Listed below is acceptable documentation that may be sent to
CharterChoice Collaborative (SFA)
1. SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP), TEMPORARY ASSITANCE FOR NEEDY FAMILIES (TANF) or FOOD DISTRIBUTION PROGRAMS ON INDIAN RESERVATIONS (FDPIR) HOUSEHOLDS:
If your household receives SNAP, TANF or FDPIR benefits, you have to provide information that shows your participation in the program; no other income information is required. This information can be:
- SNAP, TANF (Basic Cash Assistance or State Diversion) or FDPIR Certification Notice showing the beginning and ending dates of the certification period, or
- Letter from the SNAP, TANF or FDPIR office, or welfare office stating that you receive SNAP, TANF or FDPIR benefits.
Timeframe: You may use documentation from SNAP/TANF/FDPIR from the month preceding your original application through the current month.
2. FOR HOUSEHOLDS THAT DO NOT RECEIVE SNAP, TANF or FDPIR:
Write the name of each household member (related or unrelated) on the Household Members Form and indicate whether or not they have income.
Any household member receiving income must send copies of information or papers that show each applicable household member’s income. The information you submit must show:
(1) the amount of gross income received
(2) the name of the person who received it
(3) the date the income was received
(4) how often the income is received
To show the amount of money your household received, please submit one of the following for appropriate category of income:
EARNING/WAGES/SALARY FOR EACH JOB:
- A paycheck stub that shows how often it is received
- A pay envelope that shows how often it is received
- Letter from employer stating gross wages paid and how often they are paid. Click here to download the Statement of Earnings template (to be completed by employer if applicable).
- Self-employed/Farm income: Business or farming papers, such as ledger or tax books, or tax return (if still representative of current income)
- Social Security retirement benefit letter
- Statement of benefits received. Click here to download the Social Security and/or Supplemental Security Income template (to be completed at the social security office if applicable).
- Pension award notice
UNEMPLOYMENT COMPENSATION/DISABILITY/WORKER’S COMP:
- Notice of eligibility from state employment security office
- Check stub that shows how often it is received
- Letter from Worker’s Compensation
- Benefit letter from welfare agency
- Court decree, child support registry, agreement, legal papers, or copies of checks received
MILITARY HOUSING PRIVATIZATION INITIATIVE:
- Letter or rental contract showing that your housing is part of the Military Housing Privatization Initiative
ALL OTHER INCOME:
- If you have other forms of income (such as rental income), provide information or documents which show the amount of income received, how often it is received, and the date received.
- Proof of annual income may be submitted, including prior year, if it is still representative of the household’s current annual rate of income.
- If you have no income, provide a brief note explaining how you provide food, clothing, and housing for your household.
Timeframe: Please submit proof of one month’s income; you could use the month prior to application, the month you applied, or any month after that.
3. IF YOU RECEIVE THIS LETTER FOR A HOMELESS, MIGRANT, OR RUNAWAY CHILD, OR A CHILD IN HEAD START, PLEASE CONTACT YOUR HOMELESS LIAISON OR CHARTERCHOICE FOR HELP.
4. IF THE CHILD IS IN FOSTER CARE
Provide written documentation that verifies the child is the legal responsibility of the agency or court—with the dates—or provide the name and contact information for a person at the agency or court who can verify that the child is a foster child.
Timeframe: You may use documentation from the month preceding your original application through the current month.
Use of Information Statement: The Richard B. Russell National School Lunch Act requires the information requested in order to verify your children’s eligibility for free or reduced price meals. If you do not provide the information or provide incomplete information, your children may no longer receive free or reduced price meals.
Non-Discrimination Statement: In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights; 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: email@example.com. This institution is an equal opportunity provider.