Wisconsin Department of Public Instruction Child and Adult Care Food Program Child Care Institutions Outside of School Hours Care Centers Maintaining the Household Size- Income Record (HSIR) Guidance Memorandum #1C:

Household Size-Income Record HSIR good for one year Complete new HSIR each fiscal year (starting October 1 st ) DO NOT create a new copy each month Print or save each month as documentation for that month’s claim

Household Size-Income Record Complete HSIR each month to report total # of FRN on the respective month’s claim File income statements in same order as HSIR CONFIDENTIAL

Enrollment Policy Defines what children to include on monthly claim Collected as part of the annual CACFP Contract Sample policies in Guidance Memorandum #6

Enrollment Policy Examples Reasonable and Measurable 1.In attendance at least one time in the month. 2.Has attended at least once in the past 3 months. After an attendance lapse of 3 months, the child is dropped from the enrollment list. 3.The center maintains a vacant opening in anticipation of the child’s future attendance at the center.

Names of Enrolled Children

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Household Size-Income Record List every enrolled child on HSIR according to your center’s enrollment policy including: – Infants – School-age children attending before and after- school – 4K participants Compare attendance records to HSIR

Household Size-Income Record List children’s names in alphabetical order, last name first Use children’s FULL names, not initials or nicknames Names on the HSIR should match names on enrollment forms, income statements and attendance records

Household Size-Income Record Obtain need category (N,R,F) for each child from HSIS’s Indicate need category of each enrolled child on HSIR with N, R, F or X

When a Child Leaves the Center When a child is no longer enrolled, do not mark in any need category for the first month after the child has terminated from the center – Draw a line through the months or leave blank Never remove or discard an income statement Never erase a name from the HSIR

Adding Newly Enrolled Children to the HSIR Paper copy of HSIR: add new children’s names to bottom of form Excel HSIR: add new children alphabetically by inserting rows

Press on the row number (on the left hand side) and select Insert and then Rows from the top menu This will add a row above the row you have clicked on

HSIR Edit Checks 1.Compare children on HSIR to attendance records 2.Check need category and approval date from “For Center Use Only" box on each HSIS to need category on HSIR 3.Check that need category is in the correct column for each child

HSIR Edit Checks 4.Double check the "Totals" row for each column of need category if completing HSIR by hand 5.Double check the totals for each need category on the monthly claim to assure they have been recorded from the correct column of the HSIR 6.Print off a copy of the Excel HSIR each month

What’s Next: Completing the CACFP Reimbursement Claim The U.S Department of Agriculture prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.) If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at or at any USDA office, or call (866) to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C , by fax (202) or at Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) ; or (800) (Spanish). USDA is an equal opportunity provider and employer.