Household Size and Total Annual Household Income Sample Clauses

Household Size and Total Annual Household Income. A. Circle the total number of people in your household in the first column. B. On the line corresponding to your household size, check the income range that includes your household’s annual income. A. Household Size B. Total Household Income 1 □ up to $50,000 □ $50,000-$76,750 □ $76,750-$119,950 2 □ up to $57,150 □ $57,150-$87,700 □ $87,700-$137,100 3 □ up to $64,300 □ $64,300-$98,650 □ $98,650-$154,200 4 □ up to $71,400 □ $71,400-$109,600 □ $109,600-$171,350 5 □ up to $77,150 □ $77,150-$118,400 □ $118,400-$185,050 6 □ up to $82,850 □ $82,850-$127,150 □ $127,150-$198,750 ❑ Check here if your income does not fall into any of the income ranges corresponding with your household size. ❑ CalWORKs ❑ Medi-Cal ❑ General Assistance ❑ Section 8 ❑ Social Security ❑ WIC ❑ Food Stamps Race/Ethnicity (Check only one, unless noted): ❑ American Indian/Alaskan Native ❑ Asian ❑ White ❑ Native Hawaiian/Pacific Islander ❑ Asian & White ❑ Black/African American
Sample 1
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Household Size and Total Annual Household Income. A. Circle the total number of people in your household (in the first column) No B. On the line corresponding to your household size, check the income range that includes your household’s annual income.
Sample 1

Related to Household Size and Total Annual Household Income

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