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Attachment 10 2021 SFSP INCOME ELIGIBILITY FORM SUMMER

Attachment 10 2021 SFSP INCOME ELIGIBILITY FORM SUMMER-2026

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4.9 out of 5

40 votes

The document is an Income Eligibility Form for the Summer Food Service Program (SFSP) intended for camps and closed enrolled sites. It provides instructions for households to report income and eligibility for free or reduced-price meals, detailing specific steps based on household circumstances, including those receiving SNAP, TANF, or FDPIR benefits, as well as foster children. The form requires personal information, income details, and signatures while ensuring compliance with privacy laws and non-discrimination policies.

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Click ‘Get Form’ to open the Attachment 10 2021 SFSP INCOME ELIGIBILITY FORM SUMMER in the editor.
In Part 1, list the participant’s name and any SNAP, TANF, or FDPIR case number if applicable. If you have a case number, skip to Part 4.
For households with foster children, enter the child's name in Part 2 and contact your sponsor for further instructions.
In Part 3, report total household income from last month. Fill in each participant's name in Column A and their gross income details in Columns B and C.
Ensure an adult household member signs the form in Part 4 and includes the last four digits of their Social Security Number if applicable.
Finally, review all entries for accuracy before submitting your completed form back to your sponsor.

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Versions	Form popularity	Fillable & printable
2023	4.8 Satisfied (49 Votes)
2021	4.9 Satisfied (40 Votes)
2013	4.6 Satisfied (39 Votes)

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