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

Purpose of Form :
This form is used as HHS Poverty Guidelines to complete Form I-912, Fee Waiver Request.
Number of Pages : 1

Edition Date :
02/06/12 (Previous editions should not be used.)

Where to File :
This form does not need to be filed. It is used only for assistance in completing Form I-912.

Filing Fee : NA

Special Instructions :