"Child and Adult Care Food Program Meal Benefit Income Eligibility Letter (Child Care Non-pricing)" - Arizona

Child and Adult Care Food Program Meal Benefit Income Eligibility Letter (Child Care Non-pricing) is a legal document that was released by the Arizona Department of Education - a government authority operating within Arizona.

Form Details:

  • Released on May 1, 2020;
  • The latest edition currently provided by the Arizona Department of Education;
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Download "Child and Adult Care Food Program Meal Benefit Income Eligibility Letter (Child Care Non-pricing)" - Arizona

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Child and Adult Care Food Program Meal Benefit Income Eligibility Letter
(Child Care Non-Pricing)
FY 2021
Dear Parent/Guardian:
Name of Center
______________ offers healthy meals and snacks to children as part of the Child and Adult Care Food
Name of Center
Program (CACFP). ______________ receives support from CACFP to serve those meals. CACFP gives
more support if your household receives SNAP, TANF or FDPIR, or if your household income is less
than or equal to the limits on this chart:
FEDERAL ELIGIBILITY INCOME CHART For 2020-2021
Household size
Yearly
Monthly
Weekly
1
23,606
1,968
454
2
31,894
2,658
614
3
40,182
3,349
773
4
48,470
4,040
933
5
56,758
4,730
1,092
6
65,046
5,421
1,251
7
73,334
6,112
1,411
8
81,622
6,802
1,570
Each additional person:
+ 8,288
+ 691
+ 160
Please fill out the attached CACFP Meal Benefit Income Eligibility form. It will help us find out how
Name of Center
much support ______________ receives. Please be sure to read the instructions carefully. Fill in all the
information we request. We can only accept complete forms. Please return the forms to the following:
Insert location here.
Thank you for taking the time to fill out the form. We hope your child enjoys CACFP meals!
In the operation of child nutrition programs, no person will be discriminated against because of race,
color, national origin, sex, age, or disability. If you have questions or need help, please contact:
Insert name, phone number, and/or email address of contact person.
Sincerely,
Name
Title
Child and Adult Care Food Program Meal Benefit Income Eligibility Letter
(Child Care Non-Pricing)
FY 2021
Dear Parent/Guardian:
Name of Center
______________ offers healthy meals and snacks to children as part of the Child and Adult Care Food
Name of Center
Program (CACFP). ______________ receives support from CACFP to serve those meals. CACFP gives
more support if your household receives SNAP, TANF or FDPIR, or if your household income is less
than or equal to the limits on this chart:
FEDERAL ELIGIBILITY INCOME CHART For 2020-2021
Household size
Yearly
Monthly
Weekly
1
23,606
1,968
454
2
31,894
2,658
614
3
40,182
3,349
773
4
48,470
4,040
933
5
56,758
4,730
1,092
6
65,046
5,421
1,251
7
73,334
6,112
1,411
8
81,622
6,802
1,570
Each additional person:
+ 8,288
+ 691
+ 160
Please fill out the attached CACFP Meal Benefit Income Eligibility form. It will help us find out how
Name of Center
much support ______________ receives. Please be sure to read the instructions carefully. Fill in all the
information we request. We can only accept complete forms. Please return the forms to the following:
Insert location here.
Thank you for taking the time to fill out the form. We hope your child enjoys CACFP meals!
In the operation of child nutrition programs, no person will be discriminated against because of race,
color, national origin, sex, age, or disability. If you have questions or need help, please contact:
Insert name, phone number, and/or email address of contact person.
Sincerely,
Name
Title
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights
regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating
in or administering USDA programs are prohibited from discriminating based on race, color, national
origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or
activity conducted or funded by USDA.
Persons with disabilities who require alternative means of communication for program information
(e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the Agency (State
or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech
disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally,
program information may be made available in languages other than English.
To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint
Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, and at any
USDA office, or write a letter addressed to USDA and provide in the letter all of the information
requested in the form. To request a copy of the complaint form, call (866) 632-9992 Submit your
completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant
Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax:
Call: (202) 690-7442; or (3) email: program.intake@usda.gov.
This institution is an equal opportunity provider.
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