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Family Size100%125%130%150%175%200%
1$ 15,650$ 19,562$ 20,345$ 23,475$ 27,387$ 31,300
2$ 21,150$ 26,437$ 27,495$ 31,725$ 37,012$ 42,300
3$ 26,650$ 33,312$ 34,645$ 39,975$ 46,637$ 53,300
4$ 32,150$ 40,187$ 41,795$ 48,225$ 56,262$ 64,300
5$ 37,650$ 47,062$ 48,945$ 56,475$ 65,887$ 75,300
6$ 43,150$ 53,937$ 56,095$ 64,725$ 75,512$ 86,300
7$ 48,650$ 60,812$ 63,245$ 72,975$ 85,137$ 97,300
8$ 54,150$ 67,687$ 70,395$ 81,225$ 94,762$ 108,300
*$ 5,500$ 6,875$ 7,150$ 8,250$ 9,625$ 11,000

*For households over 8, add the amount shown for each additional member.*

Pursuant to new IRS rules 1095-B documents will only be provided upon request. Agency employees may request a copy of their 1095-B document by: