State of California - Department of Social Services (44113g1)
State of California Department of Social ServicesNoa Msg Doc No.: M44-113G1 Page 1 of 2Action: ChangeIssue: IncomeTitle: Change in IncomeAuto ID No.:Source:Issued by:Use Form No.: NA 290Original Date: 02-01-97Revision Date: 06-01-98Reg Cite: 44-100, 89-201.5MESSAGE:As of ______, the County is changing your monthly cash aid from $______ to $______.Here’s why:Your family income has changed. When your income changes, your cash aid amount also changes.Your new cash aid amount is figured on this page.INSTRUCTIONS: Use to change the grant amount FOR CASES WHICH INCLUDE MINOR PARENTS when an assistance unit (AU) reports a change in income.Print message on NA 290 with special budget in right column. Budget includes language to accommodate the comparison of MAP for the minor parent’s child(ren).This message replaces M44-113G1 dated 01-01-98 released in Errata to ACL 97-59.file: pkian/MSERIES/44113g1State of California Department of Social ServicesNoa Msg Doc No.: M44-113G1 Page 2 of 2Original Date: 02-01-97Revision Date: 06-01-98Section A. Countable Income, Month of________Total Business Income$________Business Expenses:a. 40% Standard?________ORb. Actual?________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?________Other Sanctions.?________Bonus+________Monthly Cash Aid Amount(Line 12 or 13 Adjusted)=________ ................
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