Income Calculation Worksheet - Page 1 -

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Income Calculation Worksheet - Page 1 - Powered By Docstoc
					                                        Income Calculation Worksheet
WORK INCOME (EARNED) : PARENT #1 __________                         WORK INCOME (EARNED) : PARENT #2 __________


ONCE A MONTH                                           $________    ONCE A MONTH                                          $________

TWICE A MONTH (e.g., 1st and 15th)                     $________    TWICE A MONTH (e.g., 1st and 15th)                    $________
Multiply by 2                             $_______                  Multiply by 2                                        $_______

EVERY 2 WEEKS (e.g., every other Friday) $________                  EVERY 2 WEEKS (e.g., every other Friday) $________
Multiply by 2.167                         $_______                  Multiply by 2.167                                  $_______

EVERY WEEK (e.g., every Friday)                        $________    EVERY WEEK (e.g., every Friday)                       $________
Multiply by 4.33                                       $_______     Multiply by 4.33                                      $_______


OTHER COUNTABLE INCOME                                              OTHER COUNTABLE INCOME
(UNEARNED):$________                                                (UNEARNED):$________
(i.e., Alimony, Unemployment, Worker’s Compensation, SDI, etc.)     (i.e. Alimony, Unemployment, Worker’s Compensation, SDI, etc.)

                                                                    TOTAL GROSS INCOME: Parent #2
TOTAL GROSS INCOME: Parent #1                      $___________
                                                                    $____________

DEDUCTIONS                                                          DEDUCTIONS

Work Expense (deduct up to $90)                $___________         Work Expense (deduct up to $90)               $___________

Childcare Expense (if paid by this parent) $___________             Childcare Expense (if paid by this parent) $___________
•    If a child is less than 2 years old, deduct up to $200. If a   •   If a child is less than 2 years old, deduct up to $200. If a
     child is 2 years old or older, deduct up to $175.                  child is 2 years old or older, deduct up to $175.
•    If parent pays less than $200/$175, deduct the actual          •   If parent pays less than $200/$175, deduct the actual
     amount paid.                                                       amount paid.

Alimony RECEIVED (by this parent)               $___________        Alimony RECEIVED (by this parent)              $___________
•    Deduct up to $50. Calculate amount by determining how          •   Deduct up to $50. Calculate amount by determining how
     many family members receive alimony/child support and              many family members receive alimony/child support and
     divide $50 by that number.                                         divide $50 by that number.

Dependent Care (if paid by this parent) $____________               Dependent Care (if paid by this parent) $____________
•    For care of disabled dependents, up to $175/dependent.         •   For care of disabled dependents, up to $175/dependent.
•    If parent pays less than $175, deduct the amount paid.         •   If parent pays less than $175, deduct the amount paid.

Alimony/Child Support PAID (by this parent)                         Alimony/Child Support PAID (by this parent)
•    Deduct the actual/court-ordered amount paid, whichever is      •   Deduct the actual/court-ordered amount paid, whichever is
     less                                                               less

                                          $___________                                                       $___________



TOTAL PARENT DEDUCTIONS                          $___________       TOTAL PARENT DEDUCTIONS                         $___________



(Total Gross Income – Total Deductions) =                           (Total Gross Income – Total Deductions) =

Parent #1- Net Income                                               Parent #2- Net Income

                                         $____________                                                       $____________



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                                                         Child 1              Child 2              Child 3
            Parent’s Net Income
            (From Reverse Side)                   Age______            Age______            Age______
                                                  Family Size_______   Family Size_______   Family Size_______

Parent #1                                             $___________         $___________         $___________
(if counted for this child)
Parent #2                                             $___________         $___________         $___________
(if counted for this child)

           Total Parent Net Income
                                                      $___________         $___________         $___________
                   (Box A)



        Child’s Countable Income                         Child 1              Child 2              Child 3

Work Income (Earned)
• if not enrolled in school and over 14 years         $___________         $___________         $___________
     old
Other Countable Income (Unearned)                     $___________         $___________         $___________
(i.e., Child Support, Soc. Sec. benefits, etc.)

        Total Child Gross Income                      $___________         $___________         $___________
                 (Box B)


             Child’s Deductions                          Child 1              Child 2              Child 3

Work Expense
                                                      $___________         $___________         $___________
• deduct up to $90
Child Support Received by this child
•    Deduct up to $50. Calculate amount by
     determining how many family members              $___________         $___________         $___________
     receive alimony/child support and divide
     $50 by that number.


           Total Child Deductions
                                                      $___________         $___________         $___________
                  (Box C)


         Total Parent Net Income
                 (Box A)                              $___________         $___________         $___________
                    +
        Total Child Gross Income
                 (Box B)                          + $___________       + $___________       + $___________
                              -
           Total Child Deductions
                  (Box C)                         - $___________       - $___________       - $___________
                                                  Child 1 Net Income   Child 2 Net Income   Child 3 Net Income
              Child Net Income
                                                      =$___________        =$___________        =$___________


             May be Eligible for:




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