Health Assessment

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Health Assessment

Personal Information

Personal Characteristics

Family and Home

Money and Resources

Social and Emotional Health

General Health and Lifestyle

Additional Questions

Personal Information

Personal Characteristics

Are you a US Citizen?:
Date of entry into the US:

What is your current immigration status?:

Family and Home

Money and Resources

Social and Emotional Health

General Health and Lifestyle

Additional Questions

2024 FEDERAL POVERTY LEVELS

Size of
Household
150%
monthly
150%
yearly
200%
monthly
200%
yearly
250%
monthly
250%
yearly
1 $1,883 $22,596 $2,510 $30,120 $3,138 $37,656
2 $2,555 $30,660 $3,407 $40,880 $4,259 $51,108
3 $3,228 $38,736 $4,303 $51,640 $5,379 $64,548
4 $3,900 $46,800 $5,200 $62,400 $6,500 $78,000
5 $4,573 $54,876 $6,097 $73,160 $7,621 $91,452
6 $5,245 $62,940 $6,993 $83,920 $8,741 $104,892
7 $5,918 $71,016 $7,890 $94,680 $9,863 $118,356
8 $6,590 $79,080 $8,787 $105,440 $10,984 $131,808