Effects of Income on SSI

Earned Income Only

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Step 1
Earned Income (Gross Wages) $
Subtract General Exclusion – $20.00
Subtract Earned Income Exclusion – $ 65.00

Equals Countable Earned Income

= $
Step 2
Divide Countable Earned Income by 2 ÷ 2
Division answer = $
Subtract Division answer from Countable Earned Income – $

Equals Final Revised Countable Earned Income

= $_______

Step 3
Maximum SSI Benefit ( Federal Benefit Rate ) $________
Subtract Final Revised Countable Earned Income – $________
Equals New Monthly SSI Benefit

= $_______

Step 4
Earned Income (Gross Wages) $______
Plus New Monthly SSI Benefit + $______

Equals Total Monthly Gross Income

= $_______

Download Earned Income Form


Earned and Unearned Income

STEP 1
Unearned Income (SSDI, VA, Pension, Annuity, etc.) $________
Subtract General Exclusion – $20.00

Equals Countable Unearned Income

= $________
STEP 2
Earned Income (Gross Wages) $______
Subtract Earned Income Exclusion – $ 65.00  

Equals Countable Earned Income

= $_______

STEP 3
Countable Earned Income (from Step 2) $________
Divide by 2 ÷ 2
Division answer = $________
Subtract Division answer from Countable Earned Income – $________

Equals New Countable Earned Income

= $_______

STEP 4
Countable Unearned Income (from Step 1) $_______
Plus New Countable Earned Income (from Step 3) + $_______

Equals Final Total Countable Earned and Unearned Income

= $_______

STEP 5
Maximum SSI Benefit (Federal Benefit Rate) $_______
Subtract Final Countable Earned and Unearned Income (from Step 4)
– $_______

Equals New SSI Cash Benefit

= $_______

STEP 6
Gross Earned Income $________
Plus new SSI Benefit (from Step 5) + $________
Plus Total Unearned Income (from Step 1) + $________

Equals Total Monthly Gross Income

= $_______

Download Earned/Unearned Income Form