|
Appendix B
Recommended Consumer Contribution Schedule
NC Division of Aging
and Adult Services
Recommended Contribution Schedule
Based on the 2009 US
Poverty Guidelines
Service Recipients Name:
Service #1 Rate$ Service
#2 Rate $
Service #3 Rate
$
|
%
of Poverty
|
Monthly
Income of:
|
Suggested
Percentage of the Cost of Service
|
Recommended
Contribution Amount per Unit of Service
|
|
Individual
|
Couple
|
Service #1
|
Service #2
|
Service #3
|
|
100%
|
$903 - $1,128
|
$1,214 - $1,518
|
10%
|
|
|
|
|
125%
|
$1,129 $1,354
|
$1,519 $1,821
|
20%
|
|
|
|
|
150%
|
$1,355 $1,579
|
$1,822 $2,125
|
30%
|
|
|
|
|
175%
|
$1,580 - $1,805
|
$2,126 - $2,428
|
40%
|
|
|
|
|
200%
|
$1,806 - $2,031
|
$2,429 - $2,732
|
50%
|
|
|
|
|
225%
|
$2,032 - $2,257
|
$2,733 - $3,035
|
60%
|
|
|
|
|
250%
|
$2,258 $2,482
|
$3,036 $3,339
|
70%
|
|
|
|
|
275%
|
$2,483 $2,708
|
$3,340 $3,642
|
80%
|
|
|
|
|
300%
|
$2,709 $3,161
|
$3,643 $4,249
|
90%
|
|
|
|
|
350%
|
$3,162 -- above
|
$4,250 -- above
|
100%
|
|
|
|
* The Recommended Consumer
Contribution Schedule may only be shared with service recipients
who are above poverty and receive a Type I service(s). *
Voluntary contributions made toward the cost of services
received are not tax deductible.
|
