Martinsville-Henry County Family Ymca 2015-2016 School Year Form (Page 6 of 7) in pdf

Dear Parent/Guardian:

This letter is intended for parents or guardians of children enrolled in a child care center. The Martinsville-Henry

County Family YMCA offers healthy meals to all enrolled children as part of our participation in the U.S.

Department of Agriculture’s (USDA) Child and Adult Care Food Program (CACFP). The CACFP provides

reimbursements for healthy meals and snacks served to children enrolled in child care. Please help us comply with

the requirements of the CACFP by completing the attached Meal Benefit Income Eligibility Form. In addition, by

filling out this form, we will be able to determine if your child(ren) qualifies for free or reduced price meals.

1. Do I need to fill out a Meal Benefit Form for each of my children in day care? You may complete and submit one

CACFP Meal Benefit Income Eligibility Form for all children enrolled in child care in your household only if the children in

child care are enrolled in the same center. We cannot approve a form that is not complete, so be sure to read the instructions

carefully and fill out all required information. Return the completed form to your child’s site director

2. Who can get free meals without providing income information? Children in households getting Supplemental Nutrition Assistance

Program (SNAP) (formerly Food Stamps), Temporary Assistance for Needy Families (TANF), or Food Distribution Program

on Indian Reservations (FDPIR) benefits can get free meals. Foster children and children enrolled in Head Start are also

eligible for free meals. Children in households participating in WIC may be eligible for free meals.

3. Who can get reduced price meals? Your children can get low cost meals if your household income is within the reduced price limits

on the Federal Income Chart, shown on this application. Children in households participating in WIC may be eligible for reduced price meals.

4. May I fill out a form if someone in my household is not a U.S. citizen? Yes. You or your children do not have to be U.S.

citizens to qualify for meal benefits offered at the child care center.

5. Who should I include as members of my household? You must include everyone in your household (such as

grandparents, other relatives, or friends who live with you) who shares income and expenses. You must include yourself and

all children who live with you. You also may include foster children who live with you.

6. How do I report income information and changes in employment status? The income you report must be the total gross

income listed by source for each household member received last month. If last month’s income does not accurately reflect

your circumstances, you may provide a projection of your monthly income. If no significant change has occurred, you may use

last month’s income as a basis to make this projection. If your household’s income is equal to or less than the amounts

indicated for your household’s size on the attached Income Chart, the center will receive a higher level of reimbursement.

Once properly approved for free or reduced price benefits, whether through income or by providing a current SNAP, TANF,

FDPIR case number, you will remain eligible for those benefits for 12 months. You should notify us, however, if you or

someone in your household becomes unemployed and the loss of income causes your household income to be within the

eligibility standards.

7. What if my income is not always the same? List the amount that you normally get. For example, if you normally get

$1000 each month, but you missed some work last month and only got $900, put down that you get $1000 per month. If you

normally get overtime, include it, but not if you only get it sometimes.

8. What if I have foster children? Foster children that are under the legal responsibility of a foster care agency or court are

eligible for free meals. Any foster child in the household is eligible for free meals regardless of income. Households may

include foster children on the Meal Benefit Form, but are not required to include payments received for the foster child as

income. Households wishing to apply for such benefits for foster children should contact Becky Forestier, 276-647-3089

9. We are in the military, do we include our housing and supplemental allowances as income? If your housing is part of

the Military Housing Privatization Initiative and you receive the Family Subsistence Supplemental Allowance, do not include

these allowances as income. Also, in regard to deployed service members, only that portion of a deployed service member’s

income made available by them or on their behalf to the household will be counted as income to the household. Combat Pay,

including Deployment Extension Incentive Pay (DEIP) is also excluded and will not be counted as income to the household.

All other allowances must be included in your gross income.

10. (Pricing program only) Will the information I give be verified? Maybe. We may ask you to send written proof to verify

the information you submitted on the form. What if I disagree with the decision about the information I complete on this

form? You should talk to your The Martinsville-Henry County Family YMCA

In the operation of child feeding programs, no person will be discriminated against because of race, color, national origin, sex,

age or disability.

If you have other questions or need help, call 276-647-3089

Sincerely,

Becky Forestier

Martinsville-Henry County Family Ymca 2015-2016 School Year Form Page 6

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