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INCOME GUIDELINES FOR <br /> <br /> 'IIC PROGRAH~ CHILD HEALTlt PROGRA" <br /> I GENERAL CLINIC SERVICES <br /> <br /> To be effective 7-1-91: <br /> I Attachment IV-O <br /> <br /> I ~8~ Percent of ~o~erty (liaximua La.el) <br /> <br /> ~ Family Size ~eaT ~ont~ ~eek <br /> <br /> I ~ 12.2~7 1,021.00 236.00 <br /> 2 16,&28 1.36~.00 316.00 <br /> I 3 20,609 1,718.00 397.00 <br /> <br /> I 4 24.790 2,066.00 477,00 <br /> 5 28.971 2,415.00 558,00 <br /> <br /> I 6 33.152 2.763.00 638.00 <br /> 7 37,333 3,112.00 718.00 <br /> <br /> i 8 41,514 3,460.00 799.00 <br /> <br /> For Each <br /> I Additional <br /> Family Hember <br /> Add 4,181 349.00 81.00 <br /> I ~. Gross Income <br /> <br /> Income is the combined gross cash income before deductions of income <br /> taxes, social security taxes, insurance premiums, bonds, etc.. received <br /> by the patient or his/her family from th~ follovini sources: <br /> <br /> I 1. Salaries, rares, co~missions, or fees; <br /> 2. Earnings from self-employzent; <br /> 3. Invescaenc income, stocks, bonds, savings account interest. <br /> <br /> I i. ?ubltc assistance i.e.. AFDC; <br /> $. Unemployment compensation; <br /> 6. Alimony snd child support payments; <br /> I 7. ~ilicary allotments; <br /> 8. Social Security benefits; <br /> 9. Veterans Administration benefits; <br /> 10. Supplemental security income benefit=; <br /> I 11. Retirement and pension <br /> 12. Yorkers compensation; <br /> 13. Reguler contributions fron persons not livin~ in the <br />I household; ~nd <br /> 1~. All other sources of cash income except those specifically <br /> excluded. <br />! <br /> <br />i NC VIC 6/91 <br /> <br /> <br />