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INCOME GUIDELINES FOR <br /> <br /> WIt PROGRAH~ CItILD ItEALTI! PROGRAH <br /> <br /> GENERAL CLINIC SERVICES <br /> <br /> To be effective 2-1-90: <br /> Attachment IV-O <br /> Page 2 <br /> <br /> 185 Percent of Poverty (Maximum Level) <br /> <br /> Family Size Year Honch Week <br /> 1 11,618 968.17 223.42 <br /> 2 15,577 1,298.08 299.56 <br /> 3 19,536 1,628.00 375.69 <br /> 4 23,495 1,957.92 451.83 <br /> 5 27,454 2,287.83 527,96 <br /> 6 . 31;413 2,617.75 604.10 <br /> 7 35,372 2,947.67 680.23 <br /> 8 39,331 3,277.'58 756.37 <br /> <br /> For Each <br /> Addiciooal <br /> Family Member <br /> Add 3,959 329.92 76.13 <br /> <br />g. Gross Income <br /> <br /> Income is the combined gross cash income before deductions of income <br /> taxes, social security caxes, insurance 'premiums, bonds, etc., received <br /> by the patient or his/her family from the following sources: <br /> <br /> 1. Salaries~ wages~ commissions, or fees; <br /> 2. Earnings from self-employment| <br /> 3, Investment income, stocks, bonds, savings accouRc lnteresc~ <br /> rentals, a~d all other investment income; <br /> 4. Public assistance money, i.e., AFDC; <br /> 5. Unemploymeuc compensation; <br /> 6. Alimony and child support payments; <br /> 7. Military allotments; <br /> 8. Social Security benefitS; <br /> 9. Veterans Administration benefits; <br /> 10. Supplemental security income benefits; <br /> 11. ' Retirement and pension payments; <br /> 12. Workers compensation; <br /> 13. Re~ular contributions from persons not l{ving in the <br /> household| and <br /> 14. All other sources of cash income excepc chose specifically <br /> excluded. <br /> <br />NC ~[C 5/90 <br /> <br /> <br />