CHARTERCHOICE COLLABORATIVE (SFA) LETTER TO HOUSEHOLDS - MEAL PROGRAMS FOR 2023-2024

DEAR PARENT OR GUARDIAN:

All students attending CharterChoice (SFA) partner schools will have access to free healthy, nutritious school meals beginning in the 2023-24 school year thanks to the Healthy School Meals for All program approved by Colorado voters.  While meals will be provided for free to students through Healthy School Meals for All (HSMA), it is important for us to continue gathering this information to receive full access to available federal funds that support nutritional programs at your school. We ask all families to please complete the Combination Form (Online Meal Benefits Application/Family Economic Data Survey) for the 2023-24 school year. By providing this information, you will help your school access all available funds to cover the cost of meals, and other nutritional programs for students.


*All household income information provided through this form is strictly confidential and protected by law. Immigration, migrant, citizenship or refugee status is not required when completing the form.


HOW TO FILL OUT THIS COMBINATION FORM 
COMPLETE ONE COMBINATION FORM PER HOUSEHOLD.

PART 1 If you are currently receiving benefits from SNAP (formerly known as Food Stamps), Temporary Assistance for Needy Families (TANF) or Food Distribution Program on Indian Reservations (FDPIR), select "Yes" and enter the case number in the space provided. Then press "Continue". If you do not receive benefits from any of these programs, select "No" and "Continue".

PART 2Enter the following information of each student enrolled in a partner charter school (click here for a list): Student's birth date, last name, first name, school name, and, grade. If any income is received by a child, enter it in the box for "Student's Income." Do not include any parent income. Income to report includes any wages from full-time or regular part time employment, Child's SSI, Personal Use Income, or any other income. If applicable, indicate the child's status - homeless, runaway, or migrant - and contact your homeless liaison or migrant coordinator. Click here for a list of homeless liaisons.

PART 3 Enter the first and last name of ALL household members who are NOT ENROLLED in any of the partner charter schools listed on the link above. "Household" means a group of related or non-related individuals who are living as one economic unit and sharing living expenses to include: rent, clothing, food, doctor bills, and utility bills etc. DO NOT include the names of the students listed in Part 2. List the gross income each household member receives and how often the income is received. Gross income is the amount of money a person earned before taxes and deductions. Weekly (paid each week), Every Other Week (Example: paid every other Friday), Twice a Month (Example: paid on the 15th and the 30th), Monthly (receives one payment or paycheck a month), Annually.

PART 4 Enter your mailing address, Email address and phone number. (Email and Mailing address are not a required field but is necessary for CharterChoice Collaborative to send notification of eligibility.)

PART 5 Add together the total number of household members listed in Parts 2 and 3 and enter the number.

PART 6 Enter the last four digits of Social Security Number of adult signing this form. If you do not have a Social Security Number, check the box provided. This element is not required for CEP schools. If your student is attending a CEP school and you do not want to share the last four digits of your Social Security number, you may follow this link to print out the Combination Form to be completed without that element and return it to the school. 

PART 7 We are required to ask for information about your children's race and ethnicity. This information is important and helps to make sure we are fully serving our community. Responding to this section is optional and does not affect your children's eligibility.

PART 8 In the digital signature boxes, enter the name of the household adult who is filling out the combination form. This name should match the name entered at the beginning of the combination form. Next, select "submit my form."

 

INCOME TO REPORT

Gross earnings before deductions; Include all jobs

wages/salaries/tips before taxes, income from self-owned business, day care business or farm, strike benefits

Public Assistance, Child Support, Alimony

public assistance payments, unemployment benefits, worker's compensation, Supplemental Security Income (SSI), cash assistance from State or local government, alimony/child support payments, Veteran's benefits, adoption assistance

Pension, Retirement, All Other Income

pensions, Social Security (including railroad retirement and black lung benefits), retirement income, permanent disability benefits, cash withdrawn from savings, interest/ dividends, income from estates/trusts/investments, regular contributions from persons not living in the household, royalties/annuities/rental income


INCOME ELIGIBILITY GUIDELINES

Effective July 1, 2023 - June 30, 2024
Household
Size
Annual
Month
Twice Per
Month
Every Two
Weeks
Week
1
$26,973 $2,248 $1,124 $1,038 $519
2
$36,482 $3,041 $1,521 $1,404 $702
3
$45,991 $3,833 $1,917 $1,769 $885
4
$55,500 $4,625 $2,313 $2,135 $1,068
5
$65,009 $5,418 $2,709 $2,501 $1,251
6
$74,518 $6,210 $3,105 $2,867 $1,434
7
$84,027 $7,003 $3,502 $3,232 $1,616
8
$93,536 $7,795 $3,898 $3,598 $1,799
For EACH additional family member, add:
  $9,509 $793 $397 $366 $183

INCOMPLETE OR INCORRECT COMBINATION FORMS WILL DELAY INCOME ELIGIBILITY DETERMINATION.

 

INCOME ELIGIBILITY DETERMINATION: A new Combination Form must be completed every school year. You may complete this Combination Form at any time during the school year. If you are not eligible now but your income goes down, you lose your job, your family size becomes larger, or you become eligible for SNAP (Formerly Food Stamps), TANF or FDPIR benefits, you may complete a Combination Form at that time.

FOSTER CARE CHILDREN: A Foster Child is categorically free eligible and may be included as a member of a foster family if the foster family chooses to also apply for benefits. A Foster Child is the legal responsibility of the welfare agency or a ward of the court. Type the name of the child and select the specific school the child attends. Income is not required for Foster children. If the child receives personal-use income, list the amount of income. Personal-use income is (1) money given by the welfare office identified by catery for the child's personal use, such as clothing, school fees, and allowances; and (2) all other money the child receives, such as money from family and earnings from full-time or regular part-time employment. The Foster Parent, agency, official, or group home representative, must digitally sign the application. Your Social Security Number does not need to be listed

WIC PARTICIPANTS: If you currently receive benefits under the Special Supplemental Nutrition Program for Women, Infants, and Children - better known as the WIC Program, your child(ren) may be eligible. Please complete a Combination Form.

MILITARY HOUSING INCOME: If your housing is part of the Military Housing Privatization Initiative, DO NOT include your housing allowance as income. All other allowances must be included in your gross income.

SOCIAL SECURITY NUMBER:The online form requires the last four digits of the Social Security number of the adult who signs. If the adult does not have a Social Security number, check the box provided to show that the adult does not have a Social Security number. If a SNAP (Formerly Food Stamps), TANF or FDPIR case number for the child is listed, or if the Combination Form is for a foster child, a Social Security number is not required. If your student is attending a CEP school and you do not want to enter the last four digits of your Social Security number, you may follow this link to print out the Combination Form to be completed without that element and return it to the school.

PRIVACY ACT STATEMENT (7 CFR Section 245.6(a)(8), Interim Rule): The Richard B. Russell National School Lunch Act requires the information on this Combination Form. You do not have to give the information, but if you do not, we cannot approve your child for free or reduced price meals. You must include the last four digits of the social security number of the adult household member who signs the Combination Form. The last four digits of the social security number is not required when you apply on behalf of a foster child or you list a Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) Program or Food Distribution Program on Indian Reservations (FDPIR) case number or other FDPIR identifier for your child or when you indicate that the adult household member signing the Combination Form does not have a social security number. We will use your information to determine if your child is eligible for free or reduced price meals, and for administration and enforcement of the lunch and breakfast programs. We MAY share your eligibility information with education, health, and nutrition programs to help them evaluate, fund, or determine benefits for their programs, auditors for program reviews, and law enforcement officials to help them look into violations of program rules.

FOOD DISTRIBUTION PROGRAM ON INDIAN RESERVATION (FDPIR):Households participating in the FDPIR are categorically free eligible. The FDPIR is authorized by Section 4(b) of the Food Stamp Act of 1977. Under this section, eligible households may elect to participate in either the SNAP (Formerly Food Stamps) Program or the FDPIR. Since households are afforded the option to participate in either program, FDPIR households have been determined to receive the same categorical benefits as SNAP (Formerly Food Stamps) households. 

FAIR HEARING: If you do not agree with the CharterChoice Collaborative's decision regarding your Combination Form or the result of verification, you may discuss it with the School Food Authority. You also have the right to a fair hearing. A fair hearing may be requested by calling or writing the following school official: Brad Fischer, 9956 W. Remington Pl. Unit A10 #125 Littleton, CO 80128. (303) 953-4170.

VERIFICATION: School officials may check the information on the Combination Form at any time during the school year. You may be asked to send information to prove your income, or current eligibility for SNAP (Formerly Food Stamps), TANF or FDPIR.

NON-DISCRIMINATION: In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant's name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:

  1. mail:
    U.S. Department of Agriculture
    Office of the Assistant Secretary for Civil Rights
    1400 Independence Avenue, SW
    Washington, D.C. 20250-9410; or
  2. fax:
    (833) 256-1665 or (202) 690-7442; or
  3. email:
    program.intake@usda.gov

This institution is an equal opportunity provider.

CharterChoice Collaborative (SFA) participates in Direct Certification: If you received notification that your child(ren) has been directly certified free eligible for the 2023-2024 school year from CharterChoice Collaborative (SFA), you DO NOT need to complete a Combination Form. If you DID NOT receive notification for a child that is part of your household attending this charter school, please contact CharterChoice Collaborative (SFA) at 303-953-4170 or info@charterchoicecollaborative.org.

To download the full letter to parents, (click here ).

Your Combination Form will be processed if it has complete information. If you include a current mailing address or email address in the application, then you will receive notification of eligibility status from CharterChoice Collaborative (SFA).


Sincerely,

Britton Knickerbocker
Executive Director, CharterChoice Collaborative (SFA)
This institution is an equal opportunity provider