Get Form Sr-100 Income Worksheet For Eligibility And Parent

The Form SR-100 Income Worksheet for Eligibility and Parent Copayments is a crucial document used to determine eligibility for various programs. This guide provides you with step-by-step instructions to successfully fill out this form online.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by selecting the appropriate household type at the top of the form, choosing either 'Single Parent Household' or 'Two-Parent Household.'
3. Enter the name of the person who is employed in the corresponding field, along with their employer’s name, address, and telephone number.
4. Specify the source of earned income, followed by the gross earned income amount for each adult family member. Fill in the frequency of payment, selecting one from the provided options such as weekly, bi-weekly, monthly, or annual.
5. For parents engaged in education, enter their educational institution's name, address, and phone number, as well as the relevant gross annual earned income from educational activities.
6. Repeat the process for any additional adult family members in the home, detailing their income and education where applicable.
7. Proceed to section II, where you will check any deductions relevant to your household, such as child support or alimony payments. Enter the case or account number, monthly amount, annual amount, and the name of the family member making the payment.
8. In section III, document any unearned income received by family members, again checking applicable options and recording the necessary information, including the case/account number and amounts.
9. Calculate the total annual gross income by adding earned income, unearned income, and deducting total authorized deductions.
10. Finally, provide a signature certifying the accuracy of the information, along with the date. Ensure all necessary fields are completed before submitting the form.

Complete all necessary documents online to ensure your eligibility assessment is processed efficiently.