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Health Insurance Marketplace Coverage Options and Your Health CoverageForm Approved OMB No. 12100149 (expires 6302023)PART A: General Information Beginning in 2014 when key parts of the health care
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How to fill out household income

01
Gather all sources of income for everyone in the household including wages, salaries, tips, bonuses, retirement income, alimony, child support, etc.
02
Add together all sources of income to get total household income for the year.
03
Double check calculations and ensure all income sources are included on the form.
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Submit the household income form as required by the organization or agency requesting it.

Who needs household income?

01
Organizations providing assistance such as food stamps or housing vouchers may require household income information to determine eligibility.
02
Government agencies may use household income data to assess tax liabilities or eligibility for programs and benefits.
03
Financial institutions may request household income information for loan applications or credit assessments.
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Household income is the total gross income of all family members living in the same household.
Typically, individuals who are applying for government assistance programs or subsidies may be required to submit household income.
Household income can be filled out by gathering income information from all family members, including wages, salaries, bonuses, tips, alimony, and any other sources of income.
The purpose of household income is to determine eligibility for government assistance programs, subsidies, tax credits, and other financial aid.
Information that must be reported on household income includes all sources of income for all family members living in the same household.
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