Check whether there was self-employment income, but no self-employment work activity,
since the date in the identification section. If “no” is checked, question 2 must
be answered, otherwise, skip to question 3.
This question captures information about income that does not represent self-employment
work activity. Complete what the payment was for, the name and address of the payer,
the amount, or estimate of the payment. Skip to question 9.
Complete self-employment business information, and check the type of ownership arrangement.
If the claimant or beneficiary has a farm arrangement, see instructions in this section,
This question captures information about net earnings and hours worked. If a self-employed
individual is working more than 45 hours per month, we may determine a finding of
SGA. Show each month, the net earnings, and check if the claimant or beneficiary worked
more than 45 hours a month. Evaluate this section by referring to DI 10510.015, Test One of the General Evaluation Criteria-Significant Services and Substantial
NOTE: If you are making a trial work period (TWP) determination, 80 hours constitutes
a TWP service month (see DI 13010.060).
The claimant or beneficiary may choose to attach his or her tax return, rather than
completing the chart. If income tax returns are not attached, follow instructions
in this section, DI 10510.025E.
Show the extent that the claimant or beneficiary executed management responsibilities.
For more information on significant services, see DI 10510.015B.
Identify the effect that the disability has on the claimant or beneficiary’s ability
to perform his or her duties, and what additional assistance is required because of
the disability. Be aware of UWAs. For more information on UWAs, see DI 11010.145.
Identify possible unpaid help or un-incurred business expenses deductions. We can
deduct the value of donated business items, such as rent-free space, heat, utilities,
or services from gross earnings in determining countable income. For more information
on unpaid help and un-incurred business expenses, see DI 10510.012.
Collect information on impairment-related work expenses (IRWE). These items or services
are required for the self-employed claimant or beneficiary to work. For more information
on IRWE, see DI 10520.001.