Women’s Health Program



Healthy Texas Women Income WorksheetTotal Gross Earned Income$Earned Income Deduction(s)-Adjusted Gross Earned Income=Total Unearned Income+=Other Deductions-*Countable Monthly Income=Convert earned/unearned income and deductions to monthly using the following conversion factors: If paid or received weekly, multiply by 4.33; Bi-weekly, multiply by 2.17; or Semi-monthly, multiply by 2.Earned IncomeEarned income is related to funds received for work-related activities; entitling a household to certain allowable deductions. Earned Income Deduction(s)?The earned income deduction is the work-related expense of $120 per employed person.?The costs for care of a child or incapacitated adult (even when the child or incapacitated adult is not included in the certified group); or?Transportation of a child to and/or from day care or school.?Dependent Care Maximum Deductions –?$200 per month for each child under age two, and?$175 per month for each dependent age two or older.Note: Enter zero adjusted earned income if deductions exceed earnings.Unearned IncomeUnearned income is income received without performing work-related activities.Examples: SSI, RSDI, VA, Worker’s Compensation, Unemployment, Child Support, Alimony, Savings/Checking Account Interest, Retirement Benefits, and TANF.Other Deductions?Child Support –?Paid Out - Deduct child support payments made by a member of the budget group.?Received - Deduct up to $75 per month of total child support received by members of the budget group.?Alimony, and?Payments to dependents living outside the home.Monthly Countable IncomeCompare this amount to the Federal Poverty Limit chart for the appropriate household size. ................
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