Income Calculation
Account #:
State Abbr:
Household Member
Age
Income Source
Pay Type
Dollars Per Pay
Hours Per Week
Weeks/Bi Per Year
Months Per Year
Ending YTD
H
O
W
B
M
C
Y
H
O
W
B
M
C
Y
H
O
W
B
M
C
Y
H
O
W
B
M
C
Y
ADJUSTMENTS
UNREIMBURSED MEDICAL EXPENSE
CALCULATIONS
PP Type
$$ PP
H - Hourly
=$$ per Pay * Hours * Wks
Child Care Exp
Doctor:
W
B
M
Y
C
O-Overtime
=$$ per Pay * Hours * Wks
Elderly (Y/N)
N
Y
Hospital:
W
B
M
Y
C
W- Weekly
=$$ per Pay * Wks
Nbr Dependents
Insurance:
W
B
M
Y
C
B- Biweekly
=$$ per Pay * BiWks
Nbr In Household
Medication:
W
B
M
Y
C
M- Monthly
=$$ per Pay * Months
Other:
W
B
M
Y
C
C- Calculated
=$$ per Pay / Days * 365
Y- Yearly
=$$ per Pay
Med Expense
=Exp - (Gross Inc * 3%)
Child Care Exp
=Exp
Elderly Family
=Yes 400.00 / No 0.00
Dependents
=Number * 480.00
Handbook 1-3550, Chapter 4
Handbook 2-3550, Chapter 4
Warning:
This site is for authorized USDA employees only.
