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New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective Date:

Volume:

X

Forms

Chapter:

A

Forms

6-30-2016

Subchapter:

1

Forms

Issuance:

10.11

CP&P Form 10-11, Independent Living Stipend Budget Worksheet

 

Click here to view CP&P Form 10-11, Independent Living Stipend Budget Worksheet.

 

WHEN TO USE IT

 

The Independent Living Stipend Budget Worksheet is used for individuals who are 16 to age 21 years old.

 

Note: The IL Stipend Budget Worksheet must not be completed after the individuals 21st birthday.

 

When requesting an Independent Living Stipend for rent, food, and/or incidentals, the following forms are required to be completed and submitted for approval:

 

·         Special Approval Request (SAR), CP&P Form 16-76,

·         Transitional Plan for YOUth Success, CP&P Form 5-43,

·         Independent Living Stipend Budget Worksheet, CP&P Form 10-11,

·      Independent Living Stipend Responsibility Agreement, CP&P Form 10-7, and

·      Voluntary Services Agreement, CP&P Form 10-10 (only done for 18 to 21 year olds).

 

The Independent Living Stipend Budget Worksheet is renewed every six months or when there is a change in income or monthly expenses.

 

Note: This IL Stipend Budget Worksheet is a newly revised form that must be used when a new budget is due.

 

HOW TO USE

 

Workers use the Independent Living Stipend Budget Worksheet when teaming with16 -21 year olds to complete a budget in order to determine the amount needed for an independent living stipend(s).

 

The Worker will have two copies of the form available to complete with the 16-21 year old. The Worker and 16-21 year old sign both copies of the form. The Worker gives one version to the 16-21 year old upon completion and the Worker keeps a copy of the form for the case file.

 

At the top of the form, the Worker will mark the appropriate checkbox indicating which required forms have been completed. 

 

Monthly Income/Support

 

·         Complete Table 1, Net Monthly Independent Living Stipend Income - determines the amount of net monthly income that should be included in determining the amount of the stipend(s).

·         Complete Table 2, Other Net Monthly Youth Support - determines the amount of monthly support that a 16-21 year old receives that may be able to supplement his or her daily living expenses.

 

·         Complete Table 3, Other Net Monthly Support – determines how much assistance a 16-21 year old may receive to care for his or her child(ren). This support should not be used to determine the amount of the stipend(s). 

 

·         Complete Table 4, Savings - determines the amount of savings, up to 10% of the 16-21 year old’s wages.  Skip this table if the 16-21 year old does not have wages in Table 1. 

 

·         Complete Table 5, Total Income/Support - determines the amount of income/support a 16-21 year old has to use towards his or her expenses.  For 16-21 year olds, who do not have his or her own income, utilize Wages from Table 1 and Total Support from Table 2 to obtain the final total of income/support to be used towards expenses. 

 

Monthly Expenses

 

·         Complete Table 6, Monthly Independent Living Stipend Expenses -

monthly expenses that may be covered by the Independent Living Stipend.

 

·         Complete Table 7, Other Monthly Expenses - additional monthly expenses a 16-21 year old may have and should consider when creating his or her full budget. 

 

Independent Living Stipend Distribution

 

·         Complete Table 8, Incidentals - the amount of the Incidental portion of the stipend to request.

 

·         Complete Table 9, Food - the amount of the food portion of the stipend to request.

 

·         Complete Table 10, Rent - the amount of the rent portion of the stipend to request.

 

TIPS FOR COMPLETING THE FORM

 

·            Complete the Independent Living Stipend Budget Worksheet with the 16-21 year old utilizing the mutually agreed upon verification for income and expenses.

·            Provide a copy of the budget to the 16-21 year old.

·            If a 16-21 year old has a child of his or her own who receives income, do not count this income when developing a budget to determine the stipend(s) for the 16-21 year old. (Income received for, or on behalf of, a dependent child should not be used for calculations on Tables 8, 9, & 10).

·            When the 16-21 year old has income, and the Worker is completing Tables 8, 9, & 10, team with the 16-21 year old to determine how his or her income will be used to pay for each of the expenses listed.

·            After the Worker and the 16-21 year old complete and sign the Independent Living StipendBudget Worksheet, the Worker submits it, along with the Transitional Plan for YOUth Success CP&P Form 5-43 and Special Approval Request (SAR) CP&P Form 16-76, to his or her Supervisor for approval.

DISTRIBUTION

 

Original          -           Case Record

 

Original          -           16-21 year old

 

Note: Since the Worker completes two copies with the 16-21 year old, he or she will keep an original copy and give an original copy to the 16-21 year old.