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Family Size100%125%150%175%185%200%
1$ 15,960$ 19,950$ 23,940$ 27,930$ 29,526$ 31,920
2$ 21,640$ 27,050$ 32,460$ 37,870$ 40,034$ 43,280
3$ 27,320$ 34,150$ 40,980$ 47,810$ 50,542$ 54,640
4$ 33,000$ 41,250$ 49,500$ 57,750$ 61,050$ 66,000
5$ 38,680$ 48,350$ 58,020$ 67,690$ 71,558$ 77,360
6$ 44,360$ 55,450$ 66,540$ 77,630$ 82,066$ 88,720
7$ 50,040$ 62,550$ 75,060$ 87,570$ 92,574$ 100,080
8$ 55,720$ 69,650$ 83,580$ 97,510$ 103,082$ 111,440
*$ 5,680$ 7,100$ 8,520$ 9,940$ 10,508$ 11,360

*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: