431-9.1 SNA Budget Sheet

1.     Add the Community Spouse’s Shelter Expenses

1.      Monthly rent or Mortgage                 ___________________

2.      Homeowners Insurance (prorated)  ___________________

3.      Property taxes (prorated)                 ___________________

4.      Utility Standard (from Table II-A)     ___________________

5.      Condo maintenance or HOA fee      ___________________

2.     Enter the Shelter Standard from Table II-A

3.      Subtract line 2 from line 1. (Do not use negative numbers, if it is less than 0, enter 0)  This is the excess shelter expense.

4.      Enter the Minimum Spousal Needs Standard from Table II.-A

5.      Add lines 3 and 4, enter the total here.

      (If this amount is more than the Maximum Spousal Needs Standard on Table II-A, enter the Maximum.)

6.      Enter the Community Spouse’s total income

7.      Subtract lines 6 from line 5.       This amount is the SNA