Are you Male or Female?

  • Male
  • Female

Are you a Pennsylvania Resident?
  • Yes
  • No
Do You have children Under 5?
  • Yes
  • No
What is the size of your family (include expected child)?
  • 1
  • 2
  • 3
  • 4
  • 5 or more
Is your income $21,775 or less?
  • Yes
  • No
Is your income $29,471 or less?
  • Yes
  • No
Is your income $37,167 or less?
  • Yes
  • No
Is your income $44,863 or less?
  • Yes
  • No
Is your income $52,559 or less?
  • Yes
  • No
Are you Under 18?
  • Yes
  • No
Are you Under 18?
  • Yes
  • No
Are You Under 18?
  • No
  • Yes
Are you Under 18?
  • Yes
  • No

Are you a Pennsylvania Resident?
  • Yes
  • No
Are you pregnant?
  • Yes
  • No
Are you pregnant or have children under age 5?
  • No
  • I am pregnant only
  • I have children under 5
  • Yes, I am BOTH pregnant and have children under 5
What is your family size?
  • 1
  • 2
  • 3
  • 4
  • 5
What is your family size?
  • 1
  • 2
  • 3
  • 4
  • 5
What is your family size?
  • 1
  • 2
  • 3
  • 4
  • 5
What is your family size?
  • 1
  • 2
  • 3
  • 4
  • 5

Is your income $21,775 or less?
  • Yes
  • No
Is your income $29,471 or less?
  • Yes
  • No
Is your income $37,167 or less?
  • Yes
  • No
Is your income $44,863 or less?
  • Yes
  • No
Is your income $52,559 or less?
  • Yes
  • No

Is your income $29,425 or less?
  • Yes
  • No
Is your income $39,825 or less?
  • Yes
  • No
Is your income $50,225 or less?
  • Yes
  • No
Is your income $60,625 or less?
  • Yes
  • No
Is your income $71,025 or less?
  • Yes
  • No

Is your income $21,775 or less?
  • Yes
  • No
Is your income $29,471 or less?
  • Yes
  • No
Is your income $37,167 or less?
  • Yes
  • No
Is your income $44,863 or less?
  • Yes
  • No
Is your income $52,559 or less?
  • Yes
  • No

What is your income?
  • Less than $21,775
  • Between $21,775 and $29,425
  • More than $29,425
What is your income?
  • Less than $29,471
  • Between $29,471 and $39,825
  • More than $39,825
What is your income?
  • Less than $37,167
  • Between $37,167 and $50,225
  • More than $50,225
What is your income?
  • Less than $44,863
  • Between $44,863 and $60,625
  • More than $60,625
What is your income?
  • Less than $52,559
  • Between $52,559 and $70,025
  • More than $70,025

What is your age?
  • Under 18
  • 18-39
  • 40-64
What is your age?
  • Under 18
  • 18-39
  • 40-64
What is your age?
  • Under 18
  • 18-39
  • 40-64

What is your age?
  • Under 18
  • 18-39
  • 40-64
What county do you live in?
  • Lackawanna
  • Luzerne
  • Susquehanna
  • Wayne
  • Berks
  • Bradford
  • Carbon
  • Lehigh
  • Monroe
  • Montgomery
  • Northampton
  • Pike
  • Schuylkill
  • Sullivan
  • Tioga
  • Wyoming
What county do you live in?
  • Lackawanna
  • Luzerne
  • Berks
  • Bradford
  • Carbon
  • Lehigh
  • Monroe
  • Montgomery
  • Northampton
  • Pike
  • Schuylkill
  • Sullivan
  • Tioga
  • Wyoming

You may not be eligible for MFHS programs, please visit hhs.gov/children for information regarding your eligibility. For

more information, call 1-800-FOR-MFHS.

You MAY be eligible for Reproductive Health

Services. Find a Reproductive Health Location near

you. For more information, call 1-800-FOR-MFHS.

You MAY be eligible for free Safeteens

reproductive health services. Find a Health Center

Now. For more information, visit safeteens.org or call 1-800-FOR-

MFHS.

You MAY be eligible for Breast and Cervical Cancer

Screening Services. For more information, call 1-800-FOR-MFHS, or Find a

Location.

You MAY be eligible for the WIC Nutrition

Program. For more information, call 1-800-FOR-MFHS, or Find a

Location.

You MAY be eligible for the WIC Nutrition

Program, and free SafeTeens reproductive health services. For more

information, call 1-800-FOR-MFHS, or Find a Location.

You MAY be eligible for the WIC Nutrition

Program and , and the Nurse Family Partnership Nurse Home

Visit Program. For more information, call 1-800-FOR-MFHS, or Find a

Location.

You MAY be eligible for the WIC Nutrition

Program and Breast and Cervical Cancer Screening Services. For more

information, call 1-800-FOR-MFHS, or Find a Location.

You MAY be eligible for the WIC Nutrition

Program and Healthy Beginnings Prenatal Services. For

more information, call 1-800-FOR-MFHS, or Find a Location.

You MAY be eligible for the WIC Nutrition

Program, Healthy Beginnings Prenatal Services, and the Nurse Family Partnership Nurse Home Visit Program. For more

information, call 1-800-FOR-MFHS, or Find a Location.