Form H1049-3, Self-Employment Income Worksheet

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Documents

Effective Date: 4/2024

Instructions

Updated: 4/2024

Purpose

To provide a method for calculating:

  • a household's net monthly income from self-employment.
  • income for qualifying households with a farm loss.

Procedure

When to Prepare

When the household has annual or seasonal self-employment income or potential farm losses.

HHSC staff must return receipts, invoices or other verification documentation provided by the household.

Number of Copies

One electronic copy.

Transmittal

Scan and file an electronic copy in the case record.

Detailed Instructions

HHSC staff must document verification or calculations on Form H1049-3 or on the Form H1801, SNAP Worksheet, or H1101, TANF Worksheet.

Part I

Computation of Monthly Annual or Seasonal Self-Employment Income — HHSC staff complete Part I to capture the household’s annual or seasonal self-employment income.

Name of Self-Employed Person — Enter the name of the self-employed household member.

A. Gross income from self-employment (including capital gains) — Enter the household member’s gross income.

B. Total allowable business expenses — Enter the household member’s allowable business expenses.

C. Net monthly self-employment income (Line A less Line B) — Enter the total by subtracting Line A from Line B and enter the total.

D. Number of months covered by income statement — Enter the number of months from the period the income covered on Line A.

E. Monthly self-employment income (divide Line C by Line D) — Enter the total by dividing Line C by Line D.

Part II 

Computation of Monthly Self-Employment Income — HHSC staff complete Part III to calculate all other self-employment income and frequency, except annual or seasonal.

Part III

Computation of Farm Loss — HHSC staff complete Part III to calculate the household’s farm losses.

A. Total monthly self-employment income from Part I, Line E. — Enter the number from Part I, Line E.

B. Monthly farm loss amount. — Enter the total expenditures of the farm.

C. If Line A is more than Line B, subtract B from A. — Complete the calculation, if applicable. If the number is negative, calculate self-employment income as $0. This is the amount of self-employment income to enter on Form H1801, Step 2.1, and to include on Form H1101, Page 3, Step 1, Line 2; Form H1102, Page 2, Step 1, Line 2; and Form H1119, Step 1, Line 2.

D. If Line B is more than Line A, subtract A from B. — Complete the calculation, if applicable. If the number is negative, calculate self-employment income as $0. This number is the amount of remaining farm loss to enter on Form H1801, Step 3.3, Form H1101, Page 3, Step 4, Line 10, Form H1102, Page 2, Step 4, Line 10, and Form H1119, Step 2, Line 4.

Part IV

Documentation — HHSC staff document the verification and method used to calculate self-employment income. Document the projection period of Part I.

Signature – HHSC Staff — HHSC staff calculating the household member’s self-employment income sign the form.

Date — Enter the date HHSC staff signed the form.