694 Income limits and co-payments for the Subsidized Child Care Program

DEPARTMENT OF
PUBLIC WELFARE

Income Limits and Co-payments for the Subsidized Child Care Program

[41 Pa.B. 2172]
[Saturday, April 23, 2011]

 The purpose of this notice is to increase the income limits codified at 55 Pa. Code Chapter 3041, Appendix B (relating to co-payment chart family co-payment scale (based on the 2011 Federal Poverty Income Guidelines (FPIG)) under 55 Pa. Code § 3041.107(b) (relating to availability and use of the Federal Poverty Income Guidelines). This increase is effective May 2, 2011.

 Section 3041.107(b) of 55 Pa. Code requires the Department of Public Welfare to update the copayment schedule in 55 Pa. Code Chapter 3041, Appendix B to reflect changes in the FPIGs. Effective May 2, 2011, the income guidelines for the subsidized child care program are increased due to increases in the FPIG. The copayment schedule is adjusted to reflect the increases. Chapter 3041, Appendix B of 55 Pa. Code also establishes the family copayment levels according to the family's computed annual income and lists the weekly family copayment based on the annual family income.

GARY D. ALEXANDER, 
Acting Secretary

 Fiscal Note: 14-NOT-685. No fiscal impact; (8) recommends adoption.

CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)

Weekly	Family Size:	1	Family Size:	2	Family Size:	3
Co-pay	Annual Income		Annual Income		Annual Income
$5.00	Less than:	$8,890	Less than:	$12,710	Less than:	$14,530
$10.00	$8,890.01	$10,890	$12,710.01	$14,710	$14,530.01	$16,530
$15.00	$10,890.01	$12,890	$14,710.01	$16,710	$16,530.01	$18,530
$20.00	$12,890.01	$14,890	$16,710.01	$18,710	$18,530.01	$20,530
$25.00	$14,890.01	$16,890	$18,710.01	$20,710	$20,530.01	$22,530
$30.00	$16,890.01	$18,890	$20,710.01	$22,710	$22,530.01	$24,530
$35.00	$18,890.01	$20,890	$22,710.01	$24,710	$24,530.01	$26,530
$40.00	$20,890.01	$22,890	$24,710.01	$26,710	$26,530.01	$28,530
$45.00	$22,890.01	$24,890	$26,710.01	$28,710	$28,530.01	$30,530
$50.00	$24,890.01	$25,592	$28,710.01	$30,710	$30,530.01	$32,530
$55.00			$30,710.01	$32,710	$32,530.01	$34,530
$60.00			$32,710.01	$34,569	$34,530.01	$36,530
$65.00					$36,530.01	$38,530
$70.00					$38,530.01	$40,530
$75.00					$40,530.01	$42,530
$80.00					$42,530.01	$43,546
	200% FPIG	$21,780	200% FPIG	$29,420	200% FPIG	$37,060

CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)

Weekly	Family Size:	4	Family Size:	5	Family Size:	6
Co-pay	Annual Income		Annual Income		Annual Income
$5.00	Less than:	$16,350	Less than:	$18,170	Less than:	$19,990
$10.00	$16,350.01	$18,350	$18,170.01	$20,170	$19,990.01	$21,990
$15.00	$18,350.01	$20,350	$20,170.01	$22,170	$21,990.01	$23,990
$20.00	$20,350.01	$22,350	$22,170.01	$24,170	$23,990.01	$25,990
$25.00	$22,350.01	$24,350	$24,170.01	$26,170	$25,990.01	$27,990
$30.00	$24,350.01	$26,350	$26,170.01	$28,170	$27,990.01	$29,990
$35.00	$26,350.01	$28,350	$28,170.01	$30,170	$29,990.01	$31,990
$40.00	$28,350.01	$30,350	$30,170.01	$32,170	$31,990.01	$33,990
$45.00	$30,350.01	$32,350	$32,170.01	$34,170	$33,990.01	$35,990
$50.00	$32,350.01	$34,350	$34,170.01	$36,170	$35,990.01	$37,990
$55.00	$34,350.01	$36,350	$36,170.01	$38,170	$37,990.01	$39,990
$60.00	$36,350.01	$38,350	$38,170.01	$40,170	$39,990.01	$41,990
$65.00	$38,350.01	$40,350	$40,170.01	$42,170	$41,990.01	$43,990
$70.00	$40,350.01	$42,350	$42,170.01	$44,170	$43,990.01	$45,990
$75.00	$42,350.01	$44,350	$44,170.01	$46,170	$45,990.01	$47,990
$80.00	$44,350.01	$46,350	$46,170.01	$48,170	$47,990.01	$49,990
$85.00	$46,350.01	$48,350	$48,170.01	$50,170	$49,990.01	$51,990
$90.00	$48,350.01	$50,350	$50,170.01	$52,170	$51,990.01	$53,990
$95.00	$50,350.01	$52,350	$52,170.01	$54,170	$53,990.01	$55,990
$100.00	$52,350.01	$52,523	$54,170.01	$56,170	$55,990.01	$57,990
$105.00			$56,170.01	$58,170	$57,990.01	$59,990
$110.00			$58,170.01	$60,170	$59,990.01	$61,990
$115.00			$60,170.01	$61,500	$61,990.01	$63,990
$120.00					$63,990.01	$65,990
$125.00					$65,990.01	$67,990
$130.00					$67,990.01	$69,990
$135.00					$69,990.01	$70,477
	200% FPIG	$44,700	200% FPIG	$52,340	200% FPIG	$59,980

CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)

Weekly	Family Size:	7	Family Size:	8	Family Size:	9
Co-pay	Annual Income		Annual Income		Annual Income
$5.00	Less than:	$21,810	Less than:	$23,630	Less than:	$25,450
$10.00	$21,810.01	$23,810	$23,630.01	$25,630	$25,450.01	$27,450
$15.00	$23,810.01	$25,810	$25,630.01	$27,630	$27,450.01	$29,450
$20.00	$25,810.01	$27,810	$27,630.01	$29,630	$29,450.01	$31,450
$25.00	$27,810.01	$29,810	$29,630.01	$31,630	$31,450.01	$33,450
$30.00	$29,810.01	$31,810	$31,630.01	$33,630	$33,450.01	$35,450
$35.00	$31,810.01	$33,810	$33,630.01	$35,630	$35,450.01	$37,450
$40.00	$33,810.01	$35,810	$35,630.01	$37,630	$37,450.01	$39,450
$45.00	$35,810.01	$37,810	$37,630.01	$39,630	$39,450.01	$41,450
$50.00	$37,810.01	$39,810	$39,630.01	$41,630	$41,450.01	$43,450
$55.00	$39,810.01	$41,810	$41,630.01	$43,630	$43,450.01	$45,450
$60.00	$41,810.01	$43,810	$43,630.01	$45,630	$45,450.01	$47,450
$65.00	$43,810.01	$45,810	$45,630.01	$47,630	$47,450.01	$49,450
$70.00	$45,810.01	$47,810	$47,630.01	$49,630	$49,450.01	$51,450
$75.00	$47,810.01	$49,810	$49,630.01	$51,630	$51,450.01	$53,450
$80.00	$49,810.01	$51,810	$51,630.01	$53,630	$53,450.01	$55,450
$85.00	$51,810.01	$53,810	$53,630.01	$55,630	$55,450.01	$57,450
$90.00	$53,810.01	$55,810	$55,630.01	$57,630	$57,450.01	$59,450
$95.00	$55,810.01	$57,810	$57,630.01	$59,630	$59,450.01	$61,450
$100.00	$57,810.01	$59,810	$59,630.01	$61,630	$61,450.01	$63,450
$105.00	$59,810.01	$61,810	$61,630.01	$63,630	$63,450.01	$65,450
$110.00	$61,810.01	$63,810	$63,630.01	$65,630	$65,450.01	$67,450
$115.00	$63,810.01	$65,810	$65,630.01	$67,630	$67,450.01	$69,450
$120.00	$65,810.01	$67,810	$67,630.01	$69,630	$69,450.01	$71,450
$125.00	$67,810.01	$69,810	$69,630.01	$71,630	$71,450.01	$73,450
$130.00	$69,810.01	$71,810	$71,630.01	$73,630	$73,450.01	$75,450
$135.00	$71,810.01	$73,810	$73,630.01	$75,630	$75,450.01	$77,450
$140.00	$73,810.01	$75,810	$75,630.01	$77,630	$77,450.01	$79,450
$145.00	$75,810.01	$77,810	$77,630.01	$79,630	$79,450.01	$81,450
$150.00	$77,810.01	$79,454	$79,630.01	$81,630	$81,450.01	$83,450
$155.00			$81,630.01	$83,630	$83,450.01	$85,450
$160.00			$83,630.01	$85,630	$85,450.01	$87,450
$165.00			$85,630.01	$87,630	$87,450.01	$89,450
$170.00			$87,630.01	$88,431	$89,450.01	$91,450
$175.00					$91,450.01	$93,450
$180.00					$93,450.01	$95,450
$185.00					$95,450.01	$97,408
	200% FPIG	$67,620	200% FPIG	$75,260	200% FPIG	$82,900

CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)

Weekly	Family Size:	10	Family Size:	11	Family Size:	12
Co-pay	Annual Income		Annual Income		Annual Income
$5.00	Less than:	$27,270	Less than:	$29,090	Less than:	$30,910
$10.00	$27,270.01	$29,270	$29,090.01	$31,090	$30,910.01	$32,910
$15.00	$29,270.01	$31,270	$31,090.01	$33,090	$32,910.01	$34,910
$20.00	$31,270.01	$33,270	$33,090.01	$35,090	$34,910.01	$36,910
$25.00	$33,270.01	$35,270	$35,090.01	$37,090	$36,910.01	$38,910
$30.00	$35,270.01	$37,270	$37,090.01	$39,090	$38,910.01	$40,910
$35.00	$37,270.01	$39,270	$39,090.01	$41,090	$40,910.01	$42,910
$40.00	$39,270.01	$41,270	$41,090.01	$43,090	$42,910.01	$44,910
$45.00	$41,270.01	$43,270	$43,090.01	$45,090	$44,910.01	$46,910
$50.00	$43,270.01	$45,270	$45,090.01	$47,090	$46,910.01	$48,910
$55.00	$45,270.01	$47,270	$47,090.01	$49,090	$48,910.01	$50,910
$60.00	$47,270.01	$49,270	$49,090.01	$51,090	$50,910.01	$52,910
$65.00	$49,270.01	$51,270	$51,090.01	$53,090	$52,910.01	$54,910
$70.00	$51,270.01	$53,270	$53,090.01	$55,090	$54,910.01	$56,910
$75.00	$53,270.01	$55,270	$55,090.01	$57,090	$56,910.01	$58,910
$80.00	$55,270.01	$57,270	$57,090.01	$59,090	$58,910.01	$60,910
$85.00	$57,270.01	$59,270	$59,090.01	$61,090	$60,910.01	$62,910
$90.00	$59,270.01	$61,270	$61,090.01	$63,090	$62,910.01	$64,910
$95.00	$61,270.01	$63,270	$63,090.01	$65,090	$64,910.01	$66,910
$100.00	$63,270.01	$65,270	$65,090.01	$67,090	$66,910.01	$68,910
$105.00	$65,270.01	$67,270	$67,090.01	$69,090	$68,910.01	$70,910
$110.00	$67,270.01	$69,270	$69,090.01	$71,090	$70,910.01	$72,910
$115.00	$69,270.01	$71,270	$71,090.01	$73,090	$72,910.01	$74,910
$120.00	$71,270.01	$73,270	$73,090.01	$75,090	$74,910.01	$76,910
$125.00	$73,270.01	$75,270	$75,090.01	$77,090	$76,910.01	$78,910
$130.00	$75,270.01	$77,270	$77,090.01	$79,090	$78,910.01	$80,910
$135.00	$77,270.01	$79,270	$79,090.01	$81,090	$80,910.01	$82,910
$140.00	$79,270.01	$81,270	$81,090.01	$83,090	$82,910.01	$84,910
$145.00	$81,270.01	$83,270	$83,090.01	$85,090	$84,910.01	$86,910
$150.00	$83,270.01	$85,270	$85,090.01	$87,090	$86,910.01	$88,910
$155.00	$85,270.01	$87,270	$87,090.01	$89,090	$88,910.01	$90,910
$160.00	$87,270.01	$89,270	$89,090.01	$91,090	$90,910.01	$92,910
$165.00	$89,270.01	$91,270	$91,090.01	$93,090	$92,910.01	$94,910
$170.00	$91,270.01	$93,270	$93,090.01	$95,090	$94,910.01	$96,910
$175.00	$93,270.01	$95,270	$95,090.01	$97,090	$96,910.01	$98,910
$180.00	$95,270.01	$97,270	$97,090.01	$99,090	$98,910.01	$100,910
$185.00	$97,270.01	$99,270	$99,090.01	$101,090	$100,910.01	$102,910
$190.00	$99,270.01	$101,270	$101,090.01	$103,090	$102,910.01	$104,910
$195.00	$101,270.01	$103,270	$103,090.01	$105,090	$104,910.01	$106,910
$200.00	$103,270.01	$105,270	$105,090.01	$107,090	$106,910.01	$108,910
$205.00	$105,270.01	$106,385	$107,090.01	$109,090	$108,910.01	$110,910
$210.00			$109,090.01	$111,090	$110,910.01	$112,910
$215.00			$111,090.01	$113,090	$112,910.01	$114,910
$220.00			$113,090.01	$115,090	$114,910.01	$116,910
$225.00			$115,090.01	$115,362	$116,910.01	$118,910
$230.00					$118,910.01	$120,910
$235.00					$120,910.01	$122,910
$240.00					$122,910.01	$124,339
	200% FPIG	$90,540	200% FPIG	$98,180	200% FPIG	$105,820

CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)

Weekly	Family Size:	13	Family Size:	14	Family Size:	15
Co-pay	Annual Income		Annual Income		Annual Income
$5.00	Less than:	$32,730	Less than:	$34,550	Less than:	$36,370
$10.00	$32,730.01	$34,730	$34,550.01	$36,550	$36,370.01	$38,370
$15.00	$34,730.01	$36,730	$36,550.01	$38,550	$38,370.01	$40,370
$20.00	$36,730.01	$38,730	$38,550.01	$40,550	$40,370.01	$42,370
$25.00	$38,730.01	$40,730	$40,550.01	$42,550	$42,370.01	$44,370
$30.00	$40,730.01	$42,730	$42,550.01	$44,550	$44,370.01	$46,370
$35.00	$42,730.01	$44,730	$44,550.01	$46,550	$46,370.01	$48,370
$40.00	$44,730.01	$46,730	$46,550.01	$48,550	$48,370.01	$50,370
$45.00	$46,730.01	$48,730	$48,550.01	$50,550	$50,370.01	$52,370
$50.00	$48,730.01	$50,730	$50,550.01	$52,550	$52,370.01	$54,370
$55.00	$50,730.01	$52,730	$52,550.01	$54,550	$54,370.01	$56,370
$60.00	$52,730.01	$54,730	$54,550.01	$56,550	$56,370.01	$58,370
$65.00	$54,730.01	$56,730	$56,550.01	$58,550	$58,370.01	$60,370
$70.00	$56,730.01	$58,730	$58,550.01	$60,550	$60,370.01	$62,370
$75.00	$58,730.01	$60,730	$60,550.01	$62,550	$62,370.01	$64,370
$80.00	$60,730.01	$62,730	$62,550.01	$64,550	$64,370.01	$66,370
$85.00	$62,730.01	$64,730	$64,550.01	$66,550	$66,370.01	$68,370
$90.00	$64,730.01	$66,730	$66,550.01	$68,550	$68,370.01	$70,370
$95.00	$66,730.01	$68,730	$68,550.01	$70,550	$70,370.01	$72,370
$100.00	$68,730.01	$70,730	$70,550.01	$72,550	$72,370.01	$74,370
$105.00	$70,730.01	$72,730	$72,550.01	$74,550	$74,370.01	$76,370
$110.00	$72,730.01	$74,730	$74,550.01	$76,550	$76,370.01	$78,370
$115.00	$74,730.01	$76,730	$76,550.01	$78,550	$78,370.01	$80,370
$120.00	$76,730.01	$78,730	$78,550.01	$80,550	$80,370.01	$82,370
$125.00	$78,730.01	$80,730	$80,550.01	$82,550	$82,370.01	$84,370
$130.00	$80,730.01	$82,730	$82,550.01	$84,550	$84,370.01	$86,370
$135.00	$82,730.01	$84,730	$84,550.01	$86,550	$86,370.01	$88,370
$140.00	$84,730.01	$86,730	$86,550.01	$88,550	$88,370.01	$90,370
$145.00	$86,730.01	$88,730	$88,550.01	$90,550	$90,370.01	$92,370
$150.00	$88,730.01	$90,730	$90,550.01	$92,550	$92,370.01	$94,370
$155.00	$90,730.01	$92,730	$92,550.01	$94,550	$94,370.01	$96,370
$160.00	$92,730.01	$94,730	$94,550.01	$96,550	$96,370.01	$98,370
$165.00	$94,730.01	$96,730	$96,550.01	$98,550	$98,370.01	$100,370
$170.00	$96,730.01	$98,730	$98,550.01	$100,550	$100,370.01	$102,370
$175.00	$98,730.01	$100,730	$100,550.01	$102,550	$102,370.01	$104,370
$180.00	$100,730.01	$102,730	$102,550.01	$104,550	$104,370.01	$106,370
$185.00	$102,730.01	$104,730	$104,550.01	$106,550	$106,370.01	$108,370
$190.00	$104,730.01	$106,730	$106,550.01	$108,550	$108,370.01	$110,370
$195.00	$106,730.01	$108,730	$108,550.01	$110,550	$110,370.01	$112,370
$200.00	$108,730.01	$110,730	$110,550.01	$112,550	$112,370.01	$114,370
$205.00	$110,730.01	$112,730	$112,550.01	$114,550	$114,370.01	$116,370
$210.00	$112,730.01	$114,730	$114,550.01	$116,550	$116,370.01	$118,370
$215.00	$114,730.01	$116,730	$116,550.01	$118,550	$118,370.01	$120,370
$220.00	$116,730.01	$118,730	$118,550.01	$120,550	$120,370.01	$122,370
$225.00	$118,730.01	$120,730	$120,550.01	$122,550	$122,370.01	$124,370
$230.00	$120,730.01	$122,730	$122,550.01	$124,550	$124,370.01	$126,370
$235.00	$122,730.01	$124,730	$124,550.01	$126,550	$126,370.01	$128,370
$240.00	$124,730.01	$126,730	$126,550.01	$128,550	$128,370.01	$130,370
$245.00	$126,730.01	$128,730	$128,550.01	$130,550	$130,370.01	$132,370
$250.00	$128,730.01	$130,730	$130,550.01	$132,550	$132,370.01	$134,370
$255.00	$130,730.01	$132,730	$132,550.01	$134,550	$134,370.01	$136,370
$260.00	$132,730.01	$133,316	$134,550.01	$136,550	$136,370.01	$138,370
$265.00			$136,550.01	$138,550	$138,370.01	$140,370
$270.00			$138,550.01	$140,550	$140,370.01	$142,370
$275.00			$140,550.01	$142,293	$142,370.01	$144,370
$280.00					$144,370.01	$146,370
$285.00					$146,370.01	$148,370
$290.00					$148,370.01	$150,370
$295.00					$150,370.01	$151,270
	200% FPIG	$113,460	200% FPIG	$121,100	200% FPIG	$128,740

CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)

Weekly	Family Size:	16	Family Size:	17	Family Size:	18
Co-pay	Annual Income		Annual Income		Annual Income
$5.00	Less than:	$40,190	Less than:	$42,010	Less than:	$43,830
$10.00	$40,190.01	$42,190	$42,010.01	$44,010	$43,830.01	$45,830
$15.00	$42,190.01	$44,190	$44,010.01	$46,010	$45,830.01	$47,830
$20.00	$44,190.01	$46,190	$46,010.01	$48,010	$47,830.01	$49,830
$25.00	$46,190.01	$48,190	$48,010.01	$50,010	$49,830.01	$51,830
$30.00	$48,190.01	$50,190	$50,010.01	$52,010	$51,830.01	$53,830
$35.00	$50,190.01	$52,190	$52,010.01	$54,010	$53,830.01	$55,830
$40.00	$52,190.01	$54,190	$54,010.01	$56,010	$55,830.01	$57,830
$45.00	$54,190.01	$56,190	$56,010.01	$58,010	$57,830.01	$59,830
$50.00	$56,190.01	$58,190	$58,010.01	$60,010	$59,830.01	$61,830
$55.00	$58,190.01	$60,190	$60,010.01	$62,010	$61,830.01	$63,830
$60.00	$60,190.01	$62,190	$62,010.01	$64,010	$63,830.01	$65,830
$65.00	$62,190.01	$64,190	$64,010.01	$66,010	$65,830.01	$67,830
$70.00	$64,190.01	$66,190	$66,010.01	$68,010	$67,830.01	$69,830
$75.00	$66,190.01	$68,190	$68,010.01	$70,010	$69,830.01	$71,830
$80.00	$68,190.01	$70,190	$70,010.01	$72,010	$71,830.01	$73,830
$85.00	$70,190.01	$72,190	$72,010.01	$74,010	$73,830.01	$75,830
$90.00	$72,190.01	$74,190	$74,010.01	$76,010	$75,830.01	$77,830
$95.00	$74,190.01	$76,190	$76,010.01	$78,010	$77,830.01	$79,830
$100.00	$76,190.01	$78,190	$78,010.01	$80,010	$79,830.01	$81,830
$105.00	$78,190.01	$80,190	$80,010.01	$82,010	$81,830.01	$83,830
$110.00	$80,190.01	$82,190	$82,010.01	$84,010	$83,830.01	$85,830
$115.00	$82,190.01	$84,190	$84,010.01	$86,010	$85,830.01	$87,830
$120.00	$84,190.01	$86,190	$86,010.01	$88,010	$87,830.01	$89,830
$125.00	$86,190.01	$88,190	$88,010.01	$90,010	$89,830.01	$91,830
$130.00	$88,190.01	$90,190	$90,010.01	$92,010	$91,830.01	$93,830
$135.00	$90,190.01	$92,190	$92,010.01	$94,010	$93,830.01	$95,830
$140.00	$92,190.01	$94,190	$94,010.01	$96,010	$95,830.01	$97,830
$145.00	$94,190.01	$96,190	$96,010.01	$98,010	$97,830.01	$99,830
$150.00	$96,190.01	$98,190	$98,010.01	$100,010	$99,830.01	$101,830
$155.00	$98,190.01	$100,190	$100,010.01	$102,010	$101,830.01	$103,830
$160.00	$100,190.01	$102,190	$102,010.01	$104,010	$103,830.01	$105,830
$165.00	$102,190.01	$104,190	$104,010.01	$106,010	$105,830.01	$107,830
$170.00	$104,190.01	$106,190	$106,010.01	$108,010	$107,830.01	$109,830
$175.00	$106,190.01	$108,190	$108,010.01	$110,010	$109,830.01	$111,830
$180.00	$108,190.01	$110,190	$110,010.01	$112,010	$111,830.01	$113,830
$185.00	$110,190.01	$112,190	$112,010.01	$114,010	$113,830.01	$115,830
$190.00	$112,190.01	$114,190	$114,010.01	$116,010	$115,830.01	$117,830
$195.00	$114,190.01	$116,190	$116,010.01	$118,010	$117,830.01	$119,830
$200.00	$116,190.01	$118,190	$118,010.01	$120,010	$119,830.01	$121,830
$205.00	$118,190.01	$120,190	$120,010.01	$122,010	$121,830.01	$123,830
$210.00	$120,190.01	$122,190	$122,010.01	$124,010	$123,830.01	$125,830
$215.00	$122,190.01	$124,190	$124,010.01	$126,010	$125,830.01	$127,830
$220.00	$124,190.01	$126,190	$126,010.01	$128,010	$127,830.01	$129,830
$225.00	$126,190.01	$128,190	$128,010.01	$130,010	$129,830.01	$131,830
$230.00	$128,190.01	$130,190	$130,010.01	$132,010	$131,830.01	$133,830
$235.00	$130,190.01	$132,190	$132,010.01	$134,010	$133,830.01	$135,830
$240.00	$132,190.01	$134,190	$134,010.01	$136,010	$135,830.01	$137,830
$245.00	$134,190.01	$136,190	$136,010.01	$138,010	$137,830.01	$139,830
$250.00	$136,190.01	$138,190	$138,010.01	$140,010	$139,830.01	$141,830
$255.00	$138,190.01	$140,190	$140,010.01	$142,010	$141,830.01	$143,830
$260.00	$140,190.01	$142,190	$142,010.01	$144,010	$143,830.01	$145,830
$265.00	$142,190.01	$144,190	$144,010.01	$146,010	$145,830.01	$147,830
$270.00	$144,190.01	$146,190	$146,010.01	$148,010	$147,830.01	$149,830
$275.00	$146,190.01	$148,190	$148,010.01	$150,010	$149,830.01	$151,830
$280.00	$148,190.01	$150,190	$150,010.01	$152,010	$151,830.01	$153,830
$285.00	$150,190.01	$152,190	$152,010.01	$154,010	$153,830.01	$155,830
$290.00	$152,190.01	$154,190	$154,010.01	$156,010	$155,830.01	$157,830
$295.00	$154,190.01	$156,190	$156,010.01	$158,010	$157,830.01	$159,830
$300.00	$156,190.01	$158,190	$158,010.01	$160,010	$159,830.01	$161,830
$305.00	$158,190.01	$160,190	$160,010.01	$162,010	$161,830.01	$163,830
$310.00	$160,190.01	$160,247	$162,010.01	$164,010	$163,830.01	$165,830
$315.00			$164,010.01	$166,010	$165,830.01	$167,830
$320.00			$166,010.01	$168,010	$167,830.01	$169,830
$325.00			$168,010.01	$169,224	$169,830.01	$171,830
$330.00					$171,830.01	$173,830
$335.00					$173,830.01	$175,830
$340.00					$175,830.01	$177,830
$345.00					$177,830.01	$178,201
	200% FPIG	$136,380	200% FPIG	$144,020	200% FPIG	$151,660

CO-PAYMENT CHART
FAMILY CO-PAYMENT SCALE
(BASED ON THE 2011 FEDERAL POVERTY INCOME GUIDELINES)

Weekly	Family Size:	19	Family Size:	20	Family Size:	21
Co-pay	Annual Income		Annual Income		Annual Income
$5.00	Less than:	$45,650	Less than:	$47,470	Less than:	$49,290
$10.00	$45,650.01	$47,650	$47,470.01	$49,470	$49,290.01	$51,290
$15.00	$47,650.01	$49,650	$49,470.01	$51,470	$51,290.01	$53,290
$20.00	$49,650.01	$51,650	$51,470.01	$53,470	$53,290.01	$55,290
$25.00	$51,650.01	$53,650	$53,470.01	$55,470	$55,290.01	$57,290
$30.00	$53,650.01	$55,650	$55,470.01	$57,470	$57,290.01	$59,290
$35.00	$55,650.01	$57,650	$57,470.01	$59,470	$59,290.01	$61,290
$40.00	$57,650.01	$59,650	$59,470.01	$61,470	$61,290.01	$63,290
$45.00	$59,650.01	$61,650	$61,470.01	$63,470	$63,290.01	$65,290
$50.00	$61,650.01	$63,650	$63,470.01	$65,470	$65,290.01	$67,290
$55.00	$63,650.01	$65,650	$65,470.01	$67,470	$67,290.01	$69,290
$60.00	$65,650.01	$67,650	$67,470.01	$69,470	$69,290.01	$71,290
$65.00	$67,650.01	$69,650	$69,470.01	$71,470	$71,290.01	$73,290
$70.00	$69,650.01	$71,650	$71,470.01	$73,470	$73,290.01	$75,290
$75.00	$71,650.01	$73,650	$73,470.01	$75,470	$75,290.01	$77,290
$80.00	$73,650.01	$75,650	$75,470.01	$77,470	$77,290.01	$79,290
$85.00	$75,650.01	$77,650	$77,470.01	$79,470	$79,290.01	$81,290
$90.00	$77,650.01	$79,650	$79,470.01	$81,470	$81,290.01	$83,290
$95.00	$79,650.01	$81,650	$81,470.01	$83,470	$83,290.01	$85,290
$100.00	$81,650.01	$83,650	$83,470.01	$85,470	$85,290.01	$87,290
$105.00	$83,650.01	$85,650	$85,470.01	$87,470	$87,290.01	$89,290
$110.00	$85,650.01	$87,650	$87,470.01	$89,470	$89,290.01	$91,290
$115.00	$87,650.01	$89,650	$89,470.01	$91,470	$91,290.01	$93,290
$120.00	$89,650.01	$91,650	$91,470.01	$93,470	$93,290.01	$95,290
$125.00	$91,650.01	$93,650	$93,470.01	$95,470	$95,290.01	$97,290
$130.00	$93,650.01	$95,650	$95,470.01	$97,470	$97,290.01	$99,290
$135.00	$95,650.01	$97,650	$97,470.01	$99,470	$99,290.01	$101,290
$140.00	$97,650.01	$99,650	$99,470.01	$101,470	$101,290.01	$103,290
$145.00	$99,650.01	$101,650	$101,470.01	$103,470	$103,290.01	$105,290
$150.00	$101,650.01	$103,650	$103,470.01	$105,470	$105,290.01	$107,290
$155.00	$103,650.01	$105,650	$105,470.01	$107,470	$107,290.01	$109,290
$160.00	$105,650.01	$107,650	$107,470.01	$109,470	$109,290.01	$111,290
$165.00	$107,650.01	$109,650	$109,470.01	$111,470	$111,290.01	$113,290
$170.00	$109,650.01	$111,650	$111,470.01	$113,470	$113,290.01	$115,290
$175.00	$111,650.01	$113,650	$113,470.01	$115,470	$115,290.01	$117,290
$180.00	$113,650.01	$115,650	$115,470.01	$117,470	$117,290.01	$119,290
$185.00	$115,650.01	$117,650	$117,470.01	$119,470	$119,290.01	$121,290
$190.00	$117,650.01	$119,650	$119,470.01	$121,470	$121,290.01	$123,290
$195.00	$119,650.01	$121,650	$121,470.01	$123,470	$123,290.01	$125,290
$200.00	$121,650.01	$123,650	$123,470.01	$125,470	$125,290.01	$127,290
$205.00	$123,650.01	$125,650	$125,470.01	$127,470	$127,290.01	$129,290
$210.00	$125,650.01	$127,650	$127,470.01	$129,470	$129,290.01	$131,290
$215.00	$127,650.01	$129,650	$129,470.01	$131,470	$131,290.01	$133,290
$220.00	$129,650.01	$131,650	$131,470.01	$133,470	$133,290.01	$135,290
$225.00	$131,650.01	$133,650	$133,470.01	$135,470	$135,290.01	$137,290
$230.00	$133,650.01	$135,650	$135,470.01	$137,470	$137,290.01	$139,290
$235.00	$135,650.01	$137,650	$137,470.01	$139,470	$139,290.01	$141,290
$240.00	$137,650.01	$139,650	$139,470.01	$141,470	$141,290.01	$143,290
$245.00	$139,650.01	$141,650	$141,470.01	$143,470	$143,290.01	$145,290
$250.00	$141,650.01	$143,650	$143,470.01	$145,470	$145,290.01	$147,290
$255.00	$143,650.01	$145,650	$145,470.01	$147,470	$147,290.01	$149,290
$260.00	$145,650.01	$147,650	$147,470.01	$149,470	$149,290.01	$151,290
$265.00	$147,650.01	$149,650	$149,470.01	$151,470	$151,290.01	$153,290
$270.00	$149,650.01	$151,650	$151,470.01	$153,470	$153,290.01	$155,290
$275.00	$151,650.01	$153,650	$153,470.01	$155,470	$155,290.01	$157,290
$280.00	$153,650.01	$155,650	$155,470.01	$157,470	$157,290.01	$159,290
$285.00	$155,650.01	$157,650	$157,470.01	$159,470	$159,290.01	$161,290
$290.00	$157,650.01	$159,650	$159,470.01	$161,470	$161,290.01	$163,290
$295.00	$159,650.01	$161,650	$161,470.01	$163,470	$163,290.01	$165,290
$300.00	$161,650.01	$163,650	$163,470.01	$165,470	$165,290.01	$167,290
$305.00	$163,650.01	$165,650	$165,470.01	$167,470	$167,290.01	$169,290
$310.00	$165,650.01	$167,650	$167,470.01	$169,470	$169,290.01	$171,290
$315.00	$167,650.01	$169,650	$169,470.01	$171,470	$171,290.01	$173,290
$320.00	$169,650.01	$171,650	$171,470.01	$173,470	$173,290.01	$175,290
$325.00	$171,650.01	$173,650	$173,470.01	$175,470	$175,290.01	$177,290
$330.00	$173,650.01	$175,650	$175,470.01	$177,470	$177,290.01	$179,290
$335.00	$175,650.01	$177,650	$177,470.01	$179,470	$179,290.01	$181,290
$340.00	$177,650.01	$179,650	$179,470.01	$181,470	$181,290.01	$183,290
$345.00	$179,650.01	$181,650	$181,470.01	$183,470	$183,290.01	$185,290
$350.00	$181,650.01	$183,650	$183,470.01	$185,470	$185,290.01	$187,290
$355.00	$183,650.01	$185,650	$185,470.01	$187,470	$187,290.01	$189,290
$360.00	$185,650.01	$187,178	$187,470.01	$189,470	$189,290.01	$191,290
$365.00			$189,470.01	$191,470	$191,290.01	$193,290
$370.00			$191,470.01	$193,470	$193,290.01	$195,290
$375.00			$193,470.01	$195,470	$195,290.01	$197,290
$380.00			$195,470.01	$196,155	$197,290.01	$199,290
$385.00					$199,290.01	$201,290
$390.00					$201,290.01	$203,290
$395.00					$203,290.01	$205,132
	200% FPIG	$159,300	200% FPIG	$166,940	200% FPIG	$174,580

[Pa.B. Doc. No. 11-694. Filed for public inspection April 22, 2011, 9:00 a.m.]