ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
SSI Benefits and Work Calculator
2
3
Name:
4
DOB:
5
SSN:
6
7
SSI federal cash benefit when not working $ - (a)
8
9
Gross monthly earnings $ - (b)
10
11
Calculate deductions
12
(if non-applicable, leave blank)
13
Earned income exclusion = $65.00 $ 65.00
14
If SSI is the only income before working, enter $20.00 $ -
15
Impairment–Related Work Expense (IRWE) $ -
16
Plan to Achieve Self–Support (PASS) related expenses $ -
17
Total Deductions $ 65.00
18
19
Gross Monthly Earnings $ - (b)
20
 - Total Deductions $ 65.00
21
Subtotal $ (65.00)
22
Divide by 22
23
Countable income $ (32.50)(c)
24
25
SSI Cash Benefit $ - (a)
26
 - Countable Income $ (32.50)(c)
27
SSI Cash Benefit While Working $ 32.50 (d)
28
29
Gross monthly earnings $ - (b)
30
+ SSI cash benefit while working $ 32.50 (d)
31
Total income for this month $ 32.50
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100