Hs 1949-2025

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253 votes

The document is an Income Eligibility Application for the Child and Adult Care Food Program (CACFP) administered by the Tennessee Department of Human Services. It outlines the process for households to apply for meal reimbursements based on income eligibility for children enrolled in child care centers. The application includes sections for household information, income reporting, and optional sharing of data with Medicaid programs. It emphasizes the importance of accurate reporting and provides guidance on how to complete the application, including definitions of household and income sources. Additionally, it addresses non-discrimination policies and grievance procedures.

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Click ‘Get Form’ to open the hs 1949 in the editor.
In Part 1A, enter the name of the child care center. This is essential for identifying where the application is being submitted.
For Part 1B, list all children from your household enrolled at the center. Include their names and ages, and check if any are foster children.
If your household receives benefits from SNAP or Families First, complete Part 2A by entering your case number and skip to Part 4 for signing.
If not receiving those benefits, complete Part 2B by listing all other household members, their yearly earnings, and any additional income sources.
In Part 4, ensure an adult household member signs the application and includes their last four digits of their Social Security Number if applicable.
Finally, review all entries for accuracy before submitting your completed application through our platform.

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Versions	Form popularity	Fillable & printable
2011	4.9 Satisfied (253 Votes)

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