PDF Spousal Impoverishment Income Allocation Worksheet, F-01306 SPOUSAL IMPOVERISHMENT INCOME ALLOCATION WORKSHEET Primary Person Name (Last, First, MI) Social Security Number Section A - Community Spouse Income Allocation Spouse's Name (Last, First, MI) 1. ENTER Maximum Community Spouse Income Allocation 2. SUBTRACT Gross Income of Community Spouse 3. EQUALS Community Spouse Income Allocation