Subject:Household Income Statement Form Guidance
Date Issued:February 27, 2017
Effective Date:Immediately
Communication Type:Policy Clarification/New Form
For Use By:Child Care Resource and Referral Agencies (CCRRs) and EECContracted Providers
Synopsis:Introduces new Household Income Statement for use at all financial assistance assessments.
Further Info:
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Introduction
The Department of Early Education and Care (EEC) is pleased to introduce the Household Income Statement,which must be completed for every family receiving financial assistance for early education and out-of-school time placements. This form will assist Subsidy Administrators in ensuring that all household members and income are properly reported and will ensure all parents make financial declarations required under federal regulations.See 45 CFR 98.20(a)(2)(ii).
Form Instructions
When completing an assessment, all subsidy administrators must assist parents/guardians to complete the Household Income Statement to declare all earned and unearned household income. One form should be completed for each household on behalf of all household members. It is the responsibility of the subsidy administrator to ensure that the Household Income Statement is completed in its entirety and that no responses are left blank. Please be advised, if a household has assets worth more than $1 million, then the applicant is not eligible to receive a child care subsidy. The household should be issued a Notice of Denial, Reduction, Termination and a Request for Review form.
Please note that this form does not replace EEC’s existing requirements for the subsidy administrators to collect documentation of household income and family size. However, documentation does not need to be collected on the value of assets as the certification on this form is sufficient.
Effective immediately, the Household Income Statement should be completed at each assessment,both initial and reassessments,and be kept on file as part of the permanent record. The Household Income Statement must be used for all Income Eligible households, including homeless and teen parents, as well as all DTA households. The form is not required for households referred by the Department of Children and Families until the household is assessed to transition to Income Eligible.
All social security numbers listed on Household Income Statements must be entered into the household’s record in the Child Care Financial Assistance (CCFA)Application. Please note that under EEC regulations, a child care authorization cannot be denied solely if a parent refuses to, or is unable to, provide a social security number. However, this regulation does not restrict subsidy administrators from requesting social security numbers for all parents/guardians and children receiving a child care subsidy.
A copy of the Household Income Statement should be provided to the parent along with a copy of the EEC Financial Assistance Agreement and Child Care Application and Fee Agreement.
Please note that EEC is in the process of reviewing all subsidy regulations and policies as it implements the requirements inthe Child Care Development Block Grant (CCDBG) Act of 2014. See 48 USC 9858. Any forms and policies issued by EECare subject to change to meet the full implementation deadline for CCDBG, which is September 30, 2017. Subsidy administrators should pay close attention to all subsidy communications issued by EEC.
Communication FY2017-03Effective Date: February 27, 2017Page 1 of 2