Income Questions

AccessHealth Spartanburg Screening Tool

What is the combined monthly income of everyone living in your household?

Medical-Legal Partnership IHELLP

How much do you make at your job?

How many hours per week do you work?

Please indicate which of the following describe a concern you have about your income or benefits. You may select none or more than one answer.
Medicare / Medicaid / health insurance
Disability benefits
Family First
SNAP / WIC
Unemployment benefits/compensation
Child support
Pension
Other (please specify)

National Academy of Medicine Domains

Geocoded

PRAPARE

During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits.
(blank) / I choose not to answer this question

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