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 Poverty
Monthly 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