HOUSEHOLD ELIGIBILITY APPLICATION - For Providers Reapplying for Tier I Status by Income Or for Claiming Meals for Children Residing with the Provider

Oct 10, 2026

Uploaded by Mary Man

Letter and instructions for day care home providers to reapply for Tier I status by income or claim meals for qualifying children residing with the provider. It explains eligibility pathways, including income criteria and households receiving SNAP or TANF, and requires completion of the enclosed Household Eligibility Application (HEA). The document includes the Income Eligibility Guidelines effective July 1, 2024 to June 30, 2025, with reduced-price meal thresholds by household size, plus provider compliance, civil rights, and contact guidance.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

Household Eligibility Application

Provider letter for Tier I status and meal claiming

Income Eligibility Guidelines (Reduced-Price Meals)

Provider instructions for completing the HEA

HOUSEHOLD ELIGIBILITY APPLICATION FOR PROVIDERS REAPPLYING FOR TIER I STATUS BY INCOME OR FOR CLAIMING MEALS FOR CHILDREN RESIDING WITH THE PROVIDER Dear Day Care Home Provider: Our records indicate you were determined Tier I status or claimed Tier I reimbursement based on one of the following qualifications: • Your day care home qualified for Tier I based on income information submitted on last year’s Household Eligibility Application (HEA) . In order to continue the Tier I status by income you must complete the attached HEA. To be eligible for Tier I status your household income must meet or fall below the Income Eligibility Guidelines or a member of your household must be eligible to receive Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF) benefits. • Your day care home qualified for Tier I status due to school or census data and you claimed meals for qualifying children residing in your household while other children were in attendance. In order to continue to claim qualifying children residing in your household, you must complete the enclosed HEA and return it to our office. • You claimed Tier I reimbursement for meals served to a qualifying foster child(ren), residing in your household while other children were in attendance. In order to continue to receive Tier I reimbursement for a foster child(ren) residing in your household, you must complete the enclosed HEA and return it to our office. Please note that by signing Number 4 on the enclosed HEA for the Illinois All Kids Health Insurance, you are stating you do not want your information shared with the Illinois Department of Healthcare and Family Services. If you agree to disclose the application information, it maybe used to identify your child(ren) for the health insurance program. If you would like more information on All Kids , call toll-free 866/255-5437 or 877/204-1012 (TTY) . Income Eligibility Guidelines Effective from July 1, 2024, to June 30, 2025 Reduced-Price Meals 185% Federal Poverty Guideline | Household
Size | Annual | Monthly | Twice Per Month | Every Two Weeks | Weekly | | --- | --- | --- | --- | --- | --- | | 1 | 27,861 | 2,322 | 1,161 | 1,072 | 536 | | 2 | 37,814 | 3,152 | 1,576 | 1,455 | 728 | | 3 | 47,767 | 3,981 | 1,991 | 1,838 | 919 | | 4 | 57,720 | 4,810 | 2,405 | 2,220 | 1,110 | | 5 | 67,673 | 5,640 | 2,820 | 2,603 | 1,302 | | 6 | 77,626 | 6,469 | 3,235 | 2,986 | 1,493 | | 7 | 87,579 | 7,299 | 3,650 | 3,369 | 1,685 | | 8 | 97,532 | 8,128 | 4,064 | 3,752 | 1,876 | | For each additional family member, add | 9,953 | 830 | 415 | 383 | 192 | If you have any questions or need help, please contact your sponsoring organization. Sincerely, In accordance with Federal 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), age, disability, and 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 for program information (e.g. , Braille, large print, audiotape, and 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.fns.usda.gov/civil-rights/usda-nondiscrimination-statement-other-fns-programs](https://www.fns.usda.gov/civil-rights/usda-nondiscrimination-statement-other-fns-programs), from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must

FAQs

How can households receiving SNAP or TANF complete the HEA?

Follow Instruction A by listing all people residing in the provider household and recording valid SNAP or TANF case numbers for qualifying household members (excluding an Illinois LINK card number).

What information-sharing decision is referenced in the letter?

By signing Number 4 on the enclosed HEA for Illinois All Kids Health Insurance, the provider states whether they do not want information shared; agreeing to disclosure may be used to identify children for the program.

Oct 10, 2026

Uploaded by Mary Man