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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL

Division of Welfare and Supportive Services APPENDIX H Medical Assistance Manual DETERMINING COUNTABLE 17 Jul 01 MTL 04/17 PUBLICATION 915

WORKSHEET 1 - Example (see IRS Publication 915)

Example 1: George White is single and files Form 1040 for 2016. In addition to receiving social security payments, he received a fully taxable pension of $18,600, wages from a part- time job of $9,400, and taxable interest income of $990, for a total of $28,990. He received a Form SSA-1099 in January 2017 that shows his net social security benefits of $5,980 in box 5. To figure his taxable benefits, George completes Worksheet 1, shown below. On line 20a of his Form 1040, George enters his net benefits of $5,980. On line 20b, he enters his taxable benefits of $2,990.

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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL

Division of Welfare and Supportive Services APPENDIX H Medical Assistance Manual DETERMINING COUNTABLE 17 Jul 01 MTL 04/17 PUBLICATION 915

WORKSHEET 1 - Example (see IRS Publication 915)

Example 1: George White is single and files Form 1040 for 2016. In addition to receiving social security payments, he received a fully taxable pension of $18,600, wages from a part- time job of $9,400, and taxable interest income of $990, for a total of $28,990. He received a Form SSA-1099 in January 2017 that shows his net social security benefits of $5,980 in box 5. To figure his taxable benefits, George completes Worksheet 1, shown below. On line 20a of his Form 1040, George enters his net benefits of $5,980. On line 20b, he enters his taxable benefits of $2,990.