When filling out the application form, please pay careful attention to these helpful hints.
Food Stamp/TANF/FDPIR number:
This must be the complete number supplied to you by the agency including all numbers and letters, for example, E 123456, or whatever combination is used in your county. Refer to a letter you received from your local Department of Social Services for your number or contact them for your number. All children with the same case number may be listed on the same application. Separate applications are required for children with different case numbers.
If you receive food stamps or TANF, send in the Direct Certification letter from the NYS Office of Temporary and Disability Assistance instead of completing the application. Make a copy for your records.
A child who is living with a family, but who is under the legal care of the welfare agency or court. List the child’s “personal use” income. This includes only those funds provided by the agency which are identified for the personal use by the child such as personal spending allowances, money received by his/her family, or from a job. Funds provided for housing, food and care, medical, and therapeutic needs are not considered income to the foster child. Write “0” if the child has no personal use income.
A group of related or non-related people who are living in one house and share income and expenses.
Adult Family Members:
All related and non-related people who are 21 years of age and older living in your house.
A person is financially independent and a separate economic unit/household when his or her earnings and expenses are not shared by the family/household.
Is money earned or received by each member of your household before deductions. Examples of deductions are federal tax, State tax, and Social Security deductions.
Examples of gross income are:
* Wages, salaries, tips, commissions, or income from self-employment
* Net farm income
* Pensions, annuities, or other retirement income including Social Security retirement benefits
* Unemployment compensation
* Welfare payments (does not include value of food stamps)
* Public Assistance payments
* Adoption assistance
* Strike benefits
* Supplemental Security Income (SSI) or Social Security Survivor’s Benefits
* Alimony or child support payments
* Disability benefits, including workman’s compensation
* Veteran’s subsistence benefits
* Interest or dividend income
* Cash withdrawn from savings, investments, trusts, and other resources which would be available to pay for a child’s meals
* Other cash income
If you have more than one job, you must list the income from all jobs.
If you receive income from more than one source (wage, alimony, child support, etc.), you must list the income from all sources.
Your income at the present time before deductions. Farmers, self-employed workers, migrant workers and other seasonal employees may use their income for the past 12 months.
Income Exclusions: The value of any child care provided or arranged, or any amount received as payment for such child care or reimbursement for costs incurred for such care under the Child Care Development (Block Grant) Fund should not be considered as income for this program.
If you have any questions or need help in filling out the application form, please contact:
Mr. Paul Pelton
Asst. Superintendent for Management Services