Income Eligibility Templates

This document provides the income standards for individuals and families applying for support in South Carolina. It outlines the eligibility criteria based on income for different types of assistance programs.

This form is used for applying for meal benefits for children in child care centers in Arizona. It determines the income eligibility of the child and adult care food program.

This form is used to determine if adults attending a care center in Arizona are eligible for meal benefits based on their income. The form is available in Spanish.

This Form is used for renewing medical assistance for Magi-Excepted Households in Hawaii. It provides instructions on how to complete the renewal form (Form 1100B-2) for ongoing medical assistance eligibility.

This form is used for determining income eligibility for the TB (Tuberculosis) Program in California.

This Form is used to determine the income eligibility for QMB/SLMB/QI Medicare beneficiaries in California who are either couples or applicants with an ineligible spouse, with or without child(ren).

This document is a referral form used in Georgia's Pre-K program. It is used to recommend a child for enrollment in the program.

This document is a form used in Georgia for the Child and Adult Care Food Program (CACFP) and Summer Food Service Program (SFSP) to determine income eligibility. The form includes an option for selecting an effective date.

This document provides an income worksheet for the Rent Freeze Program in New York City. It is available in Haitian Creole.

This form is used for determining income eligibility for adult day care centers in Connecticut participating in the CACFP program.

This form is used to apply for free or reduced price meals or free milk in Missouri schools. It outlines the eligibility criteria and policies for these meal programs.

This form is used to determine income eligibility for the Child & Adult Care Food Program in adult care centers in Vermont.

This Form is used for determining income eligibility for child care centers in Vermont participating in the Child & Adult Care Food Program.

This Form is used for determining income eligibility for the Water Well Abandonment, Repair, and Replacement Fund in Oregon.

This form is used to determine if individuals or households in Oregon are eligible for financial assistance for water well abandonment, repair, and replacement projects.

This Form is used to determine the income eligibility for the Water Well Abandonment, Repair, and Replacement Fund in Oregon.

This document describes the process for households in North Carolina to opt out of the Supplemental Nutrition Assistance Program (SNAP), also known as food stamps.

This form is used for determining the income eligibility of a child care center to participate in the Child and Adult Care Food Program (CACFP) in Vermont.

This Form is used for notifying vacancies in project-based units in New York City.