Benefit Planning Tool .or.us
|[pic] |Public Health Division |[pic] |
| |HIV Community Services Program | |
| | | |
| | | |
Benefit Planning Tool — Guide and Instructions
|Client name: | |Client number: | |
|First calculate the projected wage for the anticipated job. |
|Hours worked per month | |multiplied by hourly wage | |
|Cash benefit type: | | | |
|Earned income: | | | |
|Total of |0[pic]$0.00 | | |
|cash income: | | | |
|SNAP[1] amount: | | | |
|Total income: |$0.00[pic]$0.00 | | |
|Expense |Current |Impacted by earned income? |Impact of earned income |
| | |(yes/no) | |
|Housing: | | | |
|Healthcare benefit: | | | |
|Childcare cost: | | | |
|Total expense: |0[pic]$0.00 | | |
|Total net income: |$0.00[pic]$0.00 | | |
|What is the change in monthly income with employment? |
| |
|What additional work incentives will your client be eligible for? |
|Detail income |
|Income |Current |Impacted by earned income? (yes/no) |Impact of earned income |
|Cash benefit type — List |List dollar amount received |Yes — cash amount is reduced by earned |Enter new amount of cash benefit based on formula; |
|benefit type |each month |income and formula |SSI — amount is reduced one |
|such as SSI, SSDI or TANF: | |No — no impact |dollar for every two earned; |
| | | |first $85 is exempt |
| | | |SSDI — no reduction if earnings remain under |
| | | |SGA — ($1,010 for 2012) |
|Earned income: |If working, enter total |N/A |Enter anticipated total monthly gross earnings including hourly|
| |monthly gross earnings | |wage and projected hours per week |
| |including hourly wage and | | |
| |hours | | |
| |per week | | |
|Total of |Add columns above |N/A |Add columns above |
|cash income: | | | |
|SNAP[2] amount: |Enter current SNAP grant |Yes — SNAP amount |Enter in amount of SNAP award |
| |amount |is reduced by | |
| | |earned income | |
| | |No — no impact | |
|Total income: |Add total cash income and | |Add total cash income and SNAP amount |
| |SNAP amount | | |
|Details expense |
|Expense |Current |Impacted by earned income? |Impact of earned income |
| | |(yes/no) | |
|Housing — State voucher type or |Enter amount of |Yes — impacted by earned income |To determine adjusted amount contact: |
|program for subsidized rent: |rent payment |No — no impact |Local Public Housing Authority (PHA) rent specialist or |
| | | |Supported Housing Program rent specialist/calculator |
|Healthcare benefit: |List out of pocket |Yes — impacted by earned income |List out of pocket cost if applicable |
| |cost if applicable |No — no impact | |
|Childcare cost: |List out of pocket |Yes — impacted by earned income |List out of pocket childcare costs/co-pay |
| |childcare costs/ |No — no impact | |
| |co-pay | | |
|Total expense (Housing, healthcare|Add housing, | |Add housing, healthcare and childcare costs |
|childcare): |healthcare and | | |
| |childcare costs | | |
|Total net income: |Subtract expenses | |Subtract expenses from income |
| |from income | | |
|What is the change in monthly income with employment? |
|(Consider the difference between income with employment and income without employment.) |
|What additional work incentives will the client be eligible for? |
|(Consider benefits that come with having a job — refer to resources.) |
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[1] Supplemental Nutrition Assistance Program (SNAP)
[2] Supplemental Nutrition Assistance Program (SNAP)
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