Fee Schedule
Sliding Fee Pay Scale
Your payment depends on your household size and yearly income. Find your family size in the first column, then look across to find your income range.
| Family Size | Nominal Fee $30≤100% FPL | 20% Charge101–120% FPL | 40% Charge121–140% FPL | 60% Charge141–160% FPL | 80% Charge161–180% FPL | 95% Charge181–200% FPL | 100% Charge>200% FPL |
|---|---|---|---|---|---|---|---|
| 1 | 0–15,650 | 15,651–18,780 | 18,781–21,910 | 21,911–25,040 | 25,041–28,170 | 28,171–31,300 | 31,301+ |
| 2 | 0–21,150 | 21,151–25,380 | 25,381–29,610 | 29,611–33,840 | 33,841–38,070 | 38,071–42,300 | 42,301+ |
| 3 | 0–26,650 | 26,651–31,980 | 31,981–37,310 | 37,311–42,640 | 42,641–47,970 | 47,971–53,300 | 53,301+ |
| 4 | 0–32,150 | 32,151–38,580 | 38,581–45,010 | 45,011–51,440 | 51,441–57,870 | 57,871–64,300 | 64,301+ |
| 5 | 0–37,650 | 37,651–45,180 | 45,181–52,710 | 52,711–60,240 | 60,241–67,770 | 67,771–75,300 | 75,301+ |
| 6 | 0–43,150 | 43,151–51,780 | 51,781–60,410 | 60,411–69,040 | 69,041–77,670 | 77,671–86,300 | 86,301+ |
*Some services may not be included in the sliding fee discount. Please ask staff for details.
Sliding Scale Application
Complete the form below to apply for our sliding scale program. All fields marked with an asterisk (*) are required. Your information is kept confidential.