I-912P, HHS Poverty Guidelines for Fee Waiver Request

Purpose of Form

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

Number of Pages


Edition Date

01/25/18. Previous editions should not be used.

Where to File

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

Filing Fee


Special Instructions

Last Reviewed/Updated: