Household Income Statements

Option to Approve Household Income Statement Forms Based on Parent Signature Date

The options for approving Household Income Statement (HIS) forms for the Child and Adult Care Food Program (CACFP) have been clarified by the U.S. Department of Agriculture (USDA). Reference: USDA memorandum Duration of Income Eligibility Determinations: Guidance and Q&As (CACFP 01-2015).

A sponsor must use the same option for approving HIS forms for all forms at all sites. The two options for approving HIS forms are:

· Certification Date Option This is the HIS approval method traditionally used by CACFP sponsors. Each HIS form is approved based on the “certification date” of the form, that is, the date that the sponsor official signed the form to certify that it was approved.

Sponsors must use the Certification Date Option unless the Minnesota Department of Education (MDE) has been notified, on the annual CACFP sponsor application, that the sponsor will use the Parent Signature Date option.

· Parent Signature Date Option Each HIS form may be approved based on the date that the adult household member provided next to their signature on the form. (Date stamping of forms is not needed.) HIS forms should be reviewed promptly after receipt.

The date from the adult household member must be either in the same month that the sponsor certifies approval or within the month immediately before certification of approval. HIS forms with an older date, or no date, from the adult household member must be approved based on the certification date from the sponsor official. See example below.

In limited situations, the Parent Signature Date option can provide an earlier effective date of eligibility than the Certification Date option. See example below. This happens only in situations where (1) The date provided by the adult household member on the HIS form was in the month preceding the month that the sponsor certifies the form and (2) The participant was enrolled in care in that preceding month.

Example: An HIS form has a parent signature date in February.

· The sponsor official certified that the form was approved in March.

The parent signature date can be used to determine effective dates of eligibility. The HIS form may be approved back to February (if the participant was enrolled in February). This is allowed because the parent signature date (in February) was in the month immediately before the sponsor certified approval (in March). The effective dates of eligibility are February 1 of the current year through February 28 of the following year.

· The sponsor official certified that the form was approved in April.

The parent signature date cannot be used to determine effective dates of eligibility. The HIS form may not be approved back to February because the parent signature date (in February) was more than one month before the sponsor certified approval (in April). Effective dates of eligibility must be based on the month that the sponsor certifies approval: April 1 of the current year through April 30 of the following year.

Incomplete Forms

A form with incomplete information may not be certified as approved until all required information has been submitted and the form has been determined to be complete. The form is then certified as approved based on the date that information was determined to be complete, not on the original date from the adult household member.

School Food Authorities

School food authorities (SFA) that administer both School Nutrition Programs (SNP) and CACFP may not use the Parent Signature Date Option for approval of HIS forms. An SFA must use the same approval procedures for HIS forms that it uses to approve SNP meal benefit applications. For information about approval procedures for school food authorities, refer to the School Nutrition Programs / Applications-Student Meals webpage on the MDE website.

Sponsors Using the Previously Allowed Submission Date Option

The Parent Signature Date Option replaces the previously allowed “Submission Date Option,” which required date stamping of HIS forms.

Sponsors that already are using the “Submission Date Option” for the 2014-15 program year may either:

· Stop date stamping and switch to the Parent Signature Date Option through the end of the program year (September 2015), or

· Continue to date stamp HIS forms and use the Submission Date Option through the end of the program year (September 2015). After September 2015, the sponsor must use either the Certification Date Option or the Parent Signature Date Option.