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 | 200% monthly | 200% yearly | 250% monthly | 250% yearly | 300% monthly | 300% yearly |
|---|---|---|---|---|---|---|
| 1 | $2,660 | $31,920 | $3,325 | $39,900 | $3,990 | $47,880 |
| 2 | $3,607 | $43,280 | $4,508 | $54,100 | $5,410 | $64,920 |
| 3 | $4,553 | $54,640 | $5,691 | $68,300 | $6,830 | $81,960 |
| 4 | $5,500 | $66,000 | $6,875 | $82,500 | $8,250 | $99,000 |
| 5 | $6,447 | $77,360 | $8,058 | $96,700 | $9,670 | $116,040 |
| 6 | $7,393 | $88,720 | $9,241 | $110,900 | $11,090 | $133,080 |
| 7 | $8,340 | $100,080 | $10,425 | $125,100 | $12,510 | $150,120 |
| 8 | $9,287 | $111,440 | $11,608 | $139,300 | $13,930 | $167,160 |