Instructions for Copayment Worksheet

Instructions

The following step-by step instructions must be used when completing the Family Income Calculation Worksheet

  1. Upon opening worksheet, the current date will appear.
  2. Enter the client's first and last name.
  3. Enter the client's CCMS case number.
  4. If there are 2 check stubs, enter the Date and Gross Wages and Salary from the Client's earliest Check Stub according to pay frequency. For 3 check stubs, go to #25.
  5. Enter the Date and Gross Wages and Salary from the Client's latest Check Stub according to pay frequency.
  6. The worksheet will automatically compute the Employment Income Sub-Total for the Gross Wages and Salary amounts entered in each of the four columns (Weekly, Bi-weekly, Semi-monthly, Monthly)
  7. The worksheet will automatically average the Employment Income for Gross Wages and Salary the client receives per pay frequency by dividing the Employment Income Sub-Total by 2.
  8. Worksheet will automatically convert to Adjusted Monthly Employment Income by multiplying the Average Employment Income by one of the numbers below, based upon the payment frequency.
Multiplier Pay Frequency
4.333 Weekly
2.1666 Bi-weekly
2 Semi-Monthly
1 Monthly
  1. Worksheet will automatically calculate the Adjusted Employment Income from Average Employment Income.
  2. Worksheet will automatically calculate the Total Employment Income for all four columns of the Adjusted Employment Income. Enter this amount on the CCMS Income Screen for the 1st Parent Actual Employment Income.
  3. Enter the Date and Gross Wages and Salary from the 2nd parent/stepparent's earliest Check Stub according to pay frequency.
  4. Enter the Date and Gross Wages and Salary from the 2nd parent/stepparent's latest Check Stub according to pay frequency.
  5. The worksheet will automatically compute the Employment Income Sub-Total for the Gross Wages and Salary amounts entered in each of the four columns (Weekly, Bi-weekly, Semi-monthly, Monthly)
  6. The worksheet will automatically average the Employment Income for Gross Wages and Salary the 2nd parent/stepparent receives per pay frequency by dividing the Employment Income Sub-Total by 2.
  7. Worksheet will automatically convert to Adjusted Monthly Employment Income by multiplying the Average Employment Income by one of the numbers below, based upon the payment frequency.
Multiplier Pay Frequency
4.333 Weekly
2.1666 Bi-weekly
2 Semi-Monthly
1 Monthly
  1. Worksheet will automatically calculate the Adjusted Employment Income from Average Employment Income.
  2. Worksheet will automatically calculate the Total Employment Income for all four columns of the Adjusted Employment Income. Enter this amount on the CCMS Income Screen for the 2nd Parent Actual Employment Income.
  3. Enter the Date and Gross Wages and Salary from all other family member's earliest Check Stub according to pay frequency.
  4. Enter the Date and Gross Wages and Salary from all other family member's latest Check Stub according to pay frequency.
  5. The worksheet will automatically compute the Employment Income Sub-Total for the Gross Wages and Salary amounts entered in each of the four columns (Weekly, Bi-weekly, Semi-monthly, Monthly)
  6. The worksheet will automatically average the Employment Income for Gross Wages and Salary the other family members receive per pay frequency by dividing the Employment Income Sub-Total by 2.
  7. Worksheet will automatically convert to Adjusted Monthly Employment Income by multiplying the Average Employment Income by one of the numbers below, based upon the payment frequency.
Multiplier Pay Frequency
4.333 Weekly
2.1666 Bi-weekly
2 Semi-Monthly
1 Monthly
  1. Worksheet will automatically calculate the Adjusted Employment Income from Average Employment Income.
  2. Worksheet will automatically calculate the Total Employment Income for all four columns of the Adjusted Employment Income. Enter this amount on the CCMS Income Screen for the Other Family Members Actual Employment Income.
  3. Use if there are 3 Check Stubs for either the Client, 2nd Parent or Other Family Members. Enter "Client", "2nd Parent" or "Other Family Members" to identify who the check stubs are for.
  4. Enter the Date and Gross Wages and Salary for the earliest Check Stub according to pay frequency.
  5. Enter the Date and Gross Wages and Salary for the 2nd Check Stub according to pay frequency.
  6. Enter the Date and Gross Wages and Salary for the latest Check Stub according to pay frequency.
  7. The worksheet will automatically compute the Employment Income Sub-Total for the Gross Wages and Salary amounts entered in each of the four columns (Weekly, Bi-weekly, Semi-monthly, Monthly)
  8. The worksheet will automatically average the Employment Income for Gross Wages and Salary the other family members receive per pay frequency by dividing the Employment Income Sub-Total by 3.
  9. Worksheet will automatically convert to Adjusted Monthly Employment Income by multiplying the Average Employment Income by one of the numbers below, based upon the payment frequency.
Multiplier Pay Frequency
4.333 Weekly
2.1666 Bi-weekly
2 Semi-Monthly
1 Monthly
  1. Worksheet will automatically calculate the Adjusted Employment Income from Average Employment Income.
  2. Worksheet will automatically calculate the Total Employment Income for all four columns of the Adjusted Employment Income. Enter this amount on the CCMS Income Screen for the 1st Parent, 2nd Parent or Other Family Members Actual Employment Income.
  3. Enter the Net Self-Employment Income from Client's (1st Parent's) documentation according to payment frequency.
  4. Worksheet will automatically convert to Monthly Self-Employment Income by multiplying Net Self-Employment Income by the one of the numbers below, based upon the payment frequency.
Multiplier Pay Frequency
4.333 Weekly
2.1666 Bi-weekly
2 Semi-Monthly
1 Monthly
  1. Worksheet will automatically calculate the Adjusted Monthly Self-Employment Income.
  2. Worksheet will automatically calculate the Total Employment Income for all four columns of the Adjusted Self-Employment Income. Enter this amount on the CCMS Income Screen for the 1st Parent Actual Self-Employment Income.
  3. Enter the Net Self-Employment Income from 2nd Parent/Stepparent's documentation according to payment frequency.
  4. Worksheet will automatically convert to Monthly Self-Employment Income by multiplying Net Self-Employment Income by the one of the numbers below, based upon the payment frequency.
Multiplier Pay Frequency
4.333 Weekly
2.1666 Bi-weekly
2 Semi-Monthly
1 Monthly
  1. Worksheet will automatically calculate the Adjusted Monthly Self-Employment Income.
  2. Worksheet will automatically calculate the Total Employment Income for all four columns of the Adjusted Self-Employment Income. Enter this amount on the CCMS Income Screen for the 2nd Parent Actual Self-Employment Income.
  3. Enter the Net Self-Employment Income from Other Family Member(s) documentation according to payment frequency.
  4. Worksheet will automatically convert to Monthly Self-Employment Income by multiplying Net Self-Employment Income by the one of the numbers below, based upon the payment frequency.
Multiplier Pay Frequency
4.333 Weekly
2.1666 Bi-weekly
2 Semi-Monthly
1 Monthly
  1. Worksheet will automatically calculate the Adjusted Monthly Self-Employment Income.
  2. Worksheet will automatically calculate the Total Employment Income for all four columns of the Adjusted Self-Employment Income. Enter this amount on the CCMS Income Screen for the Other Family Members Actual Self-Employment Income.

It's Optional whether to proceed further to calculate the Combined Gross Monthly Base Income for Family and Co-payment amounts on this worksheet. Staff are encouraged to complete the additional income entries listed below directly on the CCMS Income Entry screen.

  1. Worksheet will calculate and enter the Total Monthly Employment and Self-Employment Income for the family.
    1. Enter all Monthly Child Support Received for the family.
    2. Enter all Monthly TANF Cash Assistance received for the family.
    3. Enter all Monthly Other Federal Cash Income received for the family.
    4. Enter all Other Monthly Income received for the family.
  3. Enter Monthly Child Support Paid by Applicant and Other Family members included in family size.
  4. The worksheet will calculate and enter the Total Additional Income per Month (Add lines 47a -47d, then Subtract line 48).
  5. The worksheet will calculate and enter the Combined Gross Monthly Base Income for Family (Add: Total Monthly SE Income + Prospective Monthly Base Income + Total Additional Income per Month)
  6. Enter the Family Size as indicated on the application.
  7. Indicate whether this calculation is for an Initial Application or a Redetermination.
  8. The worksheet will assess and enter the Table A Full-Time Parent Co-Payment.
  9. The worksheet will assess and enter the Table B School-Age Parent Co-Payment.