Complete Section B if you did not complete Section A.
Section A: complete it if anyone in your household participates in SNAP, receives TANF, participates in FDPIR or is a foster child.
Section B household: write in your name and the names of all other adults and children living in the household, including unrelated people.
Section B income: enter the amount of income each person received last month, before taxes or anything else was taken out.
Valid until: the income eligibility form is valid until the last day of the month one calendar year from the date it is signed by the household member.
| Question | Answer |
|---|---|
| Form Name | DOH-3688 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 6 min |
| Edition | 7/23 |
| Issuing agency | New York State Department of Health |
| Who signs | An adult household member |
| Other names | DOH-3688, DOH 3688, DOH3688, Form DOH-3688, CACFP DOH-3688, Income Eligibility Form for Child Care Centers |
| Official source | DOH-3688 (7/23), New York State Department of Health |
Cacfp Form Doh 3688 isn’t the one you’re looking for?