Form 127

revised 04.2019

Form # 127
Revised 4/2015
INCOME ELIGIBILITY GUIDELINES
July 1, 2019 – June 30, 2020
(As announced by the United States Department of Agriculture)
HOUSE-
FREE MEALS OR MILK HOUSE-
REDUCED PRICE MEALS
HOLD Every HOLD
Twice per Twice per Every Two
SIZE Annual Monthly Two Weekly SIZE Annual Monthly Weekly
Month Month Weeks
Weeks

1 16,237 1,354 677 625 313 1 23,107 1,926 963 889 445
2 21,983 1,832 916 846 423 2 31,284 2,607 1,304 1,204 602
3 27,729 2,311 1,156 1,067 534 3 39,461 3,289 1,645 1,518 759
4 33,475 2,790 1,395 1,288 644 4 47,638 3,970 1,985 1,833 917
5 39,221 3,269 1,635 1,509 755 5 55,815 4,652 2,326 2,147 1,074
6 44,967 3,748 1,874 1,730 865 6 63,992 5,333 2,667 2,462 1,231
7 50,713 4,227 2,114 1,951 976 7 72,169 6,015 3,008 2,776 1,388
8 56,459 4,705 2,353 2,172 1,086 8 80,346 6,696 3,348 3,091 1,546

Each Each
Additional Additional
Household 5,746 479 240 221 111 Household 8,177 682 341 315 158
Member Member

When all income is reported with the same frequency i.e., all reported as weekly (W), every 2 weeks (2W), monthly (M), or twice a month (2M), total the
income and the number of household members and compare it to this chart. Cannot annualize if all income reported is the same frequency.

When income is reported with different frequencies, annualize the number, total the income and the number of household members and compare it to
the annual income column on this chart.

Annual Income Conversion: Weekly x 52, Every 2 weeks x 26, Twice a month x 24, and Monthly x 12

Error Prone: Weekly: $0 -$25 below the free or reduced price income eligibility limit.
Every two weeks or twice a month: $0 - $ 50 below the free or reduced price income eligibility limit.
Monthly: $0 - $100 below the free or reduced price income eligibility limit.
Annually: $0 - $1200 below the free or reduced price income eligibility limit.
 Form 127
Form 22904.2019
revised
February 2016

Income Eligibility Guidelines

July 1, 2019 – June 30, 2020

FREE MEALS or MILK REDUCED PRICE MEALS

Household Annual Monthly Twice Per Every Two Weekly Household Annual Monthly Twice Per Every Two Weekly
Size Month Weeks Size Month Weeks
9 62,205 5,184 2,593 2,393 1,197 9 88,523 7,378 3,689 3,406 1,704
10 67,951 5,663 2,833 2,614 1,308 10 96,700 8,060 4,030 3,721 1,862
11 73,697 6,142 3,073 2,835 1,419 11 104,877 8,742 4,371 4,036 2,020
12 79,443 6,621 3,313 3,056 1,530 12 113,054 9,424 4,712 4,351 2,178
13 85,189 7,100 3,553 3,277 1,641 13 121,231 10,106 5,053 4,666 2,336
14 90,935 7,579 3,793 3,498 1,752 14 129,408 10,788 5,394 4,981 2,494
15 96,681 8,058 4,033 3,719 1,863 15 137,585 11,470 5,735 5,296 2,652
16 102,427 8,537 4,273 3,940 1,974 16 145,762 12,152 6,076 5,611 2,810
17 108,173 9,016 4,513 4,161 2,085 17 153,939 12,834 6,417 5,926 2,968
18 113,919 9,495 4,753 4,382 2,196 18 162,116 13,516 6,758 6,241 3,126
19 119,665 9,974 4,993 4,603 2,307 19 170,293 14,198 7,099 6,556 3,284
20 125,411 10,453 5,233 4,824 2,418 20 178,470 14,880 7,440 6,871 3,442
21 131,157 10,932 5,473 5,045 2,529 21 186,647 15,562 7,781 7,186 3,600
22 136,903 11,411 5,713 5,266 2,640 22 194,824 16,244 8,122 7,501 3,758
23 142,649 11,890 5,953 5,487 2,751 23 203,001 16,926 8,463 7,816 3,916
24 148,395 12,369 6,193 5,708 2,862 24 211,178 17,608 8,804 8,131 4,074
25 154,141 12,848 6,433 5,929 2,973 25 219,355 18,290 9,145 8,446 4,232
26 159,887 13,327 6,673 6,150 3,084 26 227,532 18,972 9,486 8,761 4,390
27 165,633 13,806 6,913 6,371 3,195 27 235,709 19,654 9,827 9,076 4,548
Each Each
Additional 5,746 479 240 221 111 Additional 8,177 682 341 315 158
Household Household
Member Member