PLAN FOR ACHIEVING SELF SUPPORT
April 1, 1995
Name: Deborah
SSN:
1. My work goal is: Clinical Sociologist
2. I want my plan to begin: April 1, 1995
I expect to reach my goal by: March 1, 1999 *
*Note: I believe it will take 4 years to become a Clinical Sociologist. This PASS is only outlining the first 18 month period of that goal (and only requesting approval for the first 18 months).
3. I will have the following expenses, during the first 18 months, in order to reach my goal:
ITEM, RELATION TO GOAL, MONTHS PAID, COST PER MONTH TOTAL
Car Insurance, Required Transportation, 4/1/95-10/1/96, $34.00/mo. $612.00/total.
Initial Car Repair & Refurbish for Accessibility, Required Transportation, 4/1/95-10/1/96, $85.00/mo. $1530.00/total.
Mileage, approximately 300miles per month @ .28 per mile, Required for Education, Rehabilitation & Work related Activities, 4/1/95-10/1/96, $84.00/mo. $1512.00/total.
Dues and Subscriptions for Publications for academic and professional purposes. Required for work goal enhancement, 4/1/95-10/1/96, $17.00/mo. $306.00/total.
Computer including software, peripherals, and maintenance of equipment and software. Required for educational and work goals, 4/1/95-10/1/96, $180.00/mo. $3240.00/total.
On-line computer services such as InterNet charges, CompuServe, AOL, etc..., Required for research and educational purposes, see enclosure #1 (page 3 of this PASS), 4/1/95-10/1/96, $20.00/mo. $360.00/total.
Computer Tutoring, Required education, 4/1/95-10/1/96, $10.00/mo. $180.00/total.
School Expenses, tuition, books and fees, etc.. Educational Costs at UNC, 4/1/95-10/1/96, $170.00/mo. $3060.00/total.
TOTAL 18 Months, $600.00mo. $10,800.00/total.
NOTE: The above expenses are shown evenly amortized over the first 18 months. I anticipate that the actual monthly expenses will not reflect the "even amortization" shown above but will vary based on the billing cycles and amounts associated with the specific expense. The final totals for each item are believed to be accurate estimates at this point.
4. I already have the following money or property that I will use to reach this goal:
I have been working on this goal for several years through the University of Northern Colorado and AIMS community college. I have successfully completed an Associates Degree in Psychology and have completed 78 college credits at UNC. I believe this to be an achievable goal through my efforts to date.
5. I expect to receive the following income that I will use to reach the goal:
$614.00 SSDI per month
Note: I will deposit $600.00 per month in a PASS account.
6. I will keep the money I set aside under my plan in the following bank account: A separate PASS account will be established when this plan is approved.
7. I am already working toward this goal.
8. Signature__________________________Date________
9. Individuals who helped me with this plan:
David Hammis, Training Specialist-University of Northern Colorado
Center for Technical Assistance & Training
916 4th Avenue
Greeley, CO 80631
1-800-682-1240 or 970-352-5395
PASS Enclosures:
#1 Rationale for On-Line services
The Reason that I need the On-Line services is because such services as Compuserve or America on-Line would allow me to access information both in state and around the world that I need for reports and schooling. Plus, being able to access this at home, on my own computer, would save both money that I would have to pay more of to order this information from the Library as well as gas to go to the Library. The other reason is the conservation of energy on a personal level, which is an important aspect of Multiple Sclerosis.
#2 Rationale for completely removing the item "Clothing for work and school" from my original PASS during the PASS application process, and increasing the item "Initial Car Repairs by $25.00 per month (was $60.00 per month, now = $85.00 per month):
I would like to add the dollar amount I specified in the clothing area to the Automobile section. After further investigation I believe I have underestimated the expense of repair on my car and the cost of adapting it to handicap accessibility. I originally allowed for the equipment not the installation of it.
PASS Analysis
Without PASS:
Income: $592.00 SSDI (note: after $46.00 Medicare Part B deduction)
Expenses $30.00 Van Insurance
$40.00 Mileage
$100.00 Student Loan
$35.00 Vehicle Repairs
$205.00 Total Expenses
Discretionary income after expenses:
($592.00-$205.00) = $387.00 = Discretionary Income
With A PASS:
Income: $638.00 SSDI (Medicare Part B Paid by Medicaid)
$458.00 SSI
TOTAL: $1096.00
-PASS -618.00
TOTAL: $478.00 = Discretionary Income