Page 59

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

DFA 285-D (12/83)

2. Enter the value of the vehicle based on the blue book, CP] book, newspapers, etc., and document source used for valuation.

3. Evaluate vehicles for exclusion as a resource.

4. For licensed vehicles which are not excluded and which have a value greater than $4,500, determine the fair market value.

5. Determine if any licensed vehicle is exempt from the equity valuation. Compute the equity value of all nonexempt vehicles.

6. Compute resource value of all nonexempt vehicles. J. Resource Eligibility

Enter the issuance month for each resource eligibility test.

1. Enter the amount of resources used in the last resource eligibility test. Specify any nonexcluded additions to the household’s resources and enter the amount(s). Add Lines J1, J2a, J2b, and J2c and enter the total.

Specify any nonexciuded subtractions from the household’s resources and enter the amount(s).

Add Lines J4a, J4b and J4c and enter the total,

Subtract Line J5 from Line J3 and enter the remainder.

XN 9 g &F WON

If the household size is one and if Line J6 is less than or equal to $1,500, check “Yes”, if Line J6 is greater than $1,500, check “No”. If the household size is more than one and if Line J6 is less than or equal to $3,000, check “Yes”; if Line J6 is greater than $3,000,

check “No”. If the answer on Line J7 is “No”, deny the application, or terminate or suspend eligibility as appropriate.

Part § — Income Computations

K. Self-Employment

Enter the issuance month for each self-employment income calculation and complete Lines K1 through K3.

lf self-employment income is to be averaged, go to Line K7. if previously averaged self-employment income is to be adjusted, complete Lines K4 through K7.

L. Educational Grants, Scholarships and Loans

Complete this section if the household has income fram educational grants, scholarships, or loans.

Rev. 1371 replaces + CALIFORNIA-DSS-MANUAL-SS Issues 2194 and 2195 Effective 2/15/84.

(MANUAL LETTER NO. 84-13) Co @ A

Page 59

Official source

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

DFA 285-D (12/83)

2. Enter the value of the vehicle based on the blue book, CP] book, newspapers, etc., and document source used for valuation.

3. Evaluate vehicles for exclusion as a resource.

4. For licensed vehicles which are not excluded and which have a value greater than $4,500, determine the fair market value.

5. Determine if any licensed vehicle is exempt from the equity valuation. Compute the equity value of all nonexempt vehicles.

6. Compute resource value of all nonexempt vehicles. J. Resource Eligibility

Enter the issuance month for each resource eligibility test.

Specify any nonexciuded subtractions from the household’s resources and enter the amount(s).

Add Lines J4a, J4b and J4c and enter the total,

Subtract Line J5 from Line J3 and enter the remainder.

XN 9 g &F WON

check “No”. If the answer on Line J7 is “No”, deny the application, or terminate or suspend eligibility as appropriate.

Part § — Income Computations

K. Self-Employment

Enter the issuance month for each self-employment income calculation and complete Lines K1 through K3.

lf self-employment income is to be averaged, go to Line K7. if previously averaged self-employment income is to be adjusted, complete Lines K4 through K7.

L. Educational Grants, Scholarships and Loans

Complete this section if the household has income fram educational grants, scholarships, or loans.

Rev. 1371 replaces + CALIFORNIA-DSS-MANUAL-SS Issues 2194 and 2195 Effective 2/15/84.

(MANUAL LETTER NO. 84-13) Co @ A