Form Fa-075 - Verification Of School Attendance Page 3
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3Completion Instructions for FA-075
FA-075-FF (8-17)
Page 3 of 3
VERIFICATION OF SCHOOL ATTENDANCE
A.
Purpose. To verify school attendance.
B.
Completion. The EI completes the DATE, CASE NAME, CASE NO., E.I.’S NAME and E.I.’S PHONE NO., NAME OF
PARENT/CARETAKER RELATIVE, ADDRESS and NAME OF CHILD(REN) including the mailing address and return
address. The parent/caretaker relative authorizes the release of the information by signing his/her name and entering
date of signature. The school official completes the remainder of the form.
C.
Routing. The original is sent to the school and a copy is retained in the case file. The file copy may be destroyed upon
receipt of the original from the school.
D.
Retention. Retained in the case file until destroyed.
USDA is an equal opportunity provider and employer. • DES/TANF Agencies are Equal Opportunity Employers/Programs
• Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA),
Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Title II of the Genetic Information
Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination in admissions, programs, services, activities,
or employment based on race, color, religion, sex, national origin, age, disability, genetics and retaliation. The Department
must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. If
you believe that you will not be able to understand or take part in a program or activity because of your disability, please let
us know of your disability needs in advance if at all possible. To request this document in alternative format or for further
information about this policy, contact your local office; TTY/TDD Services: 7-1-1. • Free language assistance for DES
services is available upon request.
El USDA es un proveedor y empleador con igualdad de oportunidades • Agencias de DES/TANF son empleadores y
programas de igualdad de oportunidades • Bajo los Títulos VI y VII de la Ley de los Derechos Civiles de 1964 (Títulos VI
y VII) y la Ley de Estadounidenses con Discapacidades de 1990 (ADA por sus siglas en inglés), Sección 504 de la Ley de
Rehabilitación de 1973, Ley contra la Discriminación por Edad de 1975 y el Título II de la Ley contra la Discriminación por
Información Genética (GINA por sus siglas en inglés) de 2008; el Departamento prohíbe la discriminación en la admisión,
programas, servicios, actividades o empleo basado en raza, color, religión, sexo, origen, edad, discapacidad, genética
y represalias. El Departamento tiene que hacer las adaptaciones razonables para permitir que una persona con una
discapacidad participe en un programa, servicio o actividad. Si usted cree que su discapacidad le impedirá entender o
participar en un programa o actividad, por favor infórmenos lo antes posible de lo que usted necesita para acomodar
su discapacidad. Para obtener este documento en otro formato u obtener información adicional sobre esta política,
comuníquese con la oficina local; Servicios de TTY/TDD: 7-1-1. • Ayuda gratuita con traducciones relacionadas a los
servicios del DES está disponible a solicitud del cliente.
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