 | Enter the remainder of column F1 minus column F2. This is the amount of the federal underpayment for this month. |
F4 | Enter the amount from column E6 unless proration is involved. If proration applies and column B equals zero, then the SAM equals the SAM in the CMPH segment of the SSID. Otherwise, determine the prorated amount per SI 02005.005 E. or F. |
F5 | If offset is automated, enter the WSA from the WCMP segment of the SSID. If offset is manual, enter the new SAM from the SSA-4346 offset worksheet. |
F6 | Enter the remainder of column F4 minus column F5. This is the amount of the OSS underpayment for this month. |