Financial Qualifications

1. Find your taxable income on your Form 1040 or 1040A (line 43 on 1040 and line 27 on 1040A). If you are receiving Supplemental Security Income (SSI), you will need to submit an award letter in place of your taxes. (SSI is NOT the same as Social Security Income.)

2. Determine which table applies to you based upon the state, city or county in which you live (Table 1, 2, 3 or 4). These tables reflect the variance in the cost of living in certain areas of the country. If you don’t find your area specifically listed, use Table 1 as your guide.

3. Find your household size listed on your tax return and then find the same number on the left-hand column of the corresponding table you determined applies to you in step 2 above.

4. Go to the column on the right. If your taxable income is less than or equal to this amount, you qualify financially for SCL. Your child must meet all other qualifications for our program as well.

Note: You must submit the tax return filed by the parent/guardian who claimed the child making application to SCL. For additional information on this requirement, review the “Tax Information”.

table 1 - SCL financial guidelines

If you live in one of the individually listed states, counties or cities (or within 25 miles of a listed city) on Table 2 use the corresponding BLUE chart to the right of the Table to find your household size and taxable income limit for determining financial qualification:

table 2 - SCL financial guidelines

If you live in one of the individually listed states, counties or cities (or within 25 miles of a listed city) on Table 3 use the corresponding ORANGE chart to the right of the Table to find your household size and taxable income limit for determining financial qualification:

table 3 - SCL financial guidelines

If you live in one of the cities (or within 10 miles of a listed city) on Table 4 use the corresponding GREEN chart to the right of the Table to find your household size and taxable income limit for determining financial qualification:

table 4 - SCL financial guidelines

ADDITIONAL TAX INFORMATION:

If submitting Form 1040/1040A, please note:

  • The child applying for treatment MUST be listed as a dependent on either page 1 of Form 1040/1040A or on Statement 1 along with the child’s Social Security number.
  • If the child is NOT claimed as a dependent on your tax return, you must explain why and ALSO submit the tax return for the person who DOES claim the child, as well as proof of where the child resides (e.g. school records). In this situation, both tax returns must meet our income qualifications.
  • Page 1 of Form 1040/1040A (line 43 on 1040 and line 27 on 1040A) must show taxable income at or below our financial guidelines listed at www.smileschangelives.org/financials.
  • If your income does not require you to file taxes, but you are legally allowed to file, you must do so in order to apply for our program, even if your income is $0.

*** Additional documentation for non-parental guardians:

  • Non-parental guardians must also submit a copy of their authorization to make medical decisions.
  • For children in state custody, copies of the child’s state medical card and medical consent must also be submitted.

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