SFN 530, Part IV, Summary 415-65-10-20

(Revised 10/00 ML #2629)

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Enter the total annual income from line 5 and subtract the total deductions from line E to arrive at the Adjusted Annual Income on line 6. This is the amount which will be used to compute the household heating share and benefits.

 

Enter the number of persons in the household, the Maximum Income from the income eligibility guidelines in 415-25-05-10. Check any ineligible months determined for this household.

 

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