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Appendix B
Recommended Consumer Contribution Schedule
NC Division of Aging
and Adult Services
Recommended Contribution Schedule
Based on the 2011 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% |
$908
- $1,133 |
$1,226
- $1,531 |
10% |
|
|
|
| 125% |
$1,134
$1,360 |
$1,532
$1,838 |
20% |
|
|
|
| 150% |
$1,361
$1,587 |
$1,839
$2,144 |
30% |
|
|
|
| 175% |
$1,588
- $1,814 |
$2,145
- $2,451 |
40% |
|
|
|
| 200% |
$1,815
- $2,041 |
$2,452
- $2,757 |
50% |
|
|
|
| 225% |
$2,042
- $2,268 |
$2,758
- $3,064 |
60% |
|
|
|
| 250% |
$2,269
$2,495 |
$3,065
$3,370 |
70% |
|
|
|
| 275% |
$2,496
$2,722 |
$3,371
$3,677 |
80% |
|
|
|
| 300% |
$2,723
$3,175 |
$3,678
$4,289 |
90% |
|
|
|
| 350% |
$3,176
-- above |
$4,290
-- 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.
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