1. INCOME ELIGIBILITY STATEMENTS

2. Income Eligibility Statements What? CACFP enrollment form Income Eligibility Statement used to determine reimbursement category When? When a participant first enrolls at your center At least once annually for every participant – IES is valid for 1 year Why? Federal CACFP regulation 226.15(e)(2) requires it All participants must be formally enrolled Correct reimbursement category needed for the MEL and the claim

3. Income Eligibility Statement It’s Two Forms in One  Top Portion: Enrollment Form  Bottom Portion: Income Eligibility Statement

4. IES: Part Two and Three- Income Eligibility Information PART TWO: TANF and/or SNAP RECIPIENTS  If anyone in the household is a TANF or SNAP recipient: – Circle the benefit (TANF and/or SNAP). – Enter only the TANF and/or SNAP case number. Do not enter a SSN or any other number in this box; these other numbers are UNACCEPTABLE and will cause a delay in processing this form. PART THREE: ENROLLED IN HEAD START  If the child is enrolled in Head Start, please indicate the child’s name in this section.

5. IES: Part Four Foster Child

6. IES: Part Five- Total Household Income PART FIVE: TOTAL HOUSEHOLD INCOME

7. IES: Part Six- Certification, Signature, and Social Security Number (Last Four Digits) PART SIX: PARENT SIGNATURE & CERTIFICATION

8. IES: Back of Form PART SEVEN: CIVIL RIGHTS INFORMATION  This section does not have to be completed to receive meal benefits  But, it is important that this section is filled out to determine that everyone is receiving benefits on a fair basis and not being discriminated against CENTER USE ONLY: IES CLASSIFICATION  The determining official must check the front and back of the IES to ensure all sections are complete.  The form must be classified, signed, and dated by the determining official.  Please have an another staff member to verify that the IES is completed and classified correctly.

9. Parent Letter to Household

10. QUESTIONS