Free And Reduced Price School Meals Family Application - Nebraska Department Of Education Page 2
Download a blank fillable Free And Reduced Price School Meals Family Application - Nebraska Department Of Education in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Free And Reduced Price School Meals Family Application - Nebraska Department Of Education with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Free & Reduced Price School Meals Family Application
– complete one application per household
Attachment C: 2016-17
Your children may qualify for
FEDERAL INCOME CHART
free or reduced price meals if
for School Year 2016-17
your household income falls at
Household size
Yearly
Monthly
Twice
Every
Weekly
or below the limits on this chart.
per
Two
Month
Weeks
1
21,978
1,832
916
846
423
2
29,637
2,470
1,235
1,140
570
3
37,296
3,108
1,554
1,435
718
4
44,955
3,747
1,874
1,730
865
5
52,614
4,385
2,193
2,024
1,012
6
60,273
5,023
2,512
2,319
1,160
7
67,951
5,663
2,832
2,614
1,307
8
75,647
6,304
3,152
2,910
1,455
Each additional
7,696
642
321
296
148
person:
The Richard B. Russell National School Lunch Act requires the information on this application. You do not have to
give the information, but if you do not, we cannot approve your child for free or reduced price meals. You must include
the last four digits of the social security number of the adult household member who signs the application. The last four
digits of the social security number are not required when you apply on behalf of a foster child or you list a
Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) Program or
Food Distribution Program on Indian Reservations (FDPIR) case number or other FDPIR identifier for your child or
when you indicate that the adult household member signing the application does not have a social security number.
We will use your information to determine if your child is eligible for free or reduced price meals and for administration
and enforcement of the lunch and breakfast programs. We MAY share your eligibility information with education, health
and nutrition programs to help them evaluate, fund or determine benefits for their programs, auditors for program
reviews and law enforcement officials to help them look into violations of program rules.
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 disabili ties 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 Co mplaint Form, (AD-
3027) found online at: , 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: program.intake@usda.gov
This institution is an equal opportunity provider.
NE Department of Education – Nutrition Services
National School Lunch Program
Page 2 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Application Form For Free And Reduced-price School Meals - Oklahoma State Department Of Education Eligibility Documentation
Legal
Pennsylvania Household Application For Free & Reduced Price School Meals And Special Milk Program - 2016-2017
Legal
Related Categories
Parent category: Legal