TANF Benefit Calculator
Branch
Case Number
Program Name
Case Name
Worker Id
Date:
Policy:
Oregon Programs Eligibility Notebook (OPEN)
Explanation:
English
Spanish
Benefits Paid
Net Allotment:
$
Overpayment Recovery:
$
Benefit Amount:
$
(Net Allotment + Overpayment Recovery)
Household Information
Noncitizen Calculation?
Number in Household:
Number of Adults in Benefit Group:
Number of Children in Benefit Group:
Number in Need Group:
Use only if Household includes Ineligible Noncitizens
Allow COI:
Income Information
Reminder: Is this Microenterprise income?
Earned Income - Allow Deduction:
$
Enter Full Amount - Deduction will be calculated.
Earned Income - No Deduction:
$
Unearned Income:
$
Child Support:
$
Retained By DHS as Current Reimbursement.
Adjustment Information
EBT Adjustments:
$
Including aged off benefits.
Adjustment for Prior Overpayment:
$
Comments
Comments:
Spanish Form284G
DHS 221T
(Use only for Non-Citizen Calculation)
Enter
Clear Form