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Attachment I to FPM Ltr. 308- 24


APPENDIX D. DETERMINING AND DOCUMENTING FINANCIAL ELIGIBILITY
FOR NEEDY YOUTH PROGRAMS

D-1. PURPOSE

appendix provides instructions for determining and documenting financial eligibility
reedy youth programs conducted through excepted service appointing authorities. The
covered by these instructions are the Stay-in-School Progeam (FPM chapter 303,
or 9), the Summer Aid Program (FPM chapter 332, appendix J-6), and the Federal Junior
Progrikm (FPM chapter 308, subchapter 8).
D-2. DETERMINING FINANCIAL ELIGIBILITY

p ,eds criteria. 5tay-in-Schoolers and Summer Aids must meet the needs criteria
n M bulletin irk the 308 code. (Severely physically handicapped or mentally
indilvidluals are exempt from the needs criteria.) The criteria is divided into charts of 4
'which outline family income in relation to family size. The first category represents
atPoverty level while the others are increased by increments of $2)500. Youths are to be
fee employment in category order. (For example, category I individuals must be
Wore category, II individuals.) Junior Fellows are, subject to an overall maximum
#Oq as outlined in FPM chapter 308, subchapter 8.

amft size. In determining family income, the size of the family needs to be taken into
.Q ths purpose, two or more persons living in a single residence who are related to
by blood marriage, or adoption, are included in the definition of a "family."
or :stepparents are considered to be related by marriage.) A family of' one is
(c) below. The family size consists of the maximum number of family members during
months. A person who is claimed as a dependent on another person's Federal income
the previous year is considered to be part of the other person's family.
Sufficient individuals. Financially independent individuals who (1) have not resided
for more than 6 months during the past 12-month period, and (2) were not claimed
ton another person's Federal income tax return for the last calendar year, may be
*i family unit of I person. If however, they have resided with the family for more
during the past 12-month period they shall be consilibrod a member of that family
of these family members must be counted.

ncuions in family income. Family income refers to tofa annual cash receipts before
all sources. (Income data for a part-year period may be annualized in order to
eligbility.) These receipts include:
wLa es and salary the total money earnings received from work performed as an
Represents the amount paid before deductions for incomp taxes, social security, bond
union dues, etc.,I ,O
r~f-~oymnt icome- net income (gross receipts rUthis operating expenses) from
f irm,4 farm, or other enterprise in which a person is entoged, on his/her own;
Other, moneX income Money received from sources sueb. as public assistance payments
Sq emeda Seurity Income), social security or railroad retirement, .unemployment and
compensationo, strike benefits from union funds, training stjlpeods alimony, child support,
fAmily allotments or other regular support from an absent family member or someone
An the household; private and Government employee pensions, and regular insurance or





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Attachment 2 to F'PM Ltr. 308-24


US OFFICE OF PERSONNEL MANAGEMENT
FINANCIAL ELIGIBILITY STATEMENT FOR
STUDENT AND SUMMER AID PROGRAMS


Form Appoved
OMB8 No0 320 0149


(Plee Read the Privacy Act Statement and the Informati onn the Reverse Side Concrning Inclusions and Exclusion In
Family Income Before Completing This Form. You May Be Asked to Verity the Information You Provide.)

Name ol Applicant (La. F#at, MIddle i al) Date o Birth (Month. Day. Year)


PRIVACY ACT STATEMENT summer aid programs The information may also be disclosed to Fed-
Requesting this information is authorized by Section 3301. Civil Serv- eral, State, or local government taxing authorities or to a court dur-
ice Employment, of title 5 of the U.S. Code. The information will be ing a legal proceeding. Furnishing the information is voluntary, but
used to determine that you meet the financial need category neces- failure to do so will result in your application receiving no further con-
sary before being declared eligible for employment under the student/ sideration.

INSTRUCTIONS: List all family members living in your household during the last 12 months (include all people related by blood, marriage, or
adoption) and provide the following information:
NAME RELATIONSHIP ANNUAL INCOME (See Reverse)


TOTAL NUMBER: TOTAL AMOUNT:

If you are a candidate for the Federal Junior Fellowship Program, list your estimated college expenses per year. TOTAL EXPENSE
(Use the cost itemized in the college catalog and include tuition, fees, room and board, etc.)
Were you claimed as a dependent for income tax purposes on another individual's most recent return? .......................... YES
If "YES", on whose return? NO
CERTIFICATION: I cenify that all of the statements made by me are true, complete and correct to the best of my knowledge and belief, and are
made in good faith. [Submitting falsified information on this form may be grounds for not employing you or for dismissing you
after you begin work, and may be punishable by fine or imprisonment (U.S. Code, Title 18, Section 1001).)
Applicant's Signature and Date Signed Signature of Parent or Guardian and Date Signed


THIS SPACE IS FOR USE OF APPOINTING OFFICER OR CERTIFYING OFFICIAL ONLY
SEligible for Stay-in-School Program (Category # ) Remarks (e.g reason for neligibility)
L Summer Aid Program (Category # )
SIneligible Federal Junior Fellowship Program
Other (Specify):
Signature and Title of Appointing/Certitfyng Official Date Signed Name of Agency


REPRODUCE ALLY (Front and Back)
REPRODUCE LOCALLY (Front and Back) OeM Form ,4I I484)




UNIVERSITY OF FLORIDA

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3 1262 08729 3691


Attachment 2 to FPM Ltr. 308-24 (2)


Inclusions in Family Income
Family income refers to total annual cash receipts before taxes
from all sources. (Income data for a part-year period may be an-
nualized.) These receipts include:
* Gross Wages and Salary-The total money earnings received
from work performed as an employee. It represents the amount
paid before deductions for income taxes, social security, bond
purchases, etc.
* Net Self-Employment Income-Net income (gross receipts
minus operating expenses) from a business firm, farm, or other
enterprise in which a person is engaged on his/her own.
* Other Money Income-Money received from sources, such as
public assistance payments (including Supplemental Security
Income), social security or railroad retirement, unemployment
and workers' compensation, strike benefits from union funds,
training stipends, alimony, child support, and military family
allotments or other regular support from an absent family mem-
ber or someone not living in the household; private and Gov-
ernment employee pensions, and regular insurance or annuity
payments; and income from dividends, interest, rents, royalties,
or periodic receipts from estates or trusts.


Exclusions From Family Income
The following should not be included in the computation of total
family income:
* Capital gains.
* Any assets drawn down as withdrawals from a bank, sale of
property, house, or car.
* Tax refunds, gifts, lump-sum inheritances, one-time insurance
payments or compensation for injury.
* Veterans' benefits (i.e., educational assistance, compensation
payments).
* Earnings from the Stay-in-School and Summer Aid programs.
* Non-cash benefits such as employer-paid health insurance and
other employee fringe benefits, food or rent received in lieu of
wages, the value of food and fuel produced and consumed on
farms, and the imputed value of rent from owner-occupied non-
farm or farm housing.

Individuals Claiming Self Sufficiency
If you are financially independent and (1) have not resided with
your family for more than 6 months during the past 12-month peri-
od and (2) were not claimed as a dependent on another person's
Federal income tax return for the last calendar year, you may be
considered your own household of one person. If, however, you
have resided with your family for more than 6 months during the
past 12-month period, the income of these family members must
be reported on this form.


* U.S. GOVERNMENT PRINTING OFFICE: 1984-460-572:2126