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Chapter 3: Household Income Rev. 8/2012 11

For QMB, SLMB or QI individuals that do not have the Medical Savings Program form 271 in file director you will use the Que Budget Screen (alt 2), use the total income less medicare premiums X 3 for gross income.

SS09 Que Budget Screen-income screen (alt 2)

(C) Zero Income When an applicant claims little or no income for the past three months, question the applicant about how living expenses (rent, utilities, food, home supplies, etc.) were met during that period of time. (D) Income Rounding Enter the actual dollar amount including the cents for each income type on the application worksheet income panel, the system will automatically round each income type down. (E) Verification of Income Applicants are required to provide verification of all income received in the required reporting period. Individuals that are categorically income eligible do not need to provide verification of income. The income and child support expense panels from the SNAP benefit file must be included as part of the energy assistance record. For medical the 271 form Medicare savings worksheet, que budget screen must be included as part of the energy assistance record. There are situations where the client may have special circumstances surrounding their ability to obtain and submit the necessary verifications. The caseworker should exercise prudent judgment as to whether or not the client may have physical, mental limitations or communication limitations such as no telephone or transportation. In no situation is it the responsibility of DSS to obtain information for clients simply because they are unwilling to obtain it themselves. (1) Refusal or Failure of Employer to Provide Information In situations where an employee/employer relationship is terminated and the employer refuses to provide wage verification to the applicant due to the nature of the termination or because of Take the total income from the SS09 Budg screen X 3 on your worksheet and transfer to other income on the application worksheet .