CACFP Income Eligibility Guidance for Adult Day Care Centers

• Each participant, family member, or legal guardian shall be given the participant letter and an IEF on a yearly basis. If the participant, family member, or legal guardian does not return the completed form, the participant must be classified as paid.
• The IEF shall be reviewed by the center representative to determine if all Parts (1-4) of the application have been completed. The IEF is not valid if not fully completed by the participant, family member, or legal guardian.
• The center representative must ensure that the participant’s full name and date of birth are listed on the IEF.
• If the participant, family member, or legal guardian checks that the participant receives Medicaid, Supplemental Security Income (SSI), or Supplemental Nutrition Assistance Program (SNAP) and enters the case number in the space provided, the participant is automatically eligible for free meals and the participant, family member, or legal guardian does not have to complete Part 2.
• If the participant, family member, or legal guardian did not report a Medicaid, SSI, or SNAP case number, they must complete all entries in Parts 2 and 4 to determine free or reduced-price eligibility.
• Check that the participant, family member, or legal guardian listed all household members. A household member is defined as the adult participant, and if residing with the adult participant, the spouse and dependents of the adult participant. Functionally impaired adults living with their parents are considered a "family" separate from their parents.
• Check that the participant, family member, or legal guardian listed each household member and indicated gross monthly income by source before any deductions are made. Current income is defined as income received during the month prior to the application. If the prior month's income is not representative of the household's annual rate of income, the household should report projected annual income.
• Completion of the Racial Ethnic Information (Part 3) is not mandatory, and the failure to complete this information shall not affect the classification of the participant.
• The participant, family member, or legal guardian completing the IEF must sign Part 4 to certify that the information provided is correct, that it is being given in connection with the receipt of federal funds, that institution officials may verify information, and that deliberate misrepresentation may subject the individual to prosecution under applicable state and federal laws. If the adult does not have a Social Security number, "none" should be written in the space provided. The IEF cannot be approved for free or reduced-price meals unless it is fully completed, signed, and dated by the participant, family member, or legal guardian.
• The participant, family member, or legal guardian must fully complete the IEF. The center representative shall complete only the section labeled "For Center Use Only."
• The center representative shall determine the participant’s claiming category by completing the bottom section of the IEF marked “For Center Use Only”. The IEF is effective from the first day of the month the form was signed and dated.

Center Representative Instructions for Completing the “For Center Use Only” Section

• Enter the total household size and total income.
• Indicate if eligibility status is based on household income by marking the payment cycle as reported in Part 2 (year, month, 2 times a month, every 2 weeks, or weekly).
• Indicate if the eligibility status is based on Medicaid, SSI, or SNAP benefits. Check to make sure the eight-digit case number is provided; if the participant’s SNAP number is a ten-digit case number, the first two zeros do not need to be entered on the form. If the participant is receiving Medicaid, SSI, or SNAP benefits, the participant is automatically eligible for free meals.
• Determine claiming status based on the income eligibility guidelines and indicate whether the participant’s claiming category is free, reduced, or paid.
• Sign the form.
• Date the form.

The participant must be claimed in the Paid category if:

• The information given by the participant, family member, or legal guardian is incomplete.
• The income does not meet eligibility criteria for free or reduced-price meals.
• The participant, family member, or legal guardian does not sign and date the form.
• The last four digits of the social security number of the person signing the form are missing, and the participant is not a Medicaid, SSI, or SNAP recipient.
• The SNAP number is not a valid eight-digit number.
• The participant, family member, or legal guardian chooses not to disclose their income or complete the IEF.
• The center representative did not fully complete, sign, and date the form.