FAMILY APPLICATION FOR FREE AND REDUCED PRICE MEALS 2020-2021 SCHOOL YEAR

FEDERAL INCOME CHART

For school year 2020-21

Household Size

Yearly

Monthly

Twice per Month

Every 2 weeks

Weekly

1

$23,606

$1,968

$984

$908

$454

2

$31,894

$2,658

$1,329

$1,227

$614

3

$40,182

$3,349

$1,675

$1,546

$773

4

$48,470

$4,040

$2,020

$1,865

$933

5

$56,758

$4,730

$2,365

$2,183

$1,092

6

$65,046

$5,421

$2,711

$2,502

$1,251

7

$73,334

$6,112

$3,056

$2,821

$1,411

8

$81,622

$6,802

$3,401

$3,140

$1,570

Each additional person:

+$8,288

+$691

+$346

+$319

+$160

INCOMPLETE, ILLEGIBLE, OR INCORRECT APPLICTAIONS WILL DELAY MEAL BENEFITS

SUBMIT: Complete ONE application to apply for free or reduced-price meals. Use ONE meal application for all students in your household. We cannot approve applications that are not complete, so be sure to fill out all required information. Return the completed application to: Waller ISD School Nutrition Services 1918 Key Street Waller Texas 77484, Fax: (936) 931-4047, email: mwarzon@wallerisd.net or to your child’s school.

REPORTING INCOME: If your income is not always the same, list the amount that you normally receive. For example, if you normally get paid $1,000 each month, but you missed work last month and only got $900, put down that you get $1,000 per month. If you normally get overtime pay, include that amount as income. If you get overtime pay sometimes, do not include it as income. If your housing is part of the Military Housing Privatization Initiative, do not include your housing allowance as income. All other income must be included in your GROSS income before deductions.

NOTICE: Children in households that receive Supplemental Nutrition Assistance Program (SNAP) benefits (formerly the Food Stamp Program) OR TANF can get free meals regardless of your income. Your benefit letter from the Texas Health and Human Service Commission (HHSC) is your documentation for free meals. You may take your HHSC letter to Waller ISD School Nutrition Services Department to be directly certified for free meals. If your household received a letter sent from the Waller ISD School Nutrition Services that states your child(ren) is/are directly qualified to receive free meals, be sure all of the children in the household are listed on the letter. If there are students not listed on the letter, please contact the School Nutrition Services Department at 936.931.2347. If you believe the child for whom you are applying is homeless, migrant, or runaway, contact Angie Davis, Chief of Schools 936.931.3685

Approval of free or reduced price meals is good for the entire school year, plus 30 calendar days into the next school year. A new application must be completed every year.

VERIFICATION: Your eligibility may be checked at any time during the school year. School officials may ask you to send records proving that your child is eligible to receive free or reduced-price meals.

Privacy Act Statement: This explains how we will use the information you give us.

The Richard B. Russell National School Lunch Act requires the information on this application. You do not have to give the information, but if you do not, we cannot approve your child for free or reduced-price meals. You must include the last four digits of your social security number of the adult household member who signs the application. The last four digits of the social security number are not required when you apply on behalf of a foster child or you list a SNAP, TANF or Food Distribution Program on Indian Reservations (FDPIR) number OR when you indicate the adult household member signing the application does not have a social security number. We will use your information to determine if your child is eligible for free or reduced price meals, and for the administration and enforcement of the lunch and breakfast programs. We MAY share your eligibility information with education, health, and nutrition programs to help them evaluate, fund, or determine benefits for their programs, auditors for program reviews, and law enforcement officials to help them look into violations of program rules.

FOSTER CHILD(REN): A foster child is eligible for free meals. This eligibility must be given to any foster child whose care and placement is the responsibility of the Texas Dept. of Family and Protective Services (DFPS) or who is placed by the court with a caretaker household. Households with foster and non-foster children may choose to include the foster child as a household member, as well as any personal income earned by the foster child on the same application with their non-foster children. In processing the application, we would certify the foster child eligible for free meals, and then make an eligibility determination for the remainder of the household based on the

household’s income (including personal income earned by the foster child) or any other information reported on the application. Foster

payments received by the family from the placing agency are NOT considered income and do not need to be reported. NOTE: The presence of a foster child in the household does NOT convey eligibility for free meals to all children in the household.

Non-discrimination Statement: 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: (202) 690-7442; or (3) email: program.intake@usda.gov. This institution is an equal opportunity provider.

APPLY FOR BENEFITS: You may apply for a benefit at any time during the school year if your household size goes up, income goes down, or if you start receiving SNAP, TANF or other benefits or if the parent or guardian becomes unemployed. Children in households participating in WIC may be eligible for free or reduced-priced meals. Please fill out an application. You or your child(ren) do not have to be a U.S. citizen to apply or qualify for free or reduced-price meals.

FAIR HEARING: If you disagree with the district’s decision regarding your application, or the result of verification, you have the right to a fair hearing by calling or writing to: Angie Davis, Chief of Schools, 2214 Waller Street, Waller, Texas 77484, 936.931.3685.

HOW TO FILL OUT THIS APPLICATION – PLEASE PRINT NEATLY WITH BLACK OR BLUE INK. PLEASE USE CAPITAL LETTERS. COMPLETE ONE APPLICATION PER HOUSEHOLD.

Part 1- If anyone in the household receives SNAP or TANF, enter the eligibility group number in the boxes. Lone Star card numbers are not accepted. If the household enters an EDG number, complete part 2 and 4.

Part 2 – Enter the enrolled student’s ID (if you know it), first name, last name, grade and the name of the school they attend. Check the box if the child is a foster child, homeless, migrant or runaway.

Part 3 – Enter the names of ALL members living in your household except students listed in part 2. You must include yourself and all people living in your household, related or not (such as grandchildren, children, grandparents, other relatives or friends). Household means a group of related, or non-related, individuals who are living as one economic unit and sharing living expenses to include: rent, clothes, food, doctor bills, and utility bills. Households with deployed service members should include their name and the income made available to the household. Enter the income BEFORE DEDUCTIONS in the appropriate column. Indicate how often that income is received in the box marked “Frequency”. Enter (W) if the income is received weekly; (E) if income is received every other week; (T) if income is receive twice a month; (M) if the income is received monthly and (A) if the income is received annually. Other income: List the amount each person receives from all other sources. Include welfare, child support, alimony, pensions, retirement, Social Security, Worker’s Compensation, unemployment, strike benefits, regular contributions from people who do not live in your household and ANY OTHER INCOME. Report net income for self-owned businesses farm or rental income. Next to the amount, write how often the person receives it. If your housing is part of the Military Housing Privatization Initiative, DO NOT include your housing allowance as income. All other allowances must be included in your gross income, excluding combat pay.

Part 4 – The adult filling out the application must SIGN and PRINT their name and the date signed. Enter your mailing address and telephone number. While disclosure of the last 4 digits of a Social Security number is voluntary, the National School Lunch Act requires the last 4 digits of a Social Security number or an indication of “none” for approval of the application.

Part 5 – An adult household member must enter the last four digits of their Social Security Number. If the adult household member does not have a Social Security Number, place an X in the box provided. The Social Security number is not required if a SNAP or TANF number

is listed in part 1.

If your income falls within the limits on this chart, your child(ren) may qualify for free or reduced price meals.