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FriendlyCAECI Community Action of East Central Indiana, Inc.
Health and Human Services FY 2009 Poverty Guidelines
200% of Poverty (Weatherization)
HOUSEHOLD SIZE
MONTHLY ANNUAL
1
$1,805.00 $21,660.00
2
$2,428.00 $29,140.00
3
$3,052.00 $36,620.00
4
$3,675.00 $44,100.00
5
$4,298.00 $51,580.00
6
$4,922.00 $59,060.00
7
$5,545.00 $66,540.00
8
$6,168.00 $74,020.00
9
$6,792.00 $81,500.00
10
$7,415.00 $88,980.00
For each additional household member add
$623.00 $7,480.00
Proof of income:
Copy of bank statement?
(direct deposit info on soc. sec., disability, retirement fund, certificate of
deposit, etc.)
Most recent award letter?
(social security, disability, V.A.)
Copy of most recent check?
(social security, disability, V.A., pension)
Copy of all check stubs or
printout of last twelve (12) months of all employment income?
Printout for unemployment
benefits, TANF, child support for the last twelve (12) months?
Household Member Verification
Form for anyone in your household 18 years of age and older and who has no
income for any or all of the last twelve (12) months? If claiming support
from someone not in your household, you will need a note from them outlining the
months and types of support they provided. The note needs to be signed, with the name, address,
and phone number of the provider.
Contact us if you need Income Verification Forms or for Agreement Forms
Other information needed:
Copies of social security
cards for all household members?
Copy of most recent heating
and electric bills?
Owner Agreement if homeowner
or, if renter
Tenant Agreement if renter
Copy of the Property tax or Mobile Trailer Title