Este cuestionario está destinado a quienes buscan atención para sí mismos o para alguien en su vida. Si usted es una organización comunitaria o un hospital asociado, utilice el formulario de remisión de clientes.
| Size of Household | 150% monthly | 150% yearly | 200% monthly | 200% yearly | 250% monthly | 250% yearly |
|---|---|---|---|---|---|---|
| 1 | $1,699 | $20,385 | $2,265 | $27,180 | $2,831 | $33,975 |
| 2 | $2,289 | $27,465 | $3,052 | $36,260 | $3,814 | $45,775 |
| 3 | $2,879 | $34,545 | $3,838 | $46,060 | $4,797 | $57,575 |
| 4 | $3,469 | $41,625 | $4,625 | $55,500 | $5,781 | $69,375 |
| 5 | $4,059 | $48,705 | $5,412 | $64,940 | $6,764 | $81,175 |
| 6 | $4,649 | $55,785 | $6,198 | $74,380 | $7,747 | $92,975 |
| 7 | $5,239 | $62,865 | $6,985 | $83,820 | $8,731 | $104,775 |
| 8 | $5,829 | $69,945 | $7,772 | $93,260 | $9,714 | $116,575 |
