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Sliding Scale Application

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Client Information

Household Information

Income Information

Gross wages, salaries, tips, etc. (before taxes).

Income from business and selfemployment

Unemployment compensation, workers’ compensation, Social Security, Supplemental Security Income, public assistance, veterans’ payments, survivor benefits, pension or retirement income

Interest; dividends; royalties; income from rental properties, estates, and trusts; alimony; child support; assistance from outside the household; and other miscellaneous sources

Total Annual Income

Supporting Documentation

Please attach one or more of the following (all documents will be kept confidential):*
Connect with PASCO Today

303.233.3122

Reach Us Online

info@pascohh.com

Locations

PASCO Lakewood
3900 S Wadsworth Blvd., Suite 225
Lakewood, CO 80235
303.233.3122
PASCO Colorado Springs
6385 Corporate Drive, Suite 303
Colorado Springs, CO 80919
719.960.4995
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