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Aged, Blind and Disabled Manual Policy Manual Number: 130.010 Section: CHOICES Chapter: Employment and Community First CHOICES August 01, 2024 Division of TennCare 9 Impairment Related Work Expense - 0.00 ½ Deduction - 1657.50 Blind Work Expense - 0.00 Total Net Earned Income = $ 1657.50 Total Countable Income (Total Net Unearned Income + Total Net Earned Income) = $ 1657.50 Qualified Income Trust - N/A Net Countable Income

$ 1657.50 Income Test Limit

$ 2684.00 Income Test Result PASS The above budget is current as of July 2021. Linda’s net countable income, $1657.50, is less than 250% of the FPL. Linda has passed the first income test. ii. SSI-FBR Test Income Budget Calculation

Unearned Income $ 0.00 Irregular Unearned Income Disregard + 0.00 In-Kind Support and Maintenance + N/A Ineligible Spouse’s Deemed Unearned Income + 0.00 Ineligible Parent’s Deemed Income + 0.00 General Deduction ($20) - 0.00 Child Support Disregard - 0.00 Widow/Widower Entitlement Disregard - N/A DAC Entitlement Disregard - N/A COLA Disregard - N/A Total Net Unearned Income = $ 0.00 Self-Employment Income

$ 0.00 Earned Income + $ 0.00 Irregular Earned Income Disregard - 0.00 Student Earned Income Exclusion - 0.00 Ineligible Spouse’s Deemed Earned Income + 2000.00 Remaining General Deduction - 20.00 Earned Income Deduction - 65.00 Impairment Related Work Expense - 0.00 ½ Deduction - 957.50 Blind Work Expense - 0.00 Total Net Earned Income = $ 957.50 Total Countable Income (Total Net Unearned Income + Total Net Earned Income) = $ 957.50