I-912P Supplement, 2021 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.13, 2021.

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:

Sponsor's Household Size 150% of HHS Poverty Guidelines*
1 $19,320
2 $26,130
3 $32,940
4 $39,750
5 $46,560
6 $53,370
7 $60,180
8 $66,990
  Add $6,810 for each additional person
For Alaska
Household Size 150% of HHS Poverty Guidelines*
1 $24,135
2 $32,655
3 $41,175
4 $49,695
5 $58,215
6 $66,735
7 $75,255
8 $83,775
  Add $8,520 for each additional person
For Hawaii:
Sponsor's Household Size 150% of HHS Poverty Guidelines*
1 $22,230
2 $30,060
3 $37,890
4 $45,720
5 $53,550
6 $61,380
7 $69,210
8 $77,040
  Add $7,830 for each additional person

Form Details

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