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FOOD STAMP HANDBOOK

Handbook _ FORMS ANDINSTRUCTIONS —_ 83-1230 {Cont.) 63-1230 STATE FORMS & INSTRUCTIONS (Continued) 63-1230

DFA 285-A2 (12/83)

Manual Information Question Section Requested EW Action 16C. 63-300.511 Other Income Check that each income source is checked 63-502.1 yes or no. For all yes answers, check that ail 63-502.2 other information is provided. in the space 63-503.212 provided, check any income amount which is 63-503.22 « exempt. Document verification of gross §3-503.23 nonexempt income in the county-use section. 63-503.24 Document in the county-use section whether 63-503.4 or not income is considered anticipated or from a terminated source for purposes of the budget calculation. 63-402.15 Separate Determine if the household with which an Household elderly and disabled individual lives meets income separate household income test entitling the Test individual and spouse to separate household status. Check appropriate box. 63-409.11 Gross Income Hf applicable to the household, total ail 63-502. 1(a) Eligibility nonexempt income and compare to the 63-503.212 Test current Maximum Gross Monthly Income Eligibility Standards. Check appropriate box. Wf gross income exceeds standard, deny application. 17. 63-300.52 Dependent if checked yes, consider for a dependent 63-502.34 Care care income deduction. 63-503.25 18. 63-300.516 Housing Costs Hf applicable, calculate allowable deductions. 63-502.35 Document in county-use section verification 63-503.25 of all housing costs: Enter in the space provided total allowable housing costs. Rev. 1358 replaces . ., CALIFORNIA-DSS-MANUAL-SS issue 2180 Effective 2/15/84

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