SFN 362 - SNAP Computation Sheet 430-05-100-05

(Revised 01/01/2022 ML 3643)

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The use of this form is for training purposes and is for optional use by the worker. The purpose is to provide the worker with a budget to compute SNAP benefits. The form should be retained in the household case file.

 

** Enter SNAP household size in upper right hand corner.

  1. Enter total monthly gross earned income from all sources.
  2. Multiply Line 1 by 80% and enter here.
  3. Enter total monthly unearned income for all sources.
  4. Add Line 2 and Line 3.
  5. Expenses:
  1. Enter farm loss offset, if appropriate.
  2. Enter the standard deduction.
  3. Complete the medical deduction computation before making any entry on this. Enter medical costs for elderly/disabled households: Total medical $___________ minus $35.00 = _____________.
  4. Enter actual out-of-pocket child care costs not to exceed the maximum allowable.
  5. Enter child support paid to a non-household member.

Total lines 5a through 5e and enter on Line 5.

  1. Subtract Line 5 from Line 4.
  2. Excess shelter costs:
  1. Enter rent or mortgage payment.
  2. Plus property taxes and home owner’s insurance.
  3. Plus actual utilities or the standard utility allowance (SUA) or the telephone standard (TL)
  4. Add Line 7a though 7c and enter total here.
  5. Enter 50% or ½ of Line 6.

Subtract Line 7e from Line 7d (up to allowance maximum).

  1. Subtract Line 7 from Line 6 to arrive at the net adjusted SNAP income.
  2. Enter the Thrifty Food Plan amount for the household size.
  3. Multiply Line 8 times 30%.
  4. Subtract Line 10 from Line 9 and round down by dropping cents. 

Example:

$40.49 would round down to $40.00.

  1. Enter the proration multiplier from the proration chart to determine the amount of benefits during the initial month.
  2. Enter the net benefit after proration (for initial application only) and round down by dropping cents.

Example:

$20.56 would be rounded to $20.00.

 

NOTES/DOCUMENTATION:

Enter verifications, calculations, and other documentation in this section.

This form is available through the Department of Human Services and may also be obtained electronically via E-Forms. (50 kb pdf)

E-Forms are presented in Adobe Acrobat and require the Adobe Acrobat reader.  If you do not currently have Adobe Acrobat reader installed, you may download a free copy by clicking the Get Adobe Reader icon below.