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Acceptable Verification Documentation - School … - ca breeze license verification



California Department of Education School Nutrition Programs
Nutrition Services Division August 2016

Acceptable Verification Documentation
In order to comply with the verification request, please provide documents that show your household's income at the time you applied for benefits, or you may submit papers from time of application up to the time of verification.

Examples of types of acceptable documents are listed below:

HOUSEHOLDS receiving CalFresh, California Work Opportunity and Responsibility to Kids (CalWORKs), and the Food Distribution Program on Indian Reservation (FDPIR) benefits:

Provide documents that show your household's current participation in this program. No other income information is required. Acceptable documents include:

( CalFresh/CalWORKs/FDPIR certification notice showing eligibility period
( Copy of CalWORKs warrant
( Letter from the CalFresh, CalWORKs, or FDPIR office stating you now receive benefits
( Authorization to Participate (ATP) card with current date, clearly identifying you or your child’s CalFresh, CalWORKs, or FDPIR eligibility.

A monthly Benefit Issuance Receipt or an Electronic Benefit Transfer (EBT) card is not proof of CalFresh eligibility. If your CalFresh eligibility has ended, you must provide proof of your current income and send the necessary documents listed on this page.


Other Welfare Payments

✓ Benefit letter from the welfare agency stating the amount of the benefit
ALL OTHER HOUSEHOLDS
Earnings/Wages/Salary
( Paycheck stub that shows how much and how often income is received
( Letter from employer stating amount of gross wages paid and how often they are paid
✓ Business or farming papers, such as ledger or tax books
Social Security/Pensions/Retirement
( Social security benefit letter
( Statement of benefits received
✓ Pension award notice
Unemployment Compensation/Disability or Worker's Compensation
( Copy of the unemployment/disability/worker's compensation award letter
✓ Check stub
Child Support/Alimony
✓ Court decree, agreement, or copies of checks received
All Other Income
If you have other types of income (such as rental income, etc.), provide information or documents that show the amount of income received, how often it is received, and the date received.
For example: Self-Employment Income
( Business or farming documents, such as ledger books
( Last quarterly tax estimate and last year's tax return
Zero or No Income
If you have no income, submit a brief note explaining how you provide food, clothing, and housing for your household and when you expect an income.

If you have any questions or need help in deciding on the kind of information to provide, please call
      at (     )       Ext.      . This call is free of charge.
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In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.
Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter 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;
(2) fax: (202) 690-7442; or
(3) email: program.intake@usda.gov.
This institution is an equal opportunity provider.

How to comply with the verification request?