1. Requirements applicable to applications from all households:
• Names of children, date of birth, grade and school.
• Check-off boxes for sharing data with Minnesota health insurance programs
(“negative” check-off – checking the box means do not share data).
• Collection of data on race and ethnicity (may be eliminated if school has already documented race/ethnicity of students).
• U.S. Department of Agriculture nondiscrimination statement and procedure for filing a complaint.
• Federal and state privacy statements – see back of Application for Educational Benefits. Certification statement.
• Electronic signature.
2. Additional requirements specific to applications based on household income:
• Names of adult household members.
• Incomes for each adult household member by type and frequency
(recommended – a check box to indicate if an individual has “no income”).
• Social Security number of signer; check box to indicate that signer has no Social Security number.
3. Additional requirements specific to applications based on categorical eligibility:
• Case number (for any member of household).
• Use Minnesota-specific terminology – Food Assistance and Minnesota Family
Investment Program (MFIP).
4. Additional requirements specific to application for a foster child:
• Identification of the foster child.
• Indication of amount of “personal use” income to the foster child
(recommended – a check box for “none” if foster child has no personal use income).