Determining Household Size-Income Statements

1. Determining Household Size-Income Statements Jill Schneeberg Dept. of Public Instruction Nutrition Program Consultant

2. Determining Official Agency must designate a �determining official� who is responsible for reviewing and approving all Household Size-Income Statements. After determining the eligibility category, the determining official completes the bottom portion of the Household Size-Income Statement, including all 3 subsections: the household size & total household income or categorical benefits, category determination (F,R,N), and Initials and date of determination.

3. Parent Letter ..

4. Household Size-Income Statement

5. Household Size-Income Statements

6. Determining Income Statements Be sure to copy both the HSIS and the Parent Letter. Before making copies write in the name of your center at the top of both the HSIS and Parent Letter. Sign the bottom of the Parent Letter. The center may write the name(s) of the child(ren) on the HSIS prior to giving to each household. Once households have returned the forms to the center, you are ready to review each income statement and make the eligibility determinations.

7. INFORMATION ON CHILD Make sure that the enrolled child�s name is listed. This must include their first and last name as it appears on the attendance records and enrollment forms. If there are siblings in the center, you may have the parent complete one application listing all siblings� names at the top of the form. If there are different last names, list the first and last name of each child.

9. Households with a Foster Child

10. Households with a Foster Child A separate HSIS should be completed for each foster child. The foster parent does NOT have to complete Part 1 or 2. The foster parent does NOT have to provide a Social Security number on the HSIS.

11. Households with a Foster Child A foster child is considered a household of 1 (one). Only the foster child�s personal use income should be listed. Personal use income is defined as money given by a welfare office for the child�s personal use and all money the child receives from his or her family. Money received by foster parents for care of the child does NOT apply and should not be listed on the HSIS. If there is no personal use income for the foster child, put $0 for income within the �For Center Use Only� Box. A foster child is generally determined as free.

12. Households with a Foster Child

14. PART 1: HOUSEHOLDS RECEIVING ASSISTANCE Part 1 is to be completed by households that receive one of the following types of assistance: Food stamps (FoodShare Wisconsin) W2 Cash Benefits FDPIR (Food Distribution Program on Indian Reservation) These are the only 3 types of assistance that result in categorical eligibility and automatically classify a child in the FREE category.

15. PART 1: HOUSEHOLDS RECEIVING ASSISTANCE Eligible W-2 Cash Benefits programs are Trial Job, Community Service Job (CSJ), Caring for a Newborn (CMC) and W-2 Transition (W-2 T). W2 Child Care Assistance eligibility does NOT automatically qualify a household in the Free category � a correctly determined HSIS MUST be on file.

16. PART 1: HOUSEHOLDS RECEIVING ASSISTANCE Case numbers should be 10 digits long. The case number does not match the number listed on the EBT (Quest) card the person uses to access their foodshare benefit. A household with a case number does NOT have to complete Part 2 (Household Income). A household with a case number does NOT have to provide a Social Security Number on the HSIS.

20. PART 2: HOUSEHOLD MEMBERS AND MONTHLY INCOME All household members must be listed, including the child whose name is on the HSIS. All income received in the month prior to completing the income statement must be reported.

21. PART 2: HOUSEHOLD MEMBERS AND MONTHLY INCOME Every HSIS using household income MUST include the Social Security number of the person who signs the form, unless the signer indicates that he/she does not have one. If the social security number is missing on the income statement where income is used, the application must be determined as Non-needy until a SS# can be obtained.

28. Convert incomes from different time periods to the same time period: Multiply Weekly X 4.33 Multiply Bi-weekly X 2.15 Multiply Bi-monthly X 2 Compute household�s total monthly income Compare total income to the Household Size-Income Scale to determine the need category. Computing Monthly Income

29. $520/wk X 4.33 = $2251.60/mo

30. Household Size-Income Scale The Household Size-Income Guidelines change each year. Our office will send each agency a copy of the revised Income Scale with the updated GM #1. Be sure that you use the most current income scale to determine any new income statements after July 1st of each year.

31. Household Size-Income Statement Reminders If the household has reported a case number in Part 1, you may disregard any income reported in Part 2. Households whose income is above the Income Eligibility Guidelines may choose to write �above guidelines� or �NA� in Part 2. These applications are classified in the Non-needy category.

32. Households Reporting $0 Income Households that report �zero� ($0) income may be approved in the Free category for 45 calendar days. At the end of the 45 days, contact the household and determine if they still have $0 income. If this is the case, the HSIS may be approved for an additional 45 days. Make a notation on the application of the information obtained, from whom the information was received, the date and your initials. If the household is receiving benefits or income at this time, have them complete a new HSIS with that information and attach it to the original application.

33. Part 3: All Households

34. Income statements that are not signed or dated by an adult household member are INCOMPLETE applications and must be listed in the Non-Needy category.

35. Dates on Income Statements The income statement remains in effect for a maximum of 12 months from the date of the adult household member signature. The date the Determining Official signs the income statement is the date the child(ren) may be determined as Free or Reduced.

37. Dates on Income Statements

38. What if an agency doesn�t approve a HSIS in the month that it was received?

39. Dates on the Income Statements Even though information on the HSIS is valid for one calendar year (12 months) from the date the adult household member signs the form, centers are encouraged to collect new applications from each household at the same time each year � usually in September or October. This procedure will reduce the chances that a child would be reported in the Free or Reduced category with an outdated HSIS, i.e., more than 12 months old.

40. Non-Needy Income Statements A HSIS would be determined as Non-needy if... an adult household member refuses to complete the form, an adult household member fails to return the form to the agency, if the household is over-income, if the adult household member writes �NA� or �Do Not Qualify� on the application, OR if the income statement is incomplete.

41. Household Size-Income Statement Reminders Make sure the application is complete. If something is missing, contact the household to clarify the information. With the exception of the signature, it is acceptable to obtain information over the telephone to complete the HSIS. Make a notation on the application of the information obtained, from whom the information was received, the date it was received and your initials. Until the HSIS is complete, the child must be considered Non-needy. The determining official (DO) must indicate if the HSIS is determined based on categorical eligibility (case number) or household size and income. The DO must initial and date the application within the �For Center Use Only� Box.

42. Questions??? Feel free to contact DPI at 608-267-9129 OR Contact your assigned Consultant A Directory is posted at: http://dpi.wi.gov/fns/directory.html Scroll down to view the Community Nutrition Team Community Nutrition Team Home Page: http://dpi.wi.gov/fns/index.html Answer Poll Question (% Polls)

43. Training Opportunities New to your role in the CACFP? Desire a refresher as regulations change? Consider participating in a CACFP training session: www.dpi.wi.gov/fns Click on �Training� to review and register for a CACFP class We also mail out training brochures throughout the year and include upcoming training reminders in the CACFP quarterly Newsletter

44. What�s Next: Maintaining the Household Size-Income Record (HSIR)