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SAMPLE LANGUAGE FOR NON-STANDARD PLAN PROVISIONS
The following language can be used for the some the non-standard plan provisions listed in the
Amended Local Rule 3023-1(b)(i)(B). Those non-standard provisions not listed below already
have language in the new Chapter 13 Plan.
1. Language for Debtor with Personal Injury, Workers’ Compensation, or Social Security
Claims: The Debtor will pay unsecured creditors any non-exempt
equity in Debtor’s (personal injury, workers’ compensation or
Social Security) claim. The Debtor must also file a Motion to
Appoint Special Counsel for their attorney handling said claim
and a Motion to Approve Settlement.
2. Language for the Debtor that intents to sell or refinance real estate: The Debtor will
sell (or refinance) the property located at 123 Main St, Dover,
DE. Mortgages, liens, property taxes, $xxx in attorney’s fees
will be forwarded to Tara Blakely, debtors’ counsel, for
preparation of the motion to sell (or refinance), customary
closing costs, with the balance of approximately $xxx to paid
directly to the Debtors at closing. A copy of the completed
HUD-1 statement shall be provided to Debtor’s counsel and the
Chapter 13 Trustee via facsimile at 656-3660, immediately upon
conclusion of settlement. The Sale of the Property is pursuant to
11 U.S.C. Section 363 and shall be free and clear of all liens
and encumbrances except as set forth herein and the Order
approving this Stipulation shall take effect immediately upon
approval by the Court. The Debtor must also file a Motion to
Approve the Sale or Refinance before the closing can occur.
3. Language for Debtor seek loan modification- Long term or mortgage debt –
Debtor is attempting to obtain a loan modification with Home
Residential for the property located at 123 Main Street, Dover,
DE. Debtor seeks six months from confirmation to obtain this loan
modification, if this is not obtained, she grants relief from the
automatic stay at that time. Sometimes the plan will state that
the Debtor will make post-petition payments.
4. Language for Debtor seeking to Avoid Junion Liens- SLS, the holder of a
second mortgage on the debtors’ residence, is to be treated as an
unsecured creditor, as, after allowing for the total due on the
first mortgage, there is no equity on which SLS’s lien can
attach. Debtors will be filing a Complaint to Strip Mortgage to
remove this lien from the property upon discharge. Adversary
Complaint must be filed and Debtor must receive discharge for
lien to be removed at Recorder of Deeds.
5. Language for Debtor relating to Domestic Support Obligation, Divorce or Property
Division. The Debtor is current on his post-petition domestic
support obligations to Jane Doe. The Debtor must also sign a
domestic support affidavit and provide to the Chapter 13 Trustee
stating that he is current on these obligations. Debtor grants
relief from the automatic stay to proceed with ancillary matters
in the Family Court of the State of Delaware. The filing of the
bankruptcy will stay all ancillary matters; however, it will not
stay the divorce decree from issuing.
6. Language for Debtor seeking to void a lien pursuant to 11 U.S.C. Section 522(f)- The
judgment lien held by Chase shall be voided as it impairs the
Debtor’s exemptions pursuant to the 11 U.S.C. Section 522 (f).
Debtor shall file a Motion to Void Lien.
Official Form 103B Application to Have the Chapter 7 Filing Fee Waived page 1
Official Form 103B
Application to Have the Chapter 7 Filing Fee Waived 12/15
Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known).
Part 1: Tell the Court About Your Family and Your Family’s Income
1. What is the size of your family?
Your family includes you, yourspouse, and any dependents listedon Schedule J: Your Expenses(Official Form 106J).
Check all that apply:
You
Your spouse
Your dependents ___________________ How many dependents?
_____________________
Total number of people
2. Fill in your family’s averagemonthly income.
Include your spouse’s income ifyour spouse is living with you, evenif your spouse is not filing.
Do not include your spouse’sincome if you are separated andyour spouse is not filing with you.
That person’s average monthly net income (take-home pay)
Add your income and your spouse’s income. Include the value (if known) of any non-cash governmental assistance that you receive, such as food stamps (benefits under the Supplemental Nutrition Assistance Program) or housing subsidies.
If you have already filled out Schedule I: Your Income, see line 10 of that schedule.
You .................. $_________________
Your spouse .... + $_________________
Subtotal ............. $_________________
Subtract any non-cash governmental assistance that you included above. – $_________________
Your family’s average monthly net income Total .................. $_________________
3. Do you receive non-cashgovernmental assistance?
No
Yes. Describe. ...........
Type of assistance
4. Do you expect your family’saverage monthly net income toincrease or decrease by more than10% during the next 6 months?
No
Yes. Explain. .............
5. Tell the court why you are unable to pay the filing fee ininstallments within 120 days. If you have some additionalcircumstances that cause you to not be able to pay your filingfee in installments, explain them.
Debtor 1 ________________________________________________________________ First Name Middle Name Last Name
Debtor 2 ________________________________________________________________ (Spouse, if filing) First Name Middle Name Last Name
United States Bankruptcy Court for the: __________ District of ___________ Case number ___________________________________________ (If known)
Fill in this information to identify your case:
Check if this is anamended filing
Debtor 1 _______________________________________________________ Case number (if known) _____________________________________ First Name Middle Name Last Name
Official Form 103B Application to Have the Chapter 7 Filing Fee Waived page 2
Part 2: Tell the Court About Your Monthly Expenses
6. Estimate your average monthly expenses.
Include amounts paid by any government assistance that youreported on line 2.
If you have already filled out Schedule J, Your Expenses, copyline 22 from that form.
$___________________
7. Do these expenses cover anyonewho is not included in your familyas reported in line 1?
No
Yes. Identify who ........
8. Does anyone other than youregularly pay any of theseexpenses?
If you have already filled outSchedule I: Your Income, copy thetotal from line 11.
No
Yes. How much do you regularly receive as contributions? $_________ monthly
9. Do you expect your averagemonthly expenses to increase ordecrease by more than 10% duringthe next 6 months?
No
Yes. Explain ................
Part 3: Tell the Court About Your Property
If you have already filled out Schedule A/B: Property (Official Form 106A/B) attach copies to this application and go to Part 4.
10. How much cash do you have?
Examples: Money you have inyour wallet, in your home, and onhand when you file this application
Cash: $_________________
11. Bank accounts and other depositsof money?
Examples: Checking, savings,money market, or other financialaccounts; certificates of deposit;shares in banks, credit unions,brokerage houses, and othersimilar institutions. If you havemore than one account with thesame institution, list each. Do notinclude 401(k) and IRA accounts.
Institution name:
Checking account: __________________________________________________
Savings account: __________________________________________________
Other financial accounts: __________________________________________________
Other financial accounts: __________________________________________________
Amount:
$__________________
$__________________
$__________________
$__________________
12. Your home? (if you own it outright orare purchasing it)
Examples: House, condominium,manufactured home, or mobile home
_______________________________________________________ Number Street
_______________________________________________________
City State ZIP Code
Current value:
Amount you owe on mortgage and liens:
$_________________
$_________________
13. Other real estate?_______________________________________________________ Number Street
_______________________________________________________
City State ZIP Code
Current value:
Amount you owe on mortgage and liens:
$_________________
$_________________
14. The vehicles you own?
Examples: Cars, vans, trucks,sports utility vehicles, motorcycles,tractors, boats
Make: _____________________
Model: _____________________
Year: ____________
Mileage _____________________
Current value:
Amount you owe on liens:
$_________________
$_________________
Make: _____________________
Model: _____________________
Year: ____________
Mileage _____________________
Current value:
Amount you owe on liens:
$_________________
$_________________
Debtor 1 _______________________________________________________ Case number (if known) _____________________________________ First Name Middle Name Last Name
Official Form 103B Application to Have the Chapter 7 Filing Fee Waived page 3
15. Other assets?
Do not include household itemsand clothing.
Describe the other assets: Current value:
Amount you owe on liens:
$_________________
$_________________
16. Money or property due you?
Examples: Tax refunds, past dueor lump sum alimony, spousalsupport, child support,maintenance, divorce or propertysettlements, Social Securitybenefits, workers’ compensation,personal injury recovery
Who owes you the money or property?
___________________________________________
___________________________________________
How much is owed?
$_________________
$_________________
Do you believe you will likely receive payment in the next 180 days?
No
Yes. Explain:
Part 4: Answer These Additional Questions
17. Have you paid anyone forservices for this case, includingfilling out this application, thebankruptcy filing package, or theschedules?
No
Yes. Whom did you pay? Check all that apply:
An attorney
A bankruptcy petition preparer, paralegal, or typing service
Someone else ________________________________________
How much did you pay?
$______________________
18. Have you promised to pay or doyou expect to pay someone forservices for your bankruptcycase?
No
Yes. Whom do you expect to pay? Check all that apply:
An attorney
A bankruptcy petition preparer, paralegal, or typing service
Someone else _________________________________________
How much do you expect to pay?
$_______________________
19. Has anyone paid someone onyour behalf for services for thiscase?
No
Yes. Who was paid on your behalf?Check all that apply:
An attorney
A bankruptcy petition preparer,paralegal, or typing service
Someone else _________________
Who paid? Check all that apply:
Parent
Brother or sister
Friend
Pastor or clergy
Someone else __________
How much did someone else pay?
$______________________
20. Have you filed for bankruptcywithin the last 8 years?
No
Yes. District _____________________________ When _____________ Case number _____________________MM/ DD/ YYYY
District _____________________________ When _____________ Case number _____________________ MM/ DD/ YYYY
District _____________________________ When _____________ Case number _____________________ MM/ DD/ YYYY
Part 5: Sign Below
By signing here under penalty of perjury, I declare that I cannot afford to pay the filing fee either in full or in installments. I also declare
that the information I provided in this application is true and correct.
_____________________________________________ _____________________________________________
Signature of Debtor 1 Signature of Debtor 2
Date __________________ Date __________________ MM / DD / YYYY MM / DD / YYYY
Order on the Application to Have the Chapter 7 Filing Fee Waived
After considering the debtor’s Application to Have the Chapter 7 Filing Fee Waived (Official Form 103B), the court orders that the application is:
[ ] Granted. However, the court may order the debtor to pay the fee in the future if developments in administering the bankruptcy case show that the waiver was unwarranted.
[ ] Denied. The debtor must pay the filing fee according to the following terms:
You must pay… On or before this date…
$_____________ _____________ Month / day / year
$_____________ _____________ Month / day / year
$_____________ _____________ Month / day / year
+ $_____________ _____________ Month / day / year
Total
If the debtor would like to propose a different payment timetable, the debtor must file a motion promptly with a payment proposal. The debtor may use Application for Individuals to Pay the Filing Fee in Installments (Official Form 103A) for this purpose. The court will consider it.
The debtor must pay the entire filing fee before making any more payments or transferring any more property to an attorney, bankruptcy petition preparer, or anyone else in connection with the bankruptcy case. The debtor must also pay the entire filing fee to receive a discharge. If the debtor does not make any payment when it is due, the bankruptcy case may be dismissed and the debtor’s rights in future bankruptcy cases may be affected.
[ ] Scheduled for hearing.
A hearing to consider the debtor’s application will be held
on _____________ at _________ AM / PM at _________________________________________. Month / day / year Address of courthouse
If the debtor does not appear at this hearing, the court may deny the application.
_____________ By the court: _____________________________________ Month / day / year United States Bankruptcy Judge
Debtor 1 ________________________________________________________________ First Name Middle Name Last Name
Debtor 2 ________________________________________________________________ (Spouse, if filing) First Name Middle Name Last Name
United States Bankruptcy Court for the: __________ District of __________
Case number _____________________________________________ (If known)
Fill in this information to identify the case:
B 210A (Form 210A) (12/09)
UNITED STATES BANKRUPTCY COURT
__________ District Of __________
In re ________________________________, Case No. ________________
TRANSFER OF CLAIM OTHER THAN FOR SECURITY
A CLAIM HAS BEEN FILED IN THIS CASE or deemed filed under 11 U.S.C. § 1111(a). Transfereehereby gives evidence and notice pursuant to Rule 3001(e)(2), Fed. R. Bankr. P., of the transfer, otherthan for security, of the claim referenced in this evidence and notice.
______________________________________ ____________________________________
Name of Transferee Name of Transferor
Name and Address where notices to transferee Court Claim # (if known):should be sent: Amount of Claim:
Date Claim Filed:
Phone: ______________________________ Phone:Last Four Digits of Acct #: ______________ Last Four Digits of Acct. #: __________
Name and Address where transferee paymentsshould be sent (if different from above):
Phone:Last Four Digits of Acct #:
I declare under penalty of perjury that the information provided in this notice is true and correct to thebest of my knowledge and belief.
By:__________________________________ Date:____________________________Transferee/Transferee’s Agent
Penalty for making a false statement: Fine of up to $500,000 or imprisonment for up to 5 years, or both. 18 U.S.C. §§ 152 & 3571.
IN THE UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF DELAWARE
) IN RE: ) Chapter 13 ) Debtor(s) ) Bk. Case No.:
CHAPTER 13 PLAN
NOTICE TO ALL CREDITORS THAT THIS PLAN AND ALL OF ITS PROVISIONS ARE
SUBJECT TO DEL. BANKR. L.R. 3023-1 The future earnings of the debtor are submitted to the supervision and
control of the Court and the Debtor’s employer shall pay the trustee
the sum of $ _________ (monthly) for _______months.
From the payment so received, after deduction of allowed Trustee’s
commission, the Trustee shall make disbursements as follows:
1. Full payment in deferred cash payments of all claims entitled to
Priority under 11 U.S.C. Section 507.
(A) Debtor’s Counsel Fees ______________
(B) Priority Taxes _____________(specify tax and tax year due)
__________________________________________________________
(C) Other Priority or Administrative Expenses-________________
2.(As applicable-Pro-rata with or subsequent to) dividends to priority
creditors, holders of allowed secured claims shall retain the liens
securing such claims and shall be paid as follows:
(A) Long term or mortgage debt – PRE-PETITION ARREARAGE ONLY, to
be paid to __________ (mortgagee creditor) $_________ (total
amount of pre-petition arrears for the real property
(collateral identified). Debtor shall continue to make regular
post-payments directly to __________ (mortgagee creditor).
This Section of the Plan specifically incorporates all of the
provisions affecting mortgage claims as set forth in Del.
Bankr. L.R. 3023-1(b) and the parties shall be so governed.
(B) Secured Vehicle debt (cramdown) – Pro-rata payments to:
____________in the amount of $___________for payment in full
of the value of property or in equal monthly payments of
$________per month for the ____________ (collateral). Total
payments will be $________.
(C) Secured Vehicle debt (910 car claim) – Pro-rata payments to
_________in the full amount of the vehicle claim or in equal
monthly payments of $_________per month for the
_________________ (identify vehicle). Total payments will be
$________.
(D) Other secured debt:___________________________________________
3. Surrender-secured collateral to: ___________________ (name of
creditor and collateral) Debtor(s) abandons such property and agrees
that the Automatic Stay under 11 U.S.C. Section 362 is terminated as
to the property and any interest in the property. Claims, if any
submitted by such creditor may receive a distribution under the Plan
if such claims reflect an applicable deficiency balance remaining
following surrender.
4. Subsequent to dividends to priority and secured creditors,
dividends to allowed non-priority general unsecured creditors shall be
distributed as follows:
1. General unsecured creditors will be paid ( ) a dividend of
100% of their allowed claim or ( )BIOC or
2. __________Disp. Income x 60 months as calculated under Section
1325(b), or ( ) a pro-rata dividend, if any.
5. (If applicable) The following leases or executor contracts of the
debtor will be treated as follows:
6. Title to Debtor's property shall revest in the Debtor on
confirmation of the Plan, except for undistributed plan payments
held by the Trustee. Upon conversion of this case to Chapter 7, or
dismissal, the Trustee is authorized to disburse undistributed plan
payments to allowed claimants in accordance with this plan.
7. Other special provisions of the Plan:
8. A proof of claim must be filed in order to share in
distributions under the plan. A proof of claim by filed either
electronically or as paper. To file an electronic claim, go to the
United States Bankruptcy Court, District of Delaware website
(http://www.deb.uscourts.gov) and click on the Programs & Services
tab, then select Filing a Claim. Click on “Submit Proof of Claim”
link and follow the instructions. Once the necessary information is
entered, the form with be automatically generated. To obtain a claim
form to file a paper claim, go to the United States Bankruptcy
Court, District of Delaware website (http:web.deb.uscourts.gov) and
click on the Forms tab. Select All Forms from the drop down menu,
then select B10-Proof of Claim. Proofs of claim in duplicate shall
be delivered or mailed to the United States Bankruptcy Court, Attn:
Claims, 824 Market St., 3rd Floor, Wilmington, Delaware 19801.
(Copies should be mailed to Tara A. Blakely, Esq., 1006 College
Road, Suite 201, Dover, DE 19904).
______________________________ _________________ Debtor’s Signature Date
______________________________ _________________ Joint Debtor’s Signature Date ______________________________ _________________ Attorney for Debtor(s) Date
PLAN ANALYSIS Debtor: Case #: Prior: Bankruptcy ( ) Chapter 13 ( ) Date: Estimated length of plan: months. Trustee Use 341 Meeting Date: ________
Continued: _______________ Confirmed Date: __________
TOTAL DEBT PROVIDED FOR UNDER THE PLAN AND ADMINISTRATIVE EXPENSES A. TOTAL PRIORITY CLAIMS (Class One) Unpaid attorney's fees .............................. $ Taxes ............................................... $ Other ............................................... $ TOTAL OF PAYMENTS TO CURE DEFAULTS (Class Two)........$ TOTAL OF PAYMENTS ON SECURED CLAIMS (Class Three).....$ TOTAL OF PAYMENTS ON UNSECURED CLAIMS (Class Four)....$ SUBTOTAL .............................................$ TOTAL TRUSTEE’S COMPENSATION..........................$ TOTAL DEBT AND ADMINISTRATIVE EXPENSES................$ _____________________________________________________________________
RECONCILIATION WITH CHAPTER 7
H. INTEREST OF CLASS FOUR CREDITORS IF CHAPTER 7 FILED Value of debtor's interest in non-exempt property ... $ .00 Plus: value of property recoverable under
avoiding powers..................................... $ .00 Less: estimated chapter 7 administrative expense .... $ .00 Less: amounts payable to priority creditors other than costs of administration .......................$ .00 Equals: estimated amount payable to Class 4 creditors
if Chapter 7 filed (if negative, enter zero) ........$ .00 I. ESTIMATED DIVIDEND FOR CLASS FOUR UNDER CHAPTER 7 ........................................... $ .00 J. ESTIMATED DIVIDEND UNDER PLAN ........................$ .00
_/s/ ___________ Debtor /s/ Joint Debtor
_/s/ Tara A. Blakely_____ Tara A. Blakely Attorney for Debtor
Page 1 of 3
Revised Form 103 (2017)
UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF DELAWARE IN RE: )
) Chapter 13 )
Debtor(s). ) Bk. Case No:
CHAPTER 13 PLAN
I. Notice
NOTICE TO ALL CREDITORS THAT THIS PLAN AND ALL OF ITS PROVISIONS ARE SUBJECT TO DEL. BANKR. L.R. 3023-1 AND YOUR RIGHTS MAY BE AFFECTED BY THIS PLAN. IF YOU OPPOSE THE PLAN’S TREATMENT OF YOUR CLAIM OR ANY PLAN PROVISION YOU OR YOUR ATTORNEY MUST FILE AN OBJECTION TO CONFIRMATION AT LEAST 7 DAYS BEFORE THE DATE SET FOR THE CONFIRMATION HEARING. THE BANKRUPTCY COURT MAY CONFIRM THIS PLAN WITHOUT FURTHER NOTICE IF NO OBJECTION IS FILED. SEE BANKRUPTCY RULE 3015. YOU SHOULD NOTE THE FOLLOWING (boxes must be checked by debtor(s) if applicable):
� The plan seeks to limit the amount of a secured claim, as set out in III.2, which may result in partial payment or no payment at all to the secured creditor
� The plan will seek avoidance of a lien or security interest � The plan contains nonstandard provisions in paragraph VI
II. Plan Payments and Length of Plan: The future earnings of the debtor are submitted to the
supervision and control of the Court and the Debtor's employer or the Debtor shall pay to the trustee the sum of $________ (monthly) for ______ months.
III. Plan Distribution: From the payment so received, after deduction of allowed Trustee's commission,
the Trustee shall make disbursements as follows:
1. Priority Claims: Full payment in deferred cash payments of all claims entitled to priority under 11 U.S.C. Section 507. � (A) Debtor's Counsel Fees _______________________________ � (B) Priority Taxes (specify tax and tax year due) � (C) Domestic Support Obligations_________________________ � (D) Other Priority or Administrative Expenses_______________
2. Secured Claims–(boxes must be checked)
� Pro-rata with or
Page 2 of 3
Revised Form 103 (2017)
� subsequent to dividends to priority creditors, holders of allowed secured claims shall retain the liens securing such claims and shall be paid as follows:
� (A) Long term or mortgage debt -PRE-PETITION ARREARAGE ONLY, to be paid to (mortgagee creditor) $____________ (total amount of pre-petition arrears for the real property (collateral identified)). � Debtor shall continue to make regular post-payments directly to (mortgagee creditor) This Section of the Plan specifically incorporates all of the provisions affecting mortgage claims as set forth in Del. Bankr. L.R. 3023-1(b) and the parties shall be so governed.
� (B) Secured Vehicle debt (cramdown) - Pro-rata payments to: _________________ in the amount of $______________ for payment in full of the value of property or in equal monthly payments of $ _________________ per month for the (collateral) . Total payments will be $ _________________.
� (C) Secured Vehicle debt (910 car claim) - Pro-rata payments to _______________ in the full amount of the vehicle claim or in equal monthly payments of $ _______________ per month for the identify vehicle) . Total payments will be $_________.
� (D) Other secured debt: _________________________________________
3. Surrender of Collateral and Co-Debtor Relief: � (A) Debtor surrenders secured collateral to: (Name of creditor and collateral)
Debtor(s) abandons such property and agrees that the Automatic Stay under 11 U.S.C. Section 362 is terminated as to the property and any interest in the property effective immediately on confirmation of this Plan. Claims, if any submitted by such creditor may receive a distribution under the Plan if such claims reflect an applicable deficiency balance remaining following surrender.
� (B) Co-Debtor relief under 11 USC Section 1301 is granted effective immediately upon confirmation of the Plan as to surrendered property.
4. Unsecured Claims:
Subsequent to dividends to priority and secured creditors, dividends to allowed non-priority general unsecured creditors shall be distributed as follows:
General unsecured creditors will be paid � a dividend of 100% of their allowed claim or � a pro rata dividend of
� 1. _____________________________________ BIOC or � 2. __________________Disp. Income x 60 months as calculated under Section 1325(b), or � 3. a pro-rata dividend from the base plan, if any.
Page 3 of 3
Revised Form 103 (2017)
798888-WILSR01A - MSW
IV. Leases or Executory Contracts: (If applicable) The following leases or executory contracts of the debtor will be treated as follows:
V. Vesting of Property: Title to Debtor’s property shall revest in the Debtor on confirmation of the
Plan, except for undistributed plan payments held by the Trustee. Unless otherwise ordered, upon conversion of this case to Chapter 7 all undistributed plan payments received from a debtor’s post-petition wages shall be refunded to the debtor(s). Upon dismissal, unless otherwise ordered, the Trustee is authorized to disburse undistributed plan payments to allowed claimants in accordance with this Plan.
VI. Nonstandard Provisions: Any other nonstandard provision placed elsewhere in this plan is void.
VII. Filing Proof of Claim Required: A proof of claim must be filed in order to share in distributions under
the plan. A proof of claim may be filed either electronically or as paper. To file an electronic claim, go to the website www.deb.uscourts.gov and click on “File a Claim” and follow the instructions. Once the necessary information is entered the form will be automatically generated. To obtain a claim form to file a paper claim, go to the website www.uscourts.gov and click on “Services and Forms, then click on Bankruptcy Forms, the Select B410-Proof of Claim. Completed paper claims should be delivered or mailed to United States Bankruptcy Court, Attn: Claims, 824 Market Street, 3rd Floor, Wilmington, Delaware 19801.
_____________________________ ________________________ Debtor's Signature Date _____________________________ ________________________ Joint Debtor's Signature Date The undersigned certifies that this plan contains no nonstandard provision other than as set forth in paragraph VI above. _____________________________ ________________________ Attorney for Debtor(s) Date _____________________________ ________________________ Self-represented Debtor(s) Date
150% of the HHS Poverty Guidelines for 2016*Monthly Basis
Persons in family unit
48 Contiguous States and
D.C. Alaska Hawaii
1 $1,485.00 $1,855.00 $1,708.75
2 $2,002.50 $2,502.50 $2,303.75
3 $2,520.00 $3,150.00 $2,898.75
4 $3,037.50 $3,797.50 $3,493.75
5 $3,555.00 $4,445.00 $4,088.75
6 $4,072.50 $5,092.50 $4,683.75
7 $4,591.25 $5,740.00 $5,278.75
8 $5,111.25 $6,390.00 $5,876.25
For each additional
person add$520.00 $650.00 $597.50
* As required by section 673(2) of the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35 - reauthorized by Pub. L. 105-285, Section 201 (1988)).
150% of the HHS Poverty Guidelines for 2016*Annual Basis
Persons in family unit
48 Contiguous States and
D.C. Alaska Hawaii
1 $17,820 $22,260 $20,505
2 $24,030 $30,030 $27,645
3 $30,240 $37,800 $34,785
4 $36,450 $45,570 $41,925
5 $42,660 $53,340 $49,065
6 $48,870 $61,110 $56,205
7 $55,095 $68,880 $63,345
8 $61,335 $76,680 $70,515
For each additional
person add$6,240 $7,800 $7,170
* As required by section 673(2) of the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35 - reauthorized by Pub. L. 105-285, Section 201 (1988)).
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