Adding a New Income Form

Household income forms are associated with every participant in a household. The effective dates of the income form will determine the income eligibility status (A-Free, B-Reduced, C-Paid, Tier I, Tier II) for each participant in a household.

• Click on "Participants & Rosters" on the main site dashboard. This will take you to the participant list page.

• On the participant list page, click on the name of the primary parent/guardian or the yellow hyperlink "Edit Household" to bring up the Household Info page.
• Scroll down to “Household Income Statement” and click the blue “Add Income Form” button.

If you would like My Food Program to auto-fill the effective date and expiration date, then complete the first two fields:

1. Parent Signature Date: use the date picker to select the date the parent (or adult participant or guardian for adult day programs) signed the form.
2. Sponsor Signature Date: use the date picker to select the date the sponsor signed the form.

And then click the blue button "Fill in Effective and Expiration Dates Based on Signature Dates". The page will refresh and the sponsor policy for effective date and sponsor policy for expiration dates will be applied.

If you do not want My Food Program to auto-fill the effective date and expiration date, you can leave these two fields blank.

• First effective month: use the date picker and click “Done” to select the first month in which the form is active. Note: if a claim has already been processed for a month, you cannot make an income form eligible for that month because it would change the claiming percentage for that month. If you wish to add the income form, you must rollback the claim, add the new income form, then reprocess the claim and submit a claim adjustment to your state agency.
• Last effective month: use the date picker and click “Done” to select the last month in which the form is active. There is no minimum amount of time an income form can be active, but there is a maximum of 13 months.
• Select the Free/Reduced/Paid or Tier I/Tier II determination for the income form. My Food Program does not automatically calculate the income eligibility category based on income and household size, however you can use the Income Category Calculator at the bottom of this page to assist with these calculations. Please see website for user responsibility.
• Select the Reason for the income eligibility category determination. The options available in the dropdown will depend on the income eligibility category and site type.

1. Case Number or PMI Number (adult day care only)*
   
2. Household Income
3. Eligibility Number
   
4. Head Start
   
5. Direct Certification
   
6. Extended Direct Certification
   
7. Foster
   
8. Migrant
   
9. Runaway
   
10. Homeless
    
11. Other
    
12. No Income
    
13. Blank Income Fields (for California sponsors)
    

*If Case Number of PMI Number is selected, then the user must enter the number

B-Reduced Reasons

1. Household Income

C-Paid and Tier II Reasons

1. Refused
   
2. Income
   

Tier I Reasons

1. Provider’s own child allowed to claim because of income verification
2. Provider’s own child allowed to claim because of Case Number
3. Participant from an income-eligible household

• Notes: for your recordkeeping.
• Upload a scan or photograph of the form, if desired.
• Click “Save”. The system will display any errors. Otherwise you will return to the Household Page

You can use our Income Eligibility Calculator to annualize the different household income amounts and frequencies. This can make it easier for you to cross-check the calculated income with our suggestion for the income eligibility category into which the household should be placed. Enter in the appropriate amounts for each item below and click "Calculate".