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 SSA2894.

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 onetime payment
(OTP).

F1

Enter the amount from column E3 unless proration is involved (preSeptember 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 SSA4346 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 SSA4346 offset worksheet.

F6

Enter the remainder of column F4 minus column F5. This is the amount of the OSS underpayment
for this month.
