▪ Indication that the benefit is being received (for example, date benefit was granted,
expiration date, and date of renewal if available).
• Your household income is at or below 150% of the Federal Poverty Guidelines when you
file. See current Federal Poverty Guidelines at https://aspe.hhs.gov/topics/poverty-
economic-mobility/poverty-guidelines.
o The household income is based on household size, which includes:
▪ The applicant;
▪ Any spouse and parent(s) residing with the applicant;
▪ Any unmarried child or legal ward under the age of 21 residing with the applicant;
▪ Any unmarried child or legal ward 21-24 years old who is a full-time student residing
with the applicant;
▪ Any unmarried child or legal ward who is disabled, residing with the applicant, and
cannot care for themselves (regardless of age); and
▪ Any other dependents listed on your federal tax return or your spouse or head of
household’s federal tax returns.
o You must list and provide documentation of all household members’ income.
o You may submit a recent IRS Form 1040, IRS Form W-2, copies of consecutive pay
statements (stubs) for a minimum of one month dated within the three months preceding
the receipt of the fee waiver request, a statement from your employer on letterhead
attesting to your salary/wages, or Social Security, veteran’s benefits, and pension
documentation.
o If you lack a stable address, you may submit a letter from a shelter or other
support organization attesting to your lack of income.
• You are experiencing extreme financial hardship that prevents you from paying the filing fee
due to extraordinary expenses or other circumstances. This could include unexpected medical
bills or emergencies affecting you or your dependents, unemployment, eviction, and lack of
stable address (homelessness).
o You may include a detailed description of your financial situation that renders you
unable to pay the fee and provide evidence, if available. If you cannot provide evidence
of your financial hardship, explain why you cannot provide it.
o You may provide documentation of your income, a list of your assets, including real
estate, bank accounts, and stocks, and your liabilities such as rent or mortgage, utilities,
childcare, and medical expenses. If you cannot provide evidence of income, you may
submit affidavits from religious institutions, nonprofits, or community-based
organizations verifying that you are receiving some benefit or support from them.
For additional information, see