OMB Approval No.: 0584-XXXX
Expiration Date: XX/XX/20XX |
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-XXXX. The time required to complete this information collection is estimated to average one hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. |
|
|
|
| Household ID |
Household reapplied for free or reduced-price school meals between this year’s verification determination date and prior to March 1, 2018 (yes/no) |
Date of reapplication (mm/dd/year) |
Certification status resulting from reapplication (free, reduced-price, paid) |
Basis of certification status resulting from reapplication (categorical eligibility or income eligibility) |
Household was directly certified (yes/no) |
Date of direct certification (mm/dd/year) |
ONLY FOR DCM-F/RP STATES Certification status resulting from Direct certification (free, reduced-price) |
Program that was the basis of direct certification (SNAP, TANF, FDPIR, Medicaid, Other) |
Student is still enrolled in school (yes/no) |
IF STUDENT IS NO LONGER ENROLLED IN SCHOOL: Last date of enrollment (mm/dd/year) |