Benefits Analysis Worksheet (Visit this link)
This worksheet is designed to help you analyze the impact of work on your benefits.
First, record your current income and expected future income level.Second, in the first column list the assistance programs for which you are eligible at your current income level, e.g., AIDS Drug Assistance program, housing assistance, childcare, food bank, and others.
Third, in the second column list all of the programs for which you would qualify at your expected future income level.
Fourth, review the two columns and examine the differences.
Questions to ask yourself:
• What changes and what stays the same?• What impact might those changes have on your life?
• What concerns or fears come up?
• What possibilities and options do you see?
• Do you need more information before deciding whether or not to increase your income?
Benefits Analysis Worksheet
| Current | Future | |
|---|---|---|
| Income Level | $ | $ |
| Program: | ||
| Description of Benefit: | ||
| Assistance Received: | $ | $ |
| Eligibility Requirement: | ||
| Program: | ||
| Description of Benefit: | ||
| Assistance Received: | $ | $ |
| Eligibility Requirement: | ||
| Program: | ||
| Description of Benefit: | ||
| Assistance Received: | $ | $ |
| Eligibility Requirement: | ||
| Program: | ||
| Description of Benefit: | ||
| Assistance Received: | $ | $ |
| Eligibility Requirement: | ||
| Program: | ||
| Description of Benefit: | ||
| Assistance Received: | $ | $ |
| Eligibility Requirement: | ||
To email, first print or save to pdf then email that document to the desired address.
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