SFN 530, Part III, Income Received 415-65-10-15

(Revised 10/00 ML #2629)

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Computing Annualized Income:

 

For each source of income the household receives during the month of application or re-computation, enter the source of income, how it was verified, and the amount/unit (month, week, year). Multiply the amount/unit times the correct annualizing figure as described in 415-25-05-15. This annualized income is then multiplied by 73%, ONLY IF IT IS EARNED INCOME, to arrive at the annualized amount for that source of income.

 

Note (*) that a deduction for a worker living away from home is made only from his earnings and is deducted after the 27% earned income deduction has been calculated.

 

Once each source of income has been annualized, all are totaled on line 5.

 

Use the "Notes" space to show the income received in months prior to the month of application.

 

This form is available through the Department of Human Services and may also be obtained electronically via E-Forms.