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 |
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