RULE 165.00.04-004 - Procedure Manual on Financial Resource Instructions (RS-16) - Amendment to Appendix E

RULE 165.00.04-004. Procedure Manual on Financial Resource Instructions (RS-16) - Amendment to Appendix E

FINANCIAL RESOURCES

INSTRUCTIONS

(RS -16)

A properly executed RS-16 must be included in the case record of each individual prior to the provision of any services based on financial need. Individuals receiving SSI/SSDI are exempt from financial need assessment, but the form should be completed to assess comparable benefits. The RS-16 is used to document financial resources and comparable benefits of the individual. (The RS-600-A and RS-600-C are used to summarize and compute the amount of supplementation necessary.) Instructions for completion of the RS-16 are to be followed to assure compliance with State policies and regulations.

* Record the individual's name, date, and the total number in household.

CAPITAL ASSETS

1. Liquid Assets : Liquid assets of the individual and spouse will be interpreted as meaning cash and those instruments that can readily be turned into cash. (Example -money on hand, savings, bonds, securities, and other negotiable papers.) Deduct the first $6,000 for persons (without dependent children), or 12,000 for persons with dependent children and enter the remainder of liquid assets on the blank line. If none, enter 0. If the individual is 24 years of age or under and unmarried, the parent(s) assets must be included. A copy of the parent(s) income tax forms must be provided for this purpose. If the parent(s) do not support the individual, the individual must provide documentation of non-support.

2. Real Property : Enter N/A in this column

3. Personal Property : Enter N/A in this column

4. Other : Enter any other capital assets.

5. Total : Enter the sum of the amounts in Lines 1-4. If none, enter 0. MONTHLY INCOME

Reported income must be verified. (See Section V)

If the individual or parent(s) reports zero income or did not file income tax forms, the individual must sign a written statement of verification. If the individual is 24 years of age or under and unmarried, the parent(s) income must be included. A copy of the parent(s) income tax forms must be provided for this purpose. If the parent(s) do not support the individual, the individual must provide documentation of non-support.

6. Net Salary : Deduct 25% of the gross income from the most recent paycheck computed on a monthly basis for a regular full-time employee.

Deduct 25% of the adjusted gross income computed on a monthly basis if the information is obtained from income tax returns or the PELL grant summary.

For farmers, teachers, or part-time employees, the amount entered will be the monthly average for the past 12 months. If income has ceased at the time of application or will not be continuing, enter 0 in the amount column.

7. Pension : Enter the amount and check or enter the type of pension.

8. AFDC : Enter the amount.

9. Other : Enter the source and the amount of any other income such as contributions, rent, board, etc. received. Enter the family income from parent(s) or spouse. If the individual is 24 years of age or under and unmarried, parent(s) income must be included.

10. Total : Enter the sum of amounts in Lines 6-9. If none, enter 0. NORMAL LIVING REQUIREMENTS

11. Family Group : Enter from the Normal Living Requirements Table the amount in accordance with the household group and any modification. NLR includes shelter, food, clothing, general health maintenance, utilities, and basic standard living requirements.

Number of persons

Monthly Amount

1

$ 2,800

2

$ 3,200

3

$ 3,600

($400 each additional family member)

(11/15/2004)

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