How many people are in your household?

Include both adults and children in your count.

1 2 3 4 5 6 7 8+

Does anyone in your household have a physical disability?

Yes
No

What is your household's annual gross income?

Annual gross income is the total amount of money that you earn before taxes each year. It includes wages, child support, Social Security, and other sources of income.

Add up the annual gross income for everyone in your household, including yourself. You may provide an estimate.