Enter the name(s) of the individual(s), SSN(s), and the month(s) the computation covers.

Items 1-7 are excluded from income and thus are not used in computing the SSI payments. For detailed infor­mation regarding these exclusions, see SI 00830.099.

Make the proper entry for any unearned income identi­fied in items A(l)-A(7). (See SI 02009.001 to determine whether the income should be en­tered in the monthly or quarterly column.) When in-kind support (A(2)) is involved, see SI 00835.001. If an eligible child receives child support (A(5)) from an absent parent, exclude one-third of the support payment (SI 00830.420). When deeming (A(7)) is involved, see SI 01320.000 ff., for the proper amount to be deemed (note SI 02009.065A.). If the general exclusion (A(8)) exceeds the sub­total of unearned income record the excess in B(4). In item A(9) enter any income based on need; e.g., VA pension, AFDC, etc., for which the general exclusion does not apply (SI 00830.170). In item A(10) enter any income used by a blind or disabled person to fulfill a plan for achieving self-support (PASS) (SI 00870.000 ff.). If the amount recorded in A(l0) exceeds the subtotal of unearned income, record the excess in B(8). Record the total countable unearned income at the foot of the col­umn and in (a).

Make the proper entry for any earned income identi­fied in items B(l) and B(2). (See SI 02009.001 to determine whether the income should be en­tered in the monthly or quarterly column.) Where deem­ing is appropriate, include the deemable earned income of the ineligible spouse if the deeming worksheets were not used for computation purposes. If the claimant is a student enter in item B(3) any student earned income exclusion (SI 00820.510). In item B(4) enter any amount of the general exclusion not used in A(8). Item B(5) has been preprinted to exclude the $65 (month­ly) or $195 (quarterly) of earned income. In item B(6) enter one-half (1/2) of the remaining countable earned income. If the claimant is blind, enter in item B(7) the ex­cludable work expenses, SI 00820.535. In item B(8) enter any amount of income not used in item A(l0) which is used by a blind or disabled person to fulfill a plan for achieving self-support. Record the total countable earned income at the foot of the column and in (b).

Add the total countable unearned income entered at (a) to the total countable earned income entered at (b) to obtain the total countable income entered at (c).

If total countable income in 5 is quarterly, convert to monthly countable income by dividing by 3.

Enter the effective month(s). Enter the appropriate FBR for each month (SI 02001.020). Deduct the monthly countable income (see SI 02009.065B.5. or SI 02009.065B.6.). The result is the monthly Federal SSI payment. If the result is positive, show the amount in item (A) and if there is Federal ad ministration of State supplementation complete the SSA-­8106A on the reverse. If the result is zero or negative, show zero (0) in item (A) and check block (B) if there is no Federal administration of State supplementation, or check block C if there is Federal administration of State supplementation.

The person preparing the SSI Payment Worksheet (SSA-8106) should sign it, show their title and the date the worksheet was completed.

Enter the name(s) of the individual(s) and the SSN(s).

1. a. 

   There is Federal ad­ministration of the State Supplementation program.

2. b. 

   If a Federal benefit is payable, complete item 2A to determine the potential combined State and Federal amount that may be payable. If a Federal benefit is not payable, complete item 2B to determine the potential amount of optional State supplement that may be payable.

3. c. 

   If the recipient is eligible for mandatory State sup­plementation (SI 01401.001), complete item 3 to determine the amount of mandatory State supplementation and the potential combined Federal/State amount that may be payable.

4. d. 

   Complete item 4 by comparing the potential amount payable with the optional State supplement ver­sus the potential amount payable with the mandatory State supplement. The amount payable to the claimant will be the higher of the two.

5. e. 

   The person preparing the SSA-8106A should sign it, show their title and the date the worksheet was completed.