FAIR

 HAVEN  COMMUNITY  HEALTH  CENTER

SLIDING  FEE  SCALE
BASED  ON  FAMILY  INCOME  AND  SIZE

ANNUAL
0  -­‐  100% 101  -­‐  150% 151  -­‐  185% 186  -­‐  200% >  200%
X  =  Nominal A B C N/A

         1   0-­‐10,830 10,831-­‐16,245 16,246-­‐20,036 20,037-­‐21,660  >21,661

         2   0-­‐14,570 14,571-­‐21,855 21,856-­‐26,955 26,956-­‐29,140 >29,141

         3   0-­‐18,310 18,311-­‐27,465 27,466-­‐33,874 33,875-­‐36,620 >36,621

         4   0-­‐22,050 22,051-­‐33,075 33,076-­‐40,793 40,794-­‐44,100 >44,101

         5   0-­‐25,790 25,791-­‐38,685 38,686-­‐47,712 47,713-­‐51,580 >51,581

         6   0-­‐29,530 29,531-­‐44,295 44,296-­‐54,631 54,632-­‐59,060 >59,061

         7   0-­‐32,270 32,271-­‐49,905 49,906-­‐61,550 61,551-­‐66,540 >66,541

         8   0-­‐37,010 37,011-­‐55,515 55,516-­‐68,469 68,470-­‐74,020 >74,021

         9   0-­‐40,750 40,751-­‐61,125 61,126-­‐75,388 75,389-­‐81,500 >81,501

     10 0-­‐44,490 44,491-­‐66,735 66,736-­‐82,307 82,308-­‐88,980 >88,981

For  more  than  10  family  members  add  $3,740.00  per  additional  member

MONTHLY
0  -­‐  100% 101  -­‐  150% 151  -­‐  185% 186  -­‐  200% >  200%
X  =  Nominal A B C N/A

1 0-­‐903 904-­‐1,354 1,355-­‐1,670 1,671-­‐1,805 >1,806

 2 0-­‐1,214 1,215-­‐1,821 1,822-­‐2,246 2,247-­‐2,428 >2,429

3 0-­‐1,526 1,527-­‐2,289 2,290-­‐2,823 2,824-­‐3,052 >3,053

4 0-­‐1,838 1,839-­‐2,756 2,757-­‐3,399 3,400-­‐3,675 >3,676

5 0-­‐2,149 2,150-­‐3,224 3,225-­‐3,976 3,977-­‐4,298 >4,299

6 0-­‐2,461 2,462-­‐3,691 3,692-­‐4,553 4,554-­‐4,922 >4,923

7 0-­‐2,773 2,774-­‐4,159 4,160-­‐5,129 5,130-­‐5,545 >5,546

8 0-­‐3,084 3,085-­‐4,626 4,627-­‐5,706 5,707-­‐6,168 >6,169

9 0-­‐3,396 3,397-­‐5,094 5,095-­‐6,282 6,283-­‐6,792 >6,793

10 0-­‐3,708 3,709-­‐5,561 5,562-­‐6,859 6,860-­‐7,415 >7,416

For  more  than  10  Family  Members  add  $312.00  for  each  additional  member.

WEEKLY
0  -­‐  100% 101  -­‐  150% 151  -­‐  185% 186  -­‐  200% >  200%
X  =  Nominal A B C N/A

1 0-­‐208 209-­‐312 313-­‐385 386-­‐417 >418

2 0-­‐280 281-­‐420 421-­‐518 519-­‐560 >561

3 0-­‐352 353-­‐528 529-­‐651 652-­‐704 >705

4 0-­‐424 425-­‐636 637-­‐784 785-­‐848 >849

5 0-­‐496 497-­‐744 745-­‐918 919-­‐992 >993

 6 0-­‐568 569-­‐852 853-­‐1,051 1,052-­‐1,136 >1,137

7 0-­‐640 641-­‐960 961-­‐1,184 1,185-­‐1,280 >1,281

8 0-­‐712 713-­‐1,068 1,069-­‐1,317 1,318-­‐1,423 >1,424

9 0-­‐784 785-­‐1,175 1,176-­‐1,450 1,451-­‐1,567 >1,568

10 0-­‐856 857-­‐1,283 1,284-­‐1,583 1,584-­‐1,711 >1,712

For  more  than  10  family  memebers  add  $72.00  for  each  additional  member.

BASED  ON  Poverty  Income  Guidelines  for  all  States

Published  in  the  Federal  Register  on  January  23,  2009
Note:  Income  refers  to  total  annual  cash  receipts  from  all  sources  before  taxes