Appendix 1530-A: AFDC Income Determination Worksheet
CPS June 2013
The worksheet is used to determine the AFDC Certified Group’s countable income and whether the certified group passes both the 185% and 100% AFDC Needs Standard tests. As of November 19, 2012 the Foster Care Assistance Application in IMPACT has been updated to include the algorithms to perform both tests. Foster care eligibility specialists can use this worksheet for eligibility training purposes.
Applied Income of Stepparents or Disqualified Parents
Complete this section when either a stepparent or a legal parent who is disqualified from the AFDC Certified Group has income and lives in the home of removal.
If both legal parents are disqualified then the applicable deductions are allowed for each parent and a separate chart for each disqualified parent must be completed.
1. Stepparent or Disqualified Parent’s Monthly Gross Earned Income
$_________________
2. Work-Related Expenses Standard Deduction of $90 (allowed only if stepparent or disqualified parent has earned income)
$_________________
3. Countable Earned Monthly Income (Line 1 minus Line 2)
$_________________
4. Other Monthly Income of Stepparent or Disqualified Parent
$_________________
5. Total Countable Monthly Income (Line 3 plus Line 4)
$_________________
6. Monthly Payments to Dependents Outside of Home
$_________________
7. Monthly Alimony and Child Support Payments Outside of Home
$_________________
8. Allowance Amount for Stepparent or Disqualified Parent and Non-certified Dependents taken from Stepparent Allowance Deduction chart at Appendix 1530-B: Stepparent or Disqualified Parent Budgetary Needs Allowance Deduction
$_________________
9. Applied Income of Stepparent or Disqualified Parent (Line 5 minus Lines 6, 7, and 8)
$_________________
If Line 9 is a positive amount, enter that amount on Line 3 of Step 1 and on Line 6 of Step 2 of the tables below.
If Line 9 is $0 or a negative amount, enter $0 on Line 3 of Step 1 and on Line 6 of Step 2 on the tables below.
Number of People in the AFDC Certified Group
__________________
Number of Parents in the AFDC Certified Group
__________________
Step 1
1. Total Monthly Earned Income amount
$_________________
2. Total Monthly Unearned Income amount
$_________________
3. Applied Income of Stepparent or Disqualified Parent
Taken from line 9 of the Applied Income for Stepparents and Disqualified Parents section above.
$_________________
4. Total Countable Income (Line 1 plus Line 2 plus Line 3)
$_________________
5. 185% AFDC Need Standard for Family
Taken from applicable 185% income limit from Appendix 1530-C: AFDC Needs Standard Income Limits
$_________________
Is the child and family’s total countable income amount at or under the applicable 185% AFDC Needs Standard?
☐ YES ☐ NO
Step 2
1. Total Monthly Earned Income amount
$_________________
2. Work-Related Expenses Deduction
Maximum deduction of $90 allowed for each person with earned income in line 1 above. The deduction amount cannot exceed the person’s monthly earned income.
$_________________
3. Dependent Care Cost Deduction Amount
Enter out-of-pocket costs up to a maximum of $200.00 for each child under age 2 and $175.00 for each dependent child age 2 and older and for each incapacitated adult in the certified group paid by the parent or managing conservator in the certified group with earned income.
$_________________
4. Total Countable Earned Income
*amount in Line 1 minus amounts on Line 2 and Line 3
$_________________
5. Total Monthly Unearned Income
$_________________
6. Applied Income of Stepparent
Taken from line 9 of the Applied Income for Stepparents and Disqualified Parents section above.
$_________________
7. Total Countable Income (Line 4 plus Line 5 plus Line 6)
$_________________
8. 100% AFDC Need Standard for Family
Taken from applicable 100% income limit from Appendix 1530-C: AFDC Needs Standard Income Limits based on the AFDC certified group size and number of parents in the AFDC certified group.
$_________________
Is the child and family’s total countable income amount at or under the applicable 100% AFDC Needs Standard?
☐ YES ☐ NO
Did the child and family meet both the 185 % and 100% AFDC Need Standard tests?
☐ YES ☐ NO