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 Size150% 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 Size150% 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 Size150% 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
Last Reviewed/Updated: