Income Calculation Worksheet
Income Calculation Worksheet
Community:
Unit No.:
Head of Household
Household Member:
YTD - 3PV
YTD Annual Gross
Income
Name of Source
1
Jan
31
28
Feb
Mar
31
Beginning Date
Apr
May
31
Jun
31
YTD Annual Gross
Income
28
Feb
Mar
31
Beginning Date
Apr
30
May
31
31
28
Feb
Mar
Jun
Beginning Date
Apr
30
Aug
May
31
31
365
Sep
30
Divided by
YTD Earnings
Weekly $
30
Jul 31
Aug
/# of
weeks
31
365
# of Days
YTD Annual Gross
Income
31
Weeks
in a year
Annualized
YTD Income
Oct
$0.000000
31
Nov
7 =
Weeks
in a year
Sep
30
Divided by
YTD Earnings
Weekly $
Oct
30
Jul 31
Aug
Sep
31
Divided by
Rate of Pay
Hours/
Frequency
Oct
52.14
Nov
30
Dec
Number of
weeks
7 =
30
31
$0.000000
Weeks
in a year
365
# of Days
Ending Date
31
Dec
Annualized
YTD Income
31
52.14
Annualized
YTD Income
52.14 = $0.000000 x 52.14 =
Jun
30
Number of
weeks
52.14 = $0.000000 x 52.14 =
$0.00
Jan
Jul 31
/# of
weeks
Ending Date
Name of Source
3
30
# of Days
$0.00
Jan
YTD Earnings
Weekly $
52.14 = $0.000000 x 52.14 =
Ending Date
Name of Source
2
30
/# of
weeks
$0.000000
31
Nov
30
Dec
Number of
weeks
7 =
31
52.14
ACTUAL - 3PV
Description
Name of Source
Annual Income
= $0.000000
1
0
x
1
0
x
x
= $0.000000
1
0
x
x
= $0.000000
1
0
x
x
= $0.000000
2
0
x
x
= $0.000000
2
0
x
x
= $0.000000
2
0
x
x
= $0.000000
3
0
x
x
= $0.000000
3
0
x
x
= $0.000000
3
0
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
YTD CHECK STUBS
1
Name of Source
YTD Annual Gross
Income
0
Beginning Date
2
Name of Source
3
Name of Source
$0.00
/# of
weeks
0.14
YTD Annual Gross
Income
/# of
weeks
0.14
1
Divided by
YTD Earnings
Weekly $
Weeks
in a year
1
Divided by
YTD Earnings
Weekly $
= $0.000000 x 52.14
1
Divided by
7 =
$0.000000
Number of
weeks
0.14
Annualized
YTD Income
$0.000000
=
Number of
weeks
7 =
Weeks
in a year
Annualized
YTD Income
=
7 =
= $0.000000 x 52.14
# of
Days
Ending Date
Weeks
in a year
= $0.000000 x 52.14
# of
Days
Ending Date
$0.00
YTD Earnings
Weekly $
# of
Days
YTD Annual Gross
Income
0
Beginning Date
0.14
Ending Date
0
Beginning Date
/# of
weeks
0.14
Annualized
YTD Income
$0.000000
=
Number of
weeks
0.14
INCOME - CHECK STUBS
1
Check Stubs
SAC-127 (Rev 12/02/15)
0
2
Check Stubs
0
1 of 10
Income Calculation Worksheet
Ending Date
Reg
SD Hours
OT Hours
DT Hours
Other Hr
Other
Ending Date
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
Annual Income
Rate of Pay Hours
Other Hr
DT Hours
SD Hours
OT Hours
Other
Annual Income
Rate of Pay Hours
Reg
$0.00 x
0.00 /
7
x
26 =
0.000000
Reg
x
0.00 /
7
x
=
0.000000
OT Hours
$0.00 x
0.00 /
7
x
26 =
0.000000
OT Hours
x
0.00 /
7
x
=
0.000000
SD Hours
$0.00 x
0.00 /
0
x
=
0.000000
SD Hours
x
0.00 /
7
x
=
0.000000
DT Hours
$0.00 x
0.00 /
0
x
=
0.000000
DT Hours
x
0.00 /
7
x
=
0.000000
Other Hr
$0.00 x
0.00 /
7
x
26 =
0.000000
Other Hr
x
0.00 /
7
x
=
0.000000
=
0.000000
Other
=
0.000000
=
0.000000
Bonus
=
0.000000
Other
$0.00
2
/
26
x
x
Bonus
x
TOTAL
3
Reg
Reg
/
2
x
0.000000
Check Stubs
Ending Date
$0.00
x
26
x
0.000000
TOTAL
0
SD Hours
OT Hours
DT Hours
Other Hr
Subtotal =
Other
$0.00
ASSET INCOME
1
Asset
Int. %
Dividend
Actual Income
3
0.00%
0.00
0.000000
4
0.00%
0.00
0.000000
5
0.00%
0.00
0.000000
6
0.00%
0.00
0.000000
7
0.00%
0.00
0.000000
8
0.00%
0.00
0.000000
9
0.00%
0.00
0.000000
10
0.00%
0.00
0.000000
11
0.00%
0.00
0.000000
12
0.00%
0.00
0.000000
13
0.00%
0.00
0.000000
14
0.00%
0.00
0.000000
0.00%
0.00
0.000000
2
Rate of Pay
Cash Value
Annual Income
Hours
Reg
x
0.00 /
7
x
=
0.000000
B. Total Cash Value
0.000000
OT Hours
x
0.00 /
7
x
=
0.000000
C. Total Actual Income
0.000000
SD Hours
x
0.00 /
7
x
=
0.000000
D. If line B is greater than $4,999.99
DT Hours
x
0.00 /
7
x
=
0.000000
multiply line B by 0.06% and enter
$0.00
Other Hr
x
0.00 /
7
x
=
0.000000
=
0.000000
E. Enter the greater of line C or D here
$0.00
=
0.000000
UNIT ANNUAL INCOME GRAND TOTAL
$0.00
Other
Bonus
$0.00
/
x
2
x
x
TOTAL
SAC-127 (Rev 12/02/15)
26
0.000000
2 of 10
Income Calculation Worksheet
Community:
Unit No.:
Head of Household
Household Member:
YTD - 3PV
YTD Annual Gross
Income
Name of Source
1
Jan
31
28
Feb
Mar
31
01/01/2014
Beginning Date
Apr
May
31
Jun
YTD Annual Gross
Income
31
28
Feb
Mar
31
Beginning Date
Apr
May
31
31
28
Feb
Mar
Jun
Beginning Date
Apr
30
Aug
May
31
31
365
Sep
30
Divided by
YTD Earnings
Weekly $
30
Jul 31
Aug
/# of
weeks
31
365
# of Days
YTD Annual Gross
Income
31
Weeks
in a year
Annualized
YTD Income
Oct
$0.000000
31
Nov
7 =
Weeks
in a year
Sep
30
Divided by
YTD Earnings
Weekly $
Oct
30
Jul 31
Aug
Sep
31
Divided by
Rate of Pay
Hours/
Frequency
Oct
52.14
Nov
30
Dec
Number of
weeks
7 =
30
31
$0.000000
Weeks
in a year
365
# of Days
Ending Date
31
Dec
Annualized
YTD Income
31
52.14
Annualized
YTD Income
52.14 = $0.000000 x 52.14 =
Jun
30
Number of
weeks
52.14 = $0.000000 x 52.14 =
$0.00
Jan
Jul 31
# of Days
Ending Date
Name of Source
3
30
30
/# of
weeks
$0.00
Jan
YTD Earnings
Weekly $
52.14 = $0.000000 x 52.14 =
05/14/2014
Ending Date
Name of Source
2
30
/# of
weeks
$0.000000
31
Nov
30
Dec
Number of
weeks
7 =
31
52.14
ACTUAL - 3PV
Description
Name of Source
Annual Income
= $0.000000
1
0
x
1
0
x
x
= $0.000000
1
0
x
x
= $0.000000
1
0
x
x
= $0.000000
2
0
x
x
= $0.000000
2
0
x
x
= $0.000000
2
0
x
x
= $0.000000
3
0
x
x
= $0.000000
3
0
x
x
= $0.000000
3
0
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
YTD CHECK STUBS
1
Name of Source
YTD Annual Gross
Income
0
Beginning Date
2
Name of Source
3
Name of Source
$0.00
/# of
weeks
0.14
YTD Annual Gross
Income
/# of
weeks
0.14
1
Divided by
YTD Earnings
Weekly $
Weeks
in a year
1
Divided by
YTD Earnings
Weekly $
= $0.000000 x 52.14
1
Divided by
7 =
$0.000000
Number of
weeks
0.14
Annualized
YTD Income
$0.000000
=
Number of
weeks
7 =
Weeks
in a year
Annualized
YTD Income
=
7 =
= $0.000000 x 52.14
# of
Days
Ending Date
Weeks
in a year
= $0.000000 x 52.14
# of
Days
Ending Date
$0.00
YTD Earnings
Weekly $
# of
Days
YTD Annual Gross
Income
0
Beginning Date
0.14
Ending Date
0
Beginning Date
/# of
weeks
0.14
Annualized
YTD Income
$0.000000
=
Number of
weeks
0.14
INCOME - CHECK STUBS
1
Check Stubs
SAC-127 (Rev 12/02/15)
0
2
Check Stubs
0
3 of 10
Income Calculation Worksheet
Ending Date
Reg
SD Hours
OT Hours
DT Hours
Other Hr
Other
Ending Date
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
Annual Income
Rate of Pay Hours
Other Hr
DT Hours
SD Hours
OT Hours
Other
Annual Income
Rate of Pay Hours
Reg
$0.00 x
0.00 /
13 x
52 =
0.000000
Reg
x
0.00 /
7
x
=
0.000000
OT Hours
$0.00 x
0.00 /
7
x
26 =
0.000000
OT Hours
x
0.00 /
7
x
=
0.000000
SD Hours
$0.00 x
0.00 /
0
x
=
0.000000
SD Hours
x
0.00 /
7
x
=
0.000000
DT Hours
$0.00 x
0.00 /
0
x
=
0.000000
DT Hours
x
0.00 /
7
x
=
0.000000
Other Hr
$0.00 x
0.00 /
7
x
26 =
0.000000
Other Hr
x
0.00 /
7
x
=
0.000000
=
0.000000
Other
=
0.000000
=
0.000000
Bonus
=
0.000000
Other
$0.00
2
/
26
x
x
Bonus
x
TOTAL
3
Reg
Reg
/
2
x
0.000000
Check Stubs
Ending Date
$0.00
x
26
x
0.000000
TOTAL
0
SD Hours
OT Hours
DT Hours
Other Hr
Subtotal =
Other
$0.00
ASSET INCOME
1
Asset
Int. %
Dividend
Actual Income
3
0.00%
0.00
0.000000
4
0.00%
0.00
0.000000
5
0.00%
0.00
0.000000
6
0.00%
0.00
0.000000
7
0.00%
0.00
0.000000
8
0.00%
0.00
0.000000
9
0.00%
0.00
0.000000
10
0.00%
0.00
0.000000
11
0.00%
0.00
0.000000
12
0.00%
0.00
0.000000
13
0.00%
0.00
0.000000
14
0.00%
0.00
0.000000
0.00%
0.00
0.000000
2
Rate of Pay
Cash Value
Annual Income
Hours
Reg
x
0.00 /
7
x
=
0.000000
Total Cash Value
0.000000
OT Hours
x
0.00 /
7
x
=
0.000000
Total Actual Income
0.000000
SD Hours
x
0.00 /
7
x
=
0.000000
Total Income for Household Member
DT Hours
x
0.00 /
7
x
=
0.000000
Other Hr
x
0.00 /
7
x
=
0.000000
=
0.000000
=
0.000000
Other
Bonus
$0.00
/
x
2
x
x
TOTAL
SAC-127 (Rev 12/02/15)
26
0.00
0.000000
4 of 10
Income Calculation Worksheet
Community:
Unit No.:
Head of Household
Household Member:
YTD - 3PV
YTD Annual Gross
Income
Name of Source
1
Jan
31
28
Feb
Mar
31
Beginning Date
Apr
May
31
Jun
31
YTD Annual Gross
Income
28
Feb
Mar
31
Beginning Date
Apr
30
May
31
31
28
Feb
Mar
Jun
Beginning Date
Apr
30
Aug
May
31
31
365
Sep
30
Divided by
YTD Earnings
Weekly $
30
Jul 31
Aug
/# of
weeks
31
365
# of Days
YTD Annual Gross
Income
31
Weeks
in a year
Annualized
YTD Income
Oct
$0.000000
31
Nov
7 =
Weeks
in a year
Sep
30
Divided by
YTD Earnings
Weekly $
Oct
30
Jul 31
Aug
Sep
31
Divided by
Rate of Pay
Hours/
Frequency
Oct
52.14
Nov
30
Dec
Number of
weeks
7 =
30
31
$0.000000
Weeks
in a year
365
# of Days
Ending Date
31
Dec
Annualized
YTD Income
31
52.14
Annualized
YTD Income
52.14 = $0.000000 x 52.14 =
Jun
30
Number of
weeks
52.14 = $0.000000 x 52.14 =
$0.00
Jan
Jul 31
/# of
weeks
Ending Date
Name of Source
3
30
# of Days
$0.00
Jan
YTD Earnings
Weekly $
52.14 = $0.000000 x 52.14 =
Ending Date
Name of Source
2
30
/# of
weeks
$0.000000
31
Nov
30
Dec
Number of
weeks
7 =
31
52.14
ACTUAL - 3PV
Description
Name of Source
Annual Income
2080
= $0.000000
1
0
x
1
0
x
x
= $0.000000
1
0
x
x
= $0.000000
1
0
x
x
= $0.000000
2
0
x
x
= $0.000000
2
0
x
x
= $0.000000
2
0
x
x
= $0.000000
3
0
x
x
= $0.000000
3
0
x
x
= $0.000000
3
0
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
x
x
= $0.000000
YTD CHECK STUBS
1
Name of Source
YTD Annual Gross
Income
0
Beginning Date
2
Name of Source
3
Name of Source
$0.00
/# of
weeks
0.14
YTD Annual Gross
Income
/# of
weeks
0.14
1
Divided by
YTD Earnings
Weekly $
Weeks
in a year
1
Divided by
YTD Earnings
Weekly $
= $0.000000 x 52.14
1
Divided by
7 =
$0.000000
Number of
weeks
0.14
Annualized
YTD Income
$0.000000
=
Number of
weeks
7 =
Weeks
in a year
Annualized
YTD Income
=
7 =
= $0.000000 x 52.14
# of
Days
Ending Date
Weeks
in a year
= $0.000000 x 52.14
# of
Days
Ending Date
$0.00
YTD Earnings
Weekly $
# of
Days
YTD Annual Gross
Income
0
Beginning Date
0.14
Ending Date
0
Beginning Date
/# of
weeks
0.14
Annualized
YTD Income
$0.000000
=
Number of
weeks
0.14
INCOME - CHECK STUBS
1
Check Stubs
PPMG127 (Rev 03/08/2018)
0
2
Check Stubs
0
5 of 10
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