Page 57
FOOD STAMP HANDBOOK Handbook FORMS AND INSTRUCTIONS ___ 63-1230 (Cont,
63-1230 STATE FORMS & INSTRUCTIONS (Continued) 63-1230
DFA 285-D (12/83)
Form Instructions (For the Eligibility Worker)
FOOD STAMP BUDGET WORKSHEET — SPECIAL MEDICAL/SHELTER DEDUCTIONS
Purpose:
The DFA 285-D is used in conjunction with the application for food stamps (DFA 285-A2) and the food stamp application for special medical deductions (DFA 285-C), or a monthly eligibility report (CA 7), or a household change report to compute and document the eligibility and benefit level for a household which has a member who is elderly or disabled. 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.
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, check the appropriate box for a retrospective or prospective budget and complete the budget.
Part 1 — Net Monthly Income
Complete Sections A through G to determine the household's net monthly income. 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 prospective or retro- spective amounts, as appropriate.
After net monthly income has been determined, go to Part 2 when net income eligibility must also be determined.
the househoid’s net income eligibility. has already been determined, skip Part 2 and go to Part 3.
Part 2 — Net Income Eligibility
H. Net Income Test
Wo the answer on Line H3 is “No”, deny the application or terminate or suspend the household, as appropriate. ff the answer on Line H3 is “Yes”, go to Part 3.
CALIFORNIA-DSS-MANUAL-SS Rev. 1368 replaces issue 2192 Effective 2/15/84
(MANUAL LETTER NO. 84-13) © 60