State of California - Department of Social Services (44133q)



State of California Department of Social ServicesNoa Msg Doc No.: M44-133Q Page 1 of 2Action : ChangeIssue: IncomeTitle: Minor Parent IncomeAuto ID No.:Source :Issued by :Use Form No.: NA 290Original Date: 02-01-97Revision Date: 06-01-98Reg Cite : 44-133.5, 89-201.5MESSAGE:As of ______, the County is changing your monthly cash aid from $______ to $______.Here’s why:Your parent’s income has changed.When you are pregnant or a parent and under age 18 living with your parent, your parent’s income is counted to figure your cash aid. When their income changes, your income also changes.Your new cash aid amount is figured on this page.INSTRUCTIONS: Use to change the grant amount in minor parent cases when a change in the family’s income (AU + Non-AU)causes the minor parent’s income to change.Print message on NA 290 with special budget in right column. Budget includes language to accommodate the comparison of MAP for the minor parent’s child(ren).This message replaces M44-133Q dated 01-01-98 released in Errata to ACL 97-59.file: pkian/MSERIES/44133qState of California Department of Social ServicesNoa Msg Doc No.: M44-133Q Page 2 of 2Original Date: 02-01-97Revision Date: 06-01-98Section A. Countable Income, Month of ________Total Business Income$________Business Expenses:40% Standard?________ORActual?________Net Earnings from Self-Employment=________Total Disability-Based Unearned Income of(Assistance Unit+ Non-Assistance Unit Members)$________$225 Disregard?________Nonexempt Unearned Disability-Based Income=________ORUnused Amount of $225 Disregard=________Total Earned Income$________Net Earnings from Self-Employment (from above)+________Subtotal=________Unused Amount of $225 Disregard (from above)?________Subtotal=________Earned Income Disregard 50%?________Subtotal=________Nonexempt Unearned Disability-Based Income(from above)+________Other Nonexempt Income of (Assistance Unit+ Non-Assistance Unit Members)+________________________________________________+________Net Countable Income=________Section B. Your Cash Aid, Month of________Maximum Aid,___Persons (Assistance Unit+ Non-Assistance Unit Members)$________Special Needs(Assistance Unit + Non-Assistance Unit Members)+________Net Countable Income from Section A?________Subtotal=________Maximum Aid,____Persons(Assistance Unit only)(Excluding Sanctioned Persons)$________Special Needs (Assistance Unit only)+________Maximum Aid Subtotal=________Full Month Aid Subtotal(Lowest Amount on Line 4 or 7)=________Maximum Aid for Minor parent’s___ eligible child(ren)$________Special Needs+________Minor parent’s child(ren) Subtotal=________Full Month Aid Subtotal(Greater Amount on Line 8 or 11)=________Line 12 Prorated for Part of Month=________Adjustments: 25% Child Support Sanction?________Overpayment?________14a.Other Sanctions?________14b.Bonus+________Monthly Cash Aid Amount(Line 12 or 13 Adjusted)=________ ................
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