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FOOD STAMP HANDBOOK __FORMS AND INSTRUCTIONS 63-1230 (Cont,}

Handbook __

63-1230 STATE FORMS & INSTRUCTIONS (Continued) 63-1230

DFA 285-B (12/83)

Form instructions (For the Eligibility Worker}

FOOD STAMP BUDGET WORKSHEET

Purpose:

The DFA 285-B is used in conjunction with the application for food stamps (DFA 285-A2), or a monthly eligibility report (CA 7), or a household change report to compute and document a household's eligibility and benefit level. The budget portion of the worksheet provides spaces for two separate budget computations. The change documentation portion of the worksheet is used for documenting resource changes, ongoing resource eligibility, and income computations resulting from information reported either at the time of application or during the certification period.

NOTE: The DFA 285-D, Food Stamp Budget Worksheet — Special Medical/Shelter Deductions, must be used for any household containing a member who is elderly or disabled.

Preparation:

Enter the following identifying information on the top of the front page of the worksheet:

_ Case Name

_ Case Number

_ Companion Case Reference _ Household Classification

Enter the beginning and ending dates of the certification period; month and year. Enter the issuance month for the budget being computed, and complete the budget.

Part 1 — Gross Income Eligibility

Complete Sections A through C using prospective amounts to determine gross income eligibility.

C. Gross Income Test

If the answer on Line C4 is “No”, deny the application, or terminate or suspend eligibility, as appropriate. If the answer on Line C4 is “Yes” continue to Part 2.

Part 2 — Net Income Eligibility

Check the appropriate box for a retrospective or prospective budget computation. When the net monthly income is used to determine net income eligibility, use prospective amounts. When the net monthly income is used to determine benefits, use either retrospective or prospective amounts, as appropriate.

Rev, 1361 replaces . CALIFORNIA-DSS-MANUAL-SS issues 2183 and 2184 Effective 2/15/84

(MANUAL LETTER NO.64-13). Ol