Request for Fee Waiver

2015 HHS Poverty Guidelines for Fee Waiver Request
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-912P
Supplement

2015 HHS Poverty Guidelines*
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*

1

$17,655

2

$23,895

3

$30,135

4

$36,375

5

$42,615

6

$48,855

7

$55,095

8

$61,335
Add $6,240 for each
additional person.

For Alaska:

For Hawaii:

Household Size

150% of HHS Poverty Guidelines*

Household Size

150% of HHS Poverty Guidelines*

1

$22,080

1

$20,325

2

$29,880

2

$27,495

3

$37,680

3

$34,665

4

$45,480

4

$41,835

5

$53,280

5

$49,005

6

$61,080

6

$56,175

7

$68,880

7

$63,345

8

$76,680

8

$70,515

Add $7,800 for each
additional person.

Add $7,170 for each
additional person.

* These poverty guidelines remain in effect for use with Form I-912, Request for Fee Waiver, from January 23, 2015 until new
guidelines go into effect in 2016.

Form I-912P 01/23/15 N

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