Appendix A: BUDGET GROUP EXAMPLES

List of Household Composition Examples

1. TANF Child Living with Single Parent (Deprivation – Absence)

2. TANF Child Living with Two Parents (Deprivation – Incapacity)

3. TANF Child Living with Two Parents (Deprivation - Under-Employed)

A) Example 1

B) Example 2

4. Non-Parental Specified Relative with TANF Parent in the Household (see CAH 110.41)

5. Exceptions to Living with Specified Relative (see CAH 127.6)

6. Pregnant Individual (see CAH 110.211)

A) Unmarried Pregnant Individual Over the Age of 18

B) Married Pregnant Individual

C) Unmarried Pregnant Minor Parent

7. TANF Minor Parent (see CAH 110.6)

A) Minor Parent also a TANF Child

B) Minor Parent NOT a TANF Child

C) Minor Parent Exempt from Requirements to live in an Adult Supervised Household

D) Minor Parent Living with Legal Guardian (Non-Relative)

8. TANF Eligibility Based on Paternity (see CAH 131.222)

A) Paternity Established

B) Paternity NOT Established

9. Stepparent in TANF Group (see CAH 110.41)

A) Stepparent Not Specified Relative

B) Stepparent as Specified Relative

10. Half Sibling in TANF Budget Group

A) Half Sibling Deprived

B) Half Sibling Not Deprived

11. Multiple TANF Budget Groups in a Common Residence

A) Example 1

B) Example 2

12. SSI Budget Groups

A) Single Parent SSI Adult

B) Two Parent with One SSI Adult

C) SSI Child – Adult Only TANF

D) Two Parent TANF with SSI Children

13. Refugee

A) Same Entry Dates

B) Different Entry Dates

Accurate data entry on the relationship screen is the key to receiving the correct eligibility results; if you are not receiving the correct eligibility results, review data entry on the relationship screen.

*The relationship codes used in the examples reflect the relationship to the Head of Household*

1. TANF Child Living with Single Parent (Deprivation - Absence)

The Household consists of Kathy Bates applying for TANF for self and child , Princess, age 11. Princess’s other parent is absent.

Head of Household: Kathy Bates

• Princess – Kathy’s 11 - year - old child – D

Budget Group Results:

C Budget Group C 00 A Kathy Bates ES Princess Bates EC

2. TANF Child Living with Two Parents (Deprivation – Incapacity)

The household consists of Mary Poppins applying for TANF for self, spouse, Jake, and Peter their 11 - year - old child. Jake has a temporary medical incapacity.

Head of Household: Mary Poppins

• Jake – (incapacitated) Mary’s spouse – H

• Peter– Mary and Jakes 11 - year - old child – S

Budget Group Results:

C Budget Group C 00 I Mary Poppins ES Jake Poppins ES Peter Poppins EC

3. TANF Child Living with Two Parents (Deprivation - Under-Employed)

A) Molly Spock is applying for TANF for self and Janet, her 7 - year - old child . Molly is married to Fred Spock and they have one common child, 4 year old Timmy. Molly and Fred are both unemployed. Fred receives Unemployment Compensation benefits.

Head of Household: Molly Spock

• Fred Spock – Molly’s spouse – H

o Janet Spock– Molly’s and Fred’s 7 - year - old child – D

o Timmy Spock – Molly and Fred’s 4 - year - old child - S

Budget Group Results:

U Budget Group U 00 C Molly Spock ES Fred Spock ES Janet Spock EC Timmy Spock EC

B) Samuel Addams applies for TANF for self, 25 - year - old significant other, Samantha, and Ned and Ted, their 5 - year - old twins.

Head of Household: Samuel Addams

• Samantha Frank – Samuel’s Significant Other – NR

o Ned – Samuel and Samantha’s 5 - year - old child - S

o Ted – Samuel and Samantha’s 5 - year - old child - S

Budget Group Results:

U Budget Group U 00 C Samuel Addams ES Samantha Pencil ES Ned Addams EC Ted Addams EC

4. Non-Parental Specified Relative with TANF Parent in the Household

*A specified relative who is not the parent of the TANF child when the parent lives in the household but does not meet specified relative requirements*

Penny Dennis is receiving TANF benefits for self and 2 children, Tommy, age 13 and Rick, age 7. Rita, the 24 - year - old child of Penny moves in and brings her 7 - month - old child Maya. The court has awarded custody of Maya to Penny (grand parent) because of Rita’s drug addiction. Penny applies for TANF for Maya. Rita is the biological parent of Maya and is required to be included in the budget group. Rita cannot be the designated specified relative because she does not have care and control of Maya. Penny Dennis will be the specified relative and payment name for 2 budget groups.

Head of Household: Penny Dennis

• Rita – Penny’s 24 - year - old child - D

o Maya – Penny’s 7 - month - old grand child - GD

• Tommy – Penny’s 13 - year - old child - S

• Rick – Penny’s 7 - year - old child – S

Budget Group Results:

C Budget Group 1 C 00 A C Budget Group 2 C2 00 A Penny Dennis ES Penny Dennis NS Tommy Dennis EC Rita Dennis EA Rick Dennis EC Maya Dennis EC Rita Dennis NA

5. Exceptions to Living with Specified Relative (also see, CAH 127.6 )

Ms. Ruiz and child, Tomas, age 5. Ms. Ruiz is involved in an automobile accident and will be hospitalized for at least three months. A neighbor who is not related to Tomas agrees to care for him until Ms. Ruiz is discharged from the hospital.

The parent’s temporary emergency has been verified and care and control of Tomas has not legally ended but the neighbor has assumed care and control, TANF payments are authorized in the name of the caretaker/neighbor.

Head of Household: Ms. Debbie Down (Neighbor)

• Tomas – TANF Child (temporarily residing with neighbor, due to an emergency situation) - OR

Note: To receive the correct eligibility results, Debbie must be listed as “Other” on the relationship screen.

Budget Group Results:

C Budget Group C 00 A Debbie Down NA Tomas Ruiz EC

6. Pregnant Individual

A) Unmarried Pregnant Individual OVER the Age of 18

Suzie Gray, an unmarried pregnant individual , applies for assistance because they are unable to continue working full-time due to pregnancy. Suzie verifies the baby is due in 2 1/2 months, and the fetus, if born, would qualify as a TANF dependent child. Suzie intends to raise the child. The CAO authorizes Suzie for TANF. Income from part-time employment is adjusted against the FSA for one, as the fetus is not included in the FSA.

Head of Household: Suzie Gray

• Number of unborn = 1

NOTE: If the alleged other parent is in the household, they would be ineligible for TANF benefits until the TANF child is born and paternity has been established and proven to be the TANF child’s parent .

Budget Group Results:

(Adult only – No TANF Child Case)

C Budget Group C 00 P Suzie Gray ES

B) MARRIED Pregnant Individual

Marcy Strayer a legally married pregnant individual is applying for TANF. Marcy Strayer resides with spouse, Philip Strayer.

NOTE: Because the two are married by law it is presumed that the spouse is the LRR of the unborn child. See Chapter 131.22

Head of Household: Marcy Strayer

• Phillip – Marcy’s Spouse - H

Budget Group Results:

C Budget Group C 00 P Marcy Strayer ES Phillip Strayer NS

NOTE: The CAO must include the spouse’s income and resources in determining eligibility for the pregnant individual and unborn child if the spouse resides in the household. See CAH 155.1 .

C) Unmarried Pregnant Minor Parent

When the pregnant individual is a minor residing in the home of a parent, legal guardian, or other adult relative or in an adult-supervised supportive living arrangement (because they do not meet any of the exemptions listed in Section 110.6 ) the minor parent may not be designated as a specified relative nor payment name for herself. The adult with whom the minor parent is living must complete the application and could be the payment name. If the adult is a specified relative for the minor parent, that person does not have to be included in the budget group.

NOTE: Income from the minor parent's parent (s) is deemed to the budget group. See Chapter 155 .

The household applying for TANF consists of Karen Phor, spouse , Ben Phor and their pregnant minor child Dottie, age 16.

Head of Household: Karen Phor

• Ben Phor – Karen’s spouse – H

• Dottie – Karen’s 16 - year - old child – D

Budget Group Results:

C Budget Group C 00 P Karen NS Ben N S Dottie EP

7. TANF Minor Parent

A) Minor Parent also a TANF Child

If the minor parent qualifies as a TANF child and their parents and siblings are applying for or receiving cash benefits, the minor parent must be included in their parent’s budget group and cannot be the specified relative for their own child. The minor parent’s child is also included as a TANF child.

Leslie Moppit and children Anthony, age 14 and April, age 17 are applying for TANF benefits. April a minor parent and child , Tyler, age 2, reside in the household. Leslie Moppit has to apply for the household.

Head of Household: Leslie Moppit

• April – Leslie’s 17 - year - old child - D

o Tyler – April’s 2 - year - old child - GS

• Anthony – Leslie’s 14 - year - old child – S

Budget Group Results:

C Budget Group C 00 A Leslie Moppit ES April Moppit EC Tyler Moppit EC Anthony Moppit EC

B) Minor Parent NOT a TANF Child

Carmen Phor is applying on behalf of her minor parent grand child , Dottie, age 16 and Dottie’s 1 month old child . Carmen's spouse , Ben also resides in the household .

Head of Household: Carmen Phor

• Ben – Carmen’s s pouse – H

• Dottie – Carmen’s 16 - year - old grandchild – GD

o Dan – Dottie’s 1 month old child – GGS

Budget Group Results:

C Budget Group C 00 A Carmen Phor NS Ben Phor NS Dottie Phor EP Dan Phor EC

C) Minor Parent Exempt from Requirements to live in an Adult Supervised Household

Teri Cameron, an emancipated minor parent is applying for self and 3 - month - old child Logan.

Head of Household: Teri Cameron – age 17

• Logan – Teri’s 3 - month - old child – S

Budget Group Results:

C Budget Group C 00 A Teri Cameroon ES Logan Cameroon EC

D) Minor Parent Living with Legal Guardian (Non-Relative)

Pat Blair is a non-relative person applying on behalf of Penny Hearst, age 16 and Penny’s 1 month old child , Lester. Pat Blair is the legal guardian and has care and control of Penny and Lester.

Head of Household: Pat Blair – Legal Guardian

• Penny Hearst – 16 - year - old minor parent – OR

• Lester Hearst – Penny’s 1 month old child – NR

NOTE: To receive the correct eligibility results, Pat must be listed as “Other” on the relationship screen.

Budget Group Results:

C Budget Group C 00 A Pat Blair NA Penny Hearst ES Lester Hearst EC

8. TANF Eligibility Based on Paternity

A) Paternity Established

Common residence consists of Kimberly Stanton, daughter Rose, age 5, Kimberly's significant other Robert Evers and child Roger Evers, age 12 and their common child Steve Stanton-Evers, age 3 months.

Head of Household: Kimberly Stanton

• Rose – Kimberly’s 5 - year - old child - D

• Robert – Kimberly’s Significant Other - NR

• Roger – Roberts 12 - year - old child - NR

• Steve – Kimberly’s and Roberts 3 - month - old child – S

Budget Group Results:

U Budget Group U 00 C Kimberly Stanton ES Rose Stanton EC Robert Evers ES Roger Evers EC Steve Stanton-Evers EC

B) Paternity NOT Established

Kimberly Stanton is applying for child , Rose, age 5 because of deprivation due to absence of a parent, Ms. Stanton is included as a parent in the budget group. Ms. Stanton is also applying for her 3 - month - old child , Steve. Steve’s alleged parent resides in the household , but paternity has not been established. Steve qualifies as a TANF child because of the absence of a parent, paternity not established. Steve is a half- sibling to Rose.

Kimberly Stanton’s significant other , Robert, and Robert’s son, Roger, age 12 also reside in the household and if they were applying for TANF, Robert and Roger would be in a separate TANF budget group. Robert's 12 - year - old child , Roger, qualifies as a dependent child because of absence of a parent. Until paternity is established, Roger would not be considered a half sibling to Steve.

Head of Household: Kimberly Stanton

• Rose – Kimberly’s 5 - year - old child - D

• Robert – Kimberly’s Significant Other - NR

• Roger – Roberts 12 - year - old child - NR

• Steve – Kimberly’s and Roberts 3 - month - old child - S

Budget Group Results:

C Budget Group 1 C 00 A C Budget Group 2 C2 00 A Robert Evers ES Kimberly Stanton ES Roger Evers EC Rose Stanton EC (The cascade builds from the eldest child) Steve Stanton-Evers (common child) EC

9. Stepparent in TANF Budget Group

A) Stepparent Requesting

Sharon Homar is applying for the household which consists of children , Theresa, age 16, Terry, age 10 and spouse Dwayne Homar. Dwayne is the step parent of Theresa and Terry.

Head of Household: Sharon Homar

• Terry Brown – Sharon’s 10 - year - old child - S

• Theresa Brown – Sharon’s 16 - year - old child – D

• Dwayne Homar – Sharon’s Spouse - H

Budget Group Results:

C Budget Group C 00 A Sharon Homar ES Terry Brown EC Theresa Brown EC Dwayne Homar ES *Step-Parent meets requirements to be a specified relative - (optional household member)*

B) Stepparent NOT Requesting

Head of Household: Sharon Homar

• Terry Brown – Sharon’s 10 - year - old child - S

• Theresa Brown – Sharon’s 16 - year - old child – D

• Dwayne Homar – Sharon’s Spouse – H

Budget Group Results:

C Budget Group C 00 A Sharon Homar ES Terry Brown EC Theresa Brown EC Dwayne Homar NS (Not Requesting) NOTE: Non-Mandatory Member – But is an LRR of spouse and income/resources would be deemed

10. Half Sibling in TANF Budget Group

The household consists of Barbara Young, child Sophie, age 10, significant other Tom Brooks and Tom and Barbara’s common child , Sean, age 5. Paternity has been established for their child Sean . Tom is incapacitated.

Head of Household: Barbara Young

• Tom Brooks – Barbara’s Significant Other - NR

• Sophie Young – Barbara’s 14 - year - old child - D

• Sean Young-Brooks – Barbara and Tom’s 5 - year - old child - S

Budget Group Results:

C Budget Group C 00 I Barbara Young ES Sophie Young EC Tom Frank (Incapacitated) ES Sean Young-Frank EC

11. Multiple TANF Budget Groups

A) The household consists of Jackie Smith, child , Mary, age 16, Mary’s child , Bob, age 1. The household also consists of Jackie 's three other children , John, age 12, Jim, age 14 and adult child Bert, age 22 and Bert’s two children, Sam and Susan, both age 4. Mary is a parent but is a minor parent who qualifies as a TANF child and is required to be in their sibling’s budget group. Mary’s child, Bob, is also included as a TANF child.

However, Jackie ’s adult child , Bert, will be in a separate budget group. Bert does not qualify as a TANF dependent child because of age , and is therefore not required to be in their siblings' budget group. Bert qualifies as the specified relative for his children and is a mandatory member in the budget group with his dependent children.

Everyone in this household is applying for cash benefits. Budget groups are established.

NOTE: Each TANF budget group will receive a full monthly assistance payment based on the FSA for the number of persons in each budget group.

Head of Household: Jackie Smith

• Bert Smith – Jackie’s 22 - year - old child - S

o Sam – Bert’s 4 - year - old child – GS

o Susan – Bert’s 4 - year - old child – GD

• Mary Smith – Jackie’s 16 - year - old child – D

o Bob Smith – Mary’s 1 year old child - GS

• Jim Smith – Jackie’s 14 - year - old child – S

• John Smith – Jackie’s 12 - year - old child - S

Budget Group Results:

Budget Group 1 C 00 A Budget Group 2 C2 00 A Jackie Smith ES Bert Smith ES John Smith EC Sam Smith EC Jim Smith EC Susan Smith EC Mary Smith EC Bob Smith EC

B) Kelly Scott is applying for self and three children , Karen, age 16, Rita, age 13 and Kaye, age 11. Kelly is also applying for three additional family members, niece Sherri Scott, age 15 (whose parents are deceased), two grandchildren, Lane, age 10, whose parents are deceased and Karen’s child , Lorene, age 1.

Head of Household: Kelly Scott

• Karen Scott – 16 - year - old child - D

o Lorene – Karen’s 1 year old child - GD

• Rita Scott – Kelly’s 13 - year - old child – D

• Kaye Scott – Kelly’s 11 - year - old child – D

• Lane Scott – Kelly’s 10 - year - old grand child – GS

• Sherri Scott – Kelly’s 15 - year - old niece - NC

Budget Group Results:

Budget Group 1 C 00 A Budget Group 2 C2 00 A Budget Group 3 C3 00 A Kelly Scott ES Kelly Scott NS Kelly Scott NS Kaye Scott EC Lane Scott EC Sherri Scott EC Rita Scott EC Karen Scott EC Lorene Scott EC Absent Parents -Deceased

NOTE: Kelly Scott will be the payment name for ALL three budget groups.

12. TANF and SSI Budget Groups

A) Single Parent SSI Adult

The household consists of Pat Smart who is an SSI Recipient , and two children, Sam, age 7 and Samantha, age 5. There will be two budget groups.

Head of Household: Pat Smart

• Sam Smart – Pat’s 7 - year - old child – S

• Samantha Smart – Pat’s 5 - year - old child – D

Budget Group Results:

(Child Only TANF Case)

C Budget Group C 00 A J Budget Group J 00 Pat Smart NS Pat Smart EA Sam Smart EC Samantha Smart EC

B) Two Parent TANF with One SSI Adult

The household applying for TANF consists of Jim Sark who is an SSI recipient, spouse , Jamie and their child , April, age 12.

Head of Household: Jim Sark

• Jamie Sark – Jim’s spouse - W

• April Sark – Jim and Jamie’s 12 - year - old child – D

Budget Group Results:

C Budget Group C 00 I J Budget Group J 00 Jamie Sark ES Jim Sark EA Jim Sark NS April Sark EC

C) SSI Child – Adult Only TANF

The household applying for TANF consists of Amber Franky and child , Annie, age 6. Ann i e is an SSI recipient.

Head of Household: Amber Franky

• Annie Franky (SSI Recipient) – Amber’s 6 - year - old child – D

Budget Group Results:

C Budget Group C 00 A J Budget Group J 00 Amber Franky ES Annie Franky EC Annie Franky NC

D) Two Parent TANF with SSI Children

The household applying for TANF consists of Burt Earnest, spouse , Bee and their two children Darlene and Cassidy, both age 8. Darlene and Cassidy are both SSI recipients.

Head of Household: Burt Earnest

• Bee Earnest – Burt’s Spouse - W

• Darlene Earnest (SSI Recipient) - Burt and Bee’s 8 - year - old child - D

• Cassidy Earnest (SSI Recipient) - Burt and Bee’s 8 - year - old child - D

Budget Group Results:

U Budget Group U 00 C J Budget Group 1 J 00 J Budget Group J2 00 Burt Earnest ES Darlene Earnest EC Cassidy Earnest EC Bee Earnest ES Darlene Earnest NC Cassidy Earnest NC

13. Refugee – (Time Limited Program – 12 months from Date of Entry)

A) Same Date of Entry

Kim Chen and spouse Jia Chen reside in a single - family home. The Chen s qualify under the Refugee Resettlement Program (RRP) as a refugee. For purposes of identifying the higher rate of Federal reimbursement for cash assistance provided to refugees, t he Budget group would be coded by the appropriate refugee program status code (D 02). The re will be one budget group.

Head of Household: Kim Chen

• Jia Chen – Kim’s Spouse - W

Budget Group Results:

D Budget Group D 02 Kim Chen EA Jia Chen EA

NOTE: Beginning with the thirteenth month, determination for continued eligibility using standard Cash/MA regulations will be required.

B) Different Date of Entry

Min Kim and spouse Sing Kim reside in a single - family home. The Kim s qualif y under the Refugee Resettlement Program (RRP) as refugee s . For purposes of identifying the higher rate of Federal reimbursement for cash assistance provided to refugees, t he budget would be coded by the appropriate refugee program status code (D 02). In this situation, there will be 2 separate time limited budget groups that will receive the full FSA.

Date of Entry: Mr. Kim (January) – Mrs. Kim (February)

Head of Household: Min Kim

• Sing Kim – Min’s Spouse - W

Budget Group Results:

Budget Group 1 D 02 Budget Group 2 D2 02 Min Kim EA Sing Kim EA

Revised July 10, 2024, replacing February 4, 2015