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Form I-912P Supplement, 2019 HHS Poverty Guidelines for Fee Waiver Request
Use the HHS Poverty Guidelines to complete Form I-912, Fee Waiver Request.
These poverty guidelines are effective beginning Jan. 11, 2019.
For the 48 Contiguous States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and the Commonwealth of the Northern Mariana Islands:
| Household Size | 150% of HHS Poverty Guidelines |
| 1 | $18,735 |
| 2 | $25, 365 |
| 3 | $31,995 |
| 4 | $38,625 |
| 5 | $45,255 |
| 6 | $51,885 |
| 7 | $58,515 |
| 8 | $65,145 |
| Add $6,630 for each additional person |
For Alaska:
| Household Size | 150% of HHS Poverty Guidelines |
| 1 | $23,400 |
| 2 | $31,695 |
| 3 | $39,990 |
| 4 | $48,285 |
| 5 | $56,580 |
| 6 | $64,875 |
| 7 | $73,170 |
| 8 | $81,465 |
| Add $8,295 for each additional person |
For Hawaii:
| Household Size | 150% of HHS Poverty Guidelines |
| 1 | $21,570 |
| 2 | $29,190 |
| 3 | $36,810 |
| 4 | $44,430 |
| 5 | $52,050 |
| 6 | $59,670 |
| 7 | $67,290 |
| 8 | $74,910 |
| Add $7,620 for each additional person |
