Request for Fee Waiver

I-912P, 2011 HHS Poverty Guidelines
for Fee Waiver Request

Department of Homeland Security
U.S.Citizenship and Immigration Services

2011 HHS Poverty Guidelines*
Minimum Income Requirements for Use in Completing Form I-912

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 Size

150% of HHS Poverty Guidelines*

$16,335
$22,065
$27,795
$33,525
$39,255
$44,985
$50,715
$56,445

1
2
3
4
5
6
7
8

Add $5,730 for each
additional person.

For Alaska:
Household Size
1
2
3
4
5
6
7
8

150% of HHS Poverty Line
$20,400
$27,570
$34,740
$41,910
$49,080
$56,250
$63,420
$70,590
Add $7,170 for each
additional person.

For Hawaii:
Household Size

150% of HHS Poverty Line

1
2
3
4
5
6
7
8

$18,810
$25,395
$31,980
$38,565
$45,150
$51,735
$58,320
$64,905
Add $6,585 for each
additional person.

* These poverty guidelines remain in effect for use with Form I-912, Request for Fee Waiver, from May 01, 2011 until
new guidelines go into effect in 2012.
Form I-912P (Rev. 05/01/11)N