Appendix 1530-G: Underemployed Parent Checklist
CPS June 2013
Complete this form to determine if parental deprivation exists based on the underemployment of the parent who is the primary wage earner (PWE) only when two legal parents live in the AFDC home of removal and neither parent is physically or mentally incapacitated. This does not apply when one of the parents is a stepparent.
1) Who is the Primary Wage Earner (PWE) in the home of removal?
¨ Father ¨ Mother
2) If the PWE has steady employment, does the PWE work less than 100 hours per month?
¨ Yes ¨ No ¨ N/A
3) If the PWE works irregularly, does the PWE work less than 100 hours per month on average?
¨ Yes ¨ No ¨ N/A
4) If the PWE works more than 100 hours per month on average, what is the amount of their gross monthly earned income?
$ ____________
5) What is the applicable Maximum Income Limit?
Taken from the Appendix 1530-D: Income Guidelines for Underemployed Parent for Parental Deprivation based on the AFDC Certified Group size.
$ ____________
6) Is the PWE’s gross monthly earnings at or below the applicable Maximum Income Limit?
¨ Yes ¨ No
If the answers to questions 2), 3) or 6) are Yes, then the deprivation based on the underemployment of the parent who is the PWE is met.
If the answers to questions 2), 3) and 6) are No, then the deprivation based on the underemployment of the parent who is the PWE is not met. The child therefore does not meet the Deprivation requirement for AFDC.