Section B
Household income more than $100,000
Enter the gross family income
$20,000 automatically substracted
Multiply by
Equals
Plus
Subtotal
Number of people in the household
2
3
4
Substract people in house credit
Does the family pay private insurance either monthly or through payroll deduction?
Yes
No
Substract approximate private insurance credit
Annual deductible : $
Quarterly deductible : $
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