Oregon Department of Education .us



|Oregon Department of Education |Office of Learning | Student Services |

|255 Capitol Street NE |Child Nutrition Programs |

|Salem, Oregon 97310 | |

Documentation for the

Summer Food Service Program

At a Housing Authority Facility

FROM: _______________________________________________________________

(Name of Housing Facility)

ADDRESS: ____________________________________________________________

(Street Address)

______________________________________________ ______________________

(City/State) (Zip +4)

TO: __________________________________________________________________

(Sponsor Name)

DATE: ___________________

Each year the Sponsor for the Summer Food Service Program (SFSP) must qualify a serving site to determine if it is eligible to serve summer meals. The eligibility determination for a Housing Authority facility is done by comparing the incomes of the families residing in the complex to the current year’s Income Eligibility Guidelines for reduced-price meals listed below.

To determine if your site qualifies for summer meals, please complete the following:

Determine the total number of children (18 years of age and under) eligible for summer meals by comparing family income to the Eligibility Guidelines below. Enter that number on line 1.

Determine the total number of children (18 years of age and under) that live in the complex and enter that number on line 2.

Divide line 1 by line 2 and multiply this number by 100. Enter this number on line 3.

1. Total number of children in housing complex eligible for free and reduced price meals: _______________

2. Total number of children in housing complex: ______________________

3. Percent Eligible_____________

____________________________________________________ _____/_____/_____

(Signature of person making housing income determinations) (Date)

Return this form to your Sponsor, who will advise you of your site’s eligibility.

Income Eligibility Guidelines

| |Reduced Price Meals |

|Household Size |Annual |Monthly |Twice Per Month |Every Two Weeks |Weekly |

|-1- |21,257 |1,772 |886 |818 |409 |

|-2- |28,694 |2,392 |1,196 |1,104 |552 |

|-3- |36,131 |3,011 |1,506 |1,390 |695 |

|-4- |43,568 |3,631 |1,816 |1,676 |838 |

|-5- |51,005 |4,251 |2,126 |1,962 |981 |

|-6- |58,442 |4,871 |2,436 |2,248 |1,124 |

|-7- |65,879 |5,490 |2,745 |2,534 |1,267 |

|-8- |73,316 |6,110 |3,055 |2,820 |1,410 |

|For each additional family member add |7,437 |620 |310 |287 |144 |

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