Supplemental Nutrition Assistance Program Budget Worksheet
Effective 10/1/15 through 9/30/16
INCOME 1Gross Monthly Earned Income______
2Monthly Unearned Income______
3 Gross Income (Line 1 + Line 2)______
4Child support paid______
5Adjusted Gross income (Line 3 - Line 4)______(cannot exceed 130% Gross Income Limit
UNLESS there is an elderly/disabled person or household incurs
dependent care costs then use 200%Gross Income Limit)
DEDUCTIONS 6Earned Income deduction (Line 1 x 20%)______
7Standard deduction (see chart)______
8Dependent care(use actual costs)______
9Homeless deduction ($143)______
10Medical expenses over $35/month*______
11Total deductions (Add Lines 6 thru 10)______
12Adjusted Income (Line 5 – Line 11)______
If the amount is a negative number, enter $0
SHELTER 13Rent/Mortgage______
EXPENSES
14Standard utility allowance (SUA)______
15Other shelter (taxes, etc.)______
16Total shelter expenses (13+14+15)______
EXCESS 17Divide line 12 (adjusted income) by 2______
SHELTER
DEDUCTION 17aShelter Excess (Line 16- Line 17):______
If the amount is greater than $504enter$504on 17a -- UNLESS there is an elderly/disabled household member (in which case enter the full amount).
If the amount is a negative number, enter $0.
CALCULATING 18Net Income (Line 12 - Line 17a) ______
THE BENEFIT cannot exceed Net Income Limit unless categorically eligible
ALLOTMENT (negative number = $0 net income)
19Thrifty Food Plan amount______
20Net Income (Line 18) multiplied by 30% ______
21Estimated Benefit (Line 19 - Line 20)** & ***______
*Medical deduction available ONLY to elderly/disabled household members
**ALL 1-2 person households, who pass the net income test or who are categorically eligible, automatically receive a minimum $16 allotment, even if Line 21 is less than $16.
***Categorically eligible households with 3 or more members who yield a zero or negative monthly SNAP benefit (line 21) will NOT be eligible for SNAP.
Poverty Guidelines Chart
Family Size / 130% of PovertyMonthly GROSS Income
10/1/15– 9/30/16 / 200% of Poverty
Monthly GROSS Income
10/1/15 – 9/30/16 / 100% of Poverty
Monthly NET Income
10/1/15 – 9/30/16
1 / $1,276 / $1,962 / $981
2 / $1,726 / $2,655 / $1,328
3 / $2,177 / $3,348 / $1,675
4 / $2,628 / $4,042 / $2,021
5 / $3,078 / $4,735 / $2,368
6 / $3,529 / $5,428 / $2,715
7 / $3,980 / $6,122 / $3,061
8 / $4,430 / $6,815 / $3,408
Each Additional Person / + $451 / + $693 / + $347
165% of poverty is used for severely disabled and elderly people who live with others and are unable to purchase and prepare their own food. See page 33 of the Prescreening Guide for more information:
Each Additional
H.H. Size 1 2 3 4 5 6 7 8 Person
165% of FPL $1,619 $2,191 $2,763 $3,335 $3,907 $4,479 $5,051 $5,623 +$572
Standard Deduction Amounts
(October 1, 2014 - September 30, 2015):
Household size1-3 people4 people5 people6 or more people
$155 $168 $197 $226
Standard Utility Allowances for NYS (Oct. 1, 2015 - Sept. 30, 2016)
Level 1Level 2Level 3 (telephone)
New York City $768$304$33
Nassau & Suffolk Counties $716$281$33
Rest of State $636$257$33
MAXIMUM SNAP (Thrifty Food Plan) ALLOTMENTS, by household size
For each
H.H. Size 1 2 3 4 5 6 7 8 Additional Person
Maximum $194 $357 $511 $649 $771 $925 $1,022 $1,169 + $146
Allotment
1