HHS Poverty Guidelines for Fee Waiver Request

I-912P

This form is used as HHS Poverty Guidelines to complete Form I-912, Fee Waiver Request.

(1) Purpose of Form
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1

(2) Number of Pages
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01/25/18. Previous editions should not be used.

(3) Edition Date
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This form does not need to be filed. It is used only for assistance in completing Form I-912.

(4) Where to File
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$0

(5) Filing Fee
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0
(6) Special Instructions
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04/17/2018
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