Page 354
Low Income Home Energy Assistance Program Division 10 Service 415 Program 415 Chapters 05 - 65 North Dakota Department of Health and Human Services
SFN 1540, Income Averaging/Annualizing Worksheet 415-65-15 (Revised 10/1/17 ML #3512) View Archives
This form is optional and may be used to help document frequent income changes.
The averaging worksheet is used to annualize fluctuating income sources as described in 415-25-05-15, Annualizing Income.
The annualizing worksheet is used to determine income eligibility for months prior to the month of application.
This form is available through the Department of Human Services and may also be obtained electronically via E-Forms.