FORM 4504
Instructions

INCOME STANDARDS FOR DETERMINING FREE
AND REDUCED-PRICE ELIGIBILITY

07-2004

PURPOSE

To provide contractors with a guide to determine free and reduced-price eligibility.

PROCEDURE

When to Prepare

HHSC provides you with copies of Form 4504 when the USDA issues new standards. Use Form 4504 to compare an applicant's family size and income to USDA standards for determining free and reduced-price eligibility.

Number of Copies

Use one copy as a reference.

Transmittal

None.

Form Supply

Photocopy Form 4504, as necessary.

Form Retention

Keep Form 4504 with all other program forms and records for three years and 90 days from the end of the contracted period. Exception: If audit findings, claims, or litigation have not been resolved, keep all forms and records until all issues are resolved.

DETAILED INSTRUCTIONS

Compare the applicant's family size and income to determine free and reduced-price eligibility.