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How many adults are in your household? *
Is anyone age 65 or older? *
How many children are in your household? *
Is at least one member a resident of Iowa? *
How much total money (before taxes) did all of the people in your household get last month? Include Income, Social Security, Child Support, etc. *
How much does the household have on hand? Include cash, money in checking accounts and saving accounts, etc. *
How much does the household pay for medical expenses monthly? *
Are all the household members United States citizens? *
If not, do they have legal documents to stay in the US? *
Does anyone have a disability? *
Is anyone pregnant? *
Is anyone in the household enrolled in Medicare? *
Do you want to find out if you or your family can get help paying for health insurance? *
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