Page 2

Appendix C-4 10/1/2026 Page 2 of 2 Schedule of Family Share Copayments Family size - 1* Adjusted monthly income Family size - 1* Co- payment amount Family size - 2 Adjusted monthly income Family size - 2 Co- payment amount Family size - 3 Adjusted monthly income Family size - 3 Co- payment amount Family size - 4 Adjusted monthly income Family size - 4 Co- payment amount Family size - 5 Adjusted monthly income Family size - 5 Co- payment amount $0 - $887 $0 $0 - $1,160 $0 $0 - $1,433 $0 $0 - $1,705 $0 $0 - $1,978 $0 $888 - $1,073 $0 $1,161 - $1,452 $0 $1,434 - $1,830 $0 $1,706 - $2,208 $0 $1,979 - $2,587 $0 $1,074 - $1,182 $27 $1,453 - $1,546 $90 $1,831 - $1,910 $128 $2,209 - $2,274 $153 $2,588 - $2,638 $178 $1,183 - $1,330 $54 $1,547 - $1,739 $115 $1,911 - $2,149 $142 $2,275 - $2,558 $169 $2,639 - $2,967 $196 $1,331 - $1,478 $77 $1,740 - $1,933 $129 $2,150 - $2,388 $159 $2,559 - $2,842 $189 $2,968 - $3,297 $219 $1,479 - $1,626 $105 $1,934 - $2,126 $142 $2,389 - $2,626 $176 $2,843 - $3,126 $209 $3,298 - $3,627 $242 $1,627 - $1,774 $119 $2,127 - $2,319 $156 $2,627 - $2,865 $192 $3,127 - $3,410 $229 $3,628 - $3,956 $265 $1,775 - $1,921 $129 $2,320 - $2,512 $169 $2,866 - $3,104 $209 $3,411 - $3,695 $249 $3,957 - $4,286 $289 $1,922 - $2,069 $140 $2,513 - $2,706 $183 $3,105 - $3,343 $226 $3,696 - $3,979 $269 $4,287 - $4,616 $312 $2,070 - $2,217 $150 $2,707 - $2,899 $196 $3,344 - $3,581 $242 $3,980 - $4,263 $289 $4,617 - $4,946 $335 $2,218 - $2,365 $160 $2,900 - $3,092 $210 $3,582 - $3,820 $259 $4,264 - $4,547 $308 $4,947 - $5,275 $358 $2,366 - $3,555 $171 $3,093 - $4,649 $223 $3,821 - $5,743 $276 $4,548 - $6,837 $328 $5,276 - $7,931 $381 Family size - 6 Adjusted monthly income Family size - 6 Co- payment amount Family size - 7 Adjusted monthly income Family size - 7 Co- payment amount Family size - 8 Adjusted monthly income Family size - 8 Co- payment amount Family size - 9 Adjusted monthly income Family size - 9 Co- payment amount Family size - 10 Adjusted monthly income Family size - 10 Co- payment amount $0 - $2,251 $0 $0 - $2,302 $0 $0 - $2,353 $0 $0 - $2,405 $0 $0 - $2,456 $0 $2,252 - $2,965 $0 $2,303 - $2,686 $0 $2,354 - $2,745 $0 $2,406 - $2,805 $0 $2,457 - $2,865 $0 $2,966, $3,001 $203 $2,687 - $3,343 $0 $2,746 - $3,138 $0 $2,806 - $3,206 $0 $2,866 - $3,274 $0 $3,002 - $3,376 $223 $3,344 - $3,453 $232 $3,139 - $3,722 $0 $3,207 - $3,892 $0 $3,275 - $3,684 $0 $3,377 - $3,752 $250 $3,454 - $3,837 $255 $3,723 - $3,922 $261 $3,893 - $4,100 $0 $3,685 - $4,478 $0 $3,753 - $4,127 $276 $3,838 - $4,221 $282 $3,923 - $4,314 $288 $4,101 - $4,408 $295 $4,479 - $4,502 $306 $4,128 - $4,502 $302 $4,222 - $4,604 $309 $4,315 - $4,706 $316 $4,409 - $4,809 $323 $4,503 - $4,912 $330 $4,503 - $4,877 $328 $4,605 - $4,988 $336 $4,707 - $5,099 $343 $4,810 - $5,210 $351 $4,913 - $5,321 $358 $4,878 - $5,252 $355 $4,989 - $5,372 $363 $5,100 - $5,491 $371 $5,211 - $5,611 $379 $5,322 - $5,730 $387 $5,253 - $5,627 $381 $5,373 - $5,756 $390 $5,492 - $5,883 $398 $5,612 - $6,011 $407 $5,731 - $6,140 $415 $5,628 - $6,002 $407 $5,757 - $6,139 $416 $5,884 - $6,275 $426 $6,012 - $6,412 $435 $6,141 - $6,549 $444 $6,003 - $9,025 $433 $6,140 - $9,230 $443 $6,276 - $9,436 $453 $6,413 - $9,641 $463 $6,550 - $9,846 $473 *A family size of one consists of a single child receiving child care benefits when the adult(s) and any other children living in the home are not considered part of the household for income consideration per OAC 340:40-7-6.