N.Y.C. FOOD STAMP BUDGET WORKSHEET
 
 Note: The Food Stamp benefit calculator has been revised to reflect changes effective April 1, 2009.
 
  Number in Household:
  Any Elderly (60+)/Disabled Member?
  Are you a working family with out-of-pocket child/dependent care expenses?
    INCOME
  		• Monthly Gross Earned Income(salary, self-employment, etc.) $
  		• Net Monthly Income from Boarder/Lodger/Rental Property: up to $176 deduction for a single person, $323 for a couple. Please use the Boarder/Lodger Worksheet $
  		• Monthly gross Unearned Public Assistance Income $
  		• Monthly gross Unearned RSI/SSD/SSI $
  		• Monthly gross Unearned "Other Income" $
  		• Child Support Payments(actually paid, legally obligated amounts) $
  		• Adjusted Gross Income $
        MAXIMUM GROSS MONTHLY INCOME TEST - see chart for correct family size.
    		 $
        DEDUCTIONS
  		• Child Care/Dependent Costs: Please use the Child Care/Dependent Care Costs Worksheet $
  		• Is this household homeless undomiciled and not in continuous shelter?   
  		• Medical expense deductions only for Elderly/Disabled members. Take the total average monthly unreimbursed medical expenses. $
        MONTHLY SHELTER COSTS
  		• Actual rent/mortgage billed to the household $
  		• Where do you live?
  		• Standard Utility Allowance(SUA) Levels
  • Level 1 - $781: Has heating/cooling or received or anticipates receipt of HEAP for the current program year
  • Level 2 - $308: Ineligible for or did not receive HEAP for the current program year, has no heating/cooling costs, but has utility costs
  • Level 3 - $33: Ineligible for or did not receive HEAP for the current program year, has no heating/cooling or utility costs, but has phone
  		• Other Owned-Property Shelter Costs: Taxes, Insurance, Repairs $
        FOOD STAMP NET INCOME $
        FOOD STAMP ENTITLEMENT
  		• Thrifty Food Plan amount for H.H. size(See below) $
  		• Food Stamp Recoupment (if applicable) $
  		• Potential Food Stamp Allotment $

    As of April 1, 2009

      FOOD PLAN MONTHLY AMOUNT HOUSEHOLDS WITH NON-ELD/DIS
    (130% FPL)    		 HOUSEHOLDS WITH CHILD/DEPENDENT CARE COSTS
    (200% FPL)
    1 2001,1271,733
    2 3671,5172,333
    3 5261,9072,933
    4 6682,2973,533
    5 7932,6874,133
    6 9523,0774,733
    7 1,0523,4675,333
    8 1,2023,8575,933
    Each additional member+$150+$390+$600
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