Effective Date: 
2/2000

Documents

Instructions

Updated: 4/2000

PURPOSE

For use in determining who qualifies for the 90% earned income deduction and to track the

  • period in which it may be received;
  • maximum number of months within that period it may be received; and
  • period in which it may not be received.

PROCEDURE

When to Prepare

Complete Form H1104 whenever a TANF applicant or recipient has earnings.

Number of Copies

Complete one form for each employed member.

Case Filing

File Form H1104 on the top right side of the case record. Keep moving it up as more items are added to the folder.

Form Retention

Retain the form until there is automation in place that records and tracks the information.

DETAILED INSTRUCTIONS

Self-explanatory.

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