SSI Budget Worksheet



SSI Budget Worksheet

(for people who receive SSI and income from working)

Name: _____________________________________ Date: ________________________

|Monthly Gross Earned Income | |

|(Weekly Gross Income x 4.3) | |

|Subtract Exclusion | |

| |- $85.00 |

|Adjusted Gross Earned Income | |

|Divide by 2 | |

|COUNTABLE EARNED INCOME | |

| | |

|Base SSI Rate | |

|Subtract COUNTABLE EARNED INCOME | |

|NEW SSI Check | |

| | |

|Monthly Income Without Working (SSI Check) | |

|Monthly Income With Working (New SSI Check + Paycheck) | |

Important Facts:

1. To be eligible for an SSI check, bank account balances must remain below $2000.

2. A person can continue to receive Medicaid, as long as their gross annual earnings are less than $33,751 (2012 threshold).

3. Changes in monthly earnings due to fluctuations in schedule or pay rate must be reported promptly and in writing to the local Social Security Office.

10/10

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