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63.1230 (Cont.) _

63-1230 STATE FORMS & INSTRUCTIONS ({

FOOD STAMP HANDBOOK” -FORMS AND INSTRUCTIONS

Continued)

S3-1230 CA 8 (2/84)

Food Stamp EAS Ques- Information Manual Manual tion Requested Section Section Food Stamp Action Cash Aid Action 12. Wages/ §3-300,511 44-104 For each source of earned income, check if exempt in the Self-Em- 63-402.92 44-113 box provided, Aiso for each source, note the date and ployment 63-502.1 amount of pay stubs or other documentation viewed. Docu- 63-502.2 ment in the county-usé section whether or net income is 63-503,212 considered anticipated or from a terminated source, or for 63-503,22 Cash Aid only, income of a Non-continuous nature for 63-503,23 purposes of the budget caiculation, 63-503.24 63-503.4 63-503.41 13, Other 63-300,.511 44-413 For all yes answers, check that all other information is pro- Incame 63-502.1 vided. In the space Provided, check any income amount 63-502.2 which is exempt. Document verification of gross non- 63-503,212 exempt income. Document whether or not income is con- 63-503.22 sidered anticipated or from a terminated source, or for Cash 63-503.23 Aid onty, income of a nen-continuous nature for purposes 63-503.24 of the budget calculation, 63-503.4 Compute earned income from self-employment using cost and income information provided by the new persoris), 14, Dependent 63-300.52 44-113.215 if checked yes, consider for a dependent care income de- Care 63-502,34 duction, 63-403.25 15, Food 63-402.8 N/A If checked yes, verify that N/A Distribution Participation in the Food Program Distribution Program has been terminated. 16. Purchase or 63-300.531 N/A if checked yes, determine if N/A Prepare 63-402.27 the person should be added Separately to the household, Document accordingly in the county- use section, CALIFORNIA-OSS-MANUAL-SS Issue 635 Issued 2/15/84