Head Start Eligibility Verification

The Head Start Program Performance Standards (HSPPS) regulations on eligibility in 45 CFR 1302.12 is published under the authority granted to the Secretary of Health and Human Services under the Head Start Act, as amended, (42 USC 9801 et seq) at sections 644(c), 645(a)(1)(A), and 645A(c). There is no standardized document for grantees to use for any of the eligibility determination requirements in 45 CFR 1302.12. Still, OHS developed this sample form to assist grantees in collecting information to meet record keeping requirements for eligibility determination records. The sample form facilitates an efficient and accurate determination and documentation of eligibility for Head Start. However, Head Start programs are not required to use this specific form. Grantees may adapt this sample form or design a form that is relevant to their program in order to meet the requirements. Programs must store eligibility determination records as long as the child is enrolled and for one year after they have either stopped receiving services or are no longer enrolled. They can be maintained electronically or in hard copy. This form can be part of that eligibility determination record alongside other documentation required as part the record. The Office of Head Start is requesting an extension, with changes, of the Head Start Eligibility Verification. Changes are minor and provide some additional clarification to the form.

The latest form for Head Start Eligibility Verification expires 2022-04-30 and is listed under ICR 201903-0970-004.

Eligibility Verification Form

Federal Enterprise Architecture: Community and Social Services - Social Services

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