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THE CHILD AND ADULT CARE FOOD PROGRAM HOUSEHOLD SIZE INCOME STATEMENT (CHILD CARE COMPONENT) (FLY 2015, Rev. 7/14) An adult household member must complete and return to center. First and Last Name(s)

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What is household size income statement?

Household size income statement is a document that reports the income, expenses, and assets of a household to determine financial eligibility for certain programs or benefits.

Who is required to file household size income statement?

Individuals or households who are seeking assistance or benefits based on income eligibility are required to file a household size income statement.

How to fill out household size income statement?

To fill out a household size income statement, you must provide accurate information about your income, expenses, and assets. You may need to provide documentation to support the information you provide.

What is the purpose of household size income statement?

The purpose of household size income statement is to determine financial eligibility for programs or benefits that are based on income criteria.

What information must be reported on household size income statement?

You must report information about your income, expenses, assets, and household size on a household size income statement.

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