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North Carolina Division of Aging and Adult Services

Consumer Contributions Policy and Procedures

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Appendix B

Recommended Consumer Contribution Schedule

NC Division of Aging and Adult Services

Recommended Contribution Schedule

Based on the 2014 US Poverty Guidelines

Service Recipient’s 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%

$973 – $1,215

$1,311 – $1,638

10%

     

125%

$1,216 – $1,458

$1,639 – $1,965

20%

     

150%

$1,459 – $1,701

$1,966 – $2,293

30%

     

175%

$1,702 – $1,944

$2,294 – $2,621

40%

     

200%

$1,945 – $2,187

$2,622 – $2,948

50%

     

225%

$2,188 – $2,430

$2,949 – $3,276

60%

     

250%

$2,431 – $2,673

$3,277 – $3,604

70%

     

275%

$2,674 – $2,917

$3,605 – $3,932

80%

     

300%

$2,918 – $3,403

$3,933 – $4,587

90%

     

350%

$3,404 --- above

$4,588 --- 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.

Last updated March 4, 2014

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