Forms

FYI
Our forms are pdf documents, you can download Adobe Reader for free HERE.

Microsoft Edge is the default program for opening PDF files on Windows 10. In four easy steps, you can make Acrobat DC or Acrobat Reader DC your default PDF program.

  • Right-click the thumbnail of a PDF file, and then choose Properties.
  • In the file’s Properties dialog box, click Change.
  • Do one of the following:
    • If you have Acrobat DC or both Acrobat DC and Acrobat Reader DC, choose Adobe Acrobat DC and click OK.
    • If you have only Acrobat Reader DC, choose Adobe Acrobat Reader DC and click OK.

On Apple computers you can use Safari or Preview to open pdf documents.

ESTIMATED HOUSEHOLD SIZE & INCOME FOR 2021 (.pdf)
Click on the above link to download the pdf form to your computer.
Open and fill out the form.
When finished, click the SUBMIT button to email the finished form.
or
Fill out the form, print, then fax the form to 1-662-594-1851.

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  • Income Limits for 2020 (These income limits are not published until AFTER Open Enrollment each year. That means that the tax credits assigned during Open Enrollment each year are based on the income limits from the previous year.) U.S. FEDERAL POVERTY GUIDELINES USED TO DETERMINE FINANCIAL ELIGIBILITY FOR CERTAIN FEDERAL PROGRAMS, including tax credits and cost share reduction from the Health Insurance Marketplace.

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