Financial information forms (FIF) are an important part of navigating any legal or financial situation. Sacc Financial Information Forms (SFIFs) have been developed to provide a clearer and more efficient way for individuals, businesses, and organizations to gather the most relevant financial information needed in such situations. By taking advantage of SFIF's versatility and user-friendly format, you can save time by streamlining your process for gathering key financial data quickly and accurately within the framework of applicable laws and regulations. In this blog post, we'll take a closer look at the benefits that the Sacc Financial Information Form offers as well as how to use it effectively in your business operations.
| Question | Answer |
|---|---|
| Form Name | Sacc Financial Information Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | fairfaxcounty, sacc form, SACC, sacc application |
***Please return within 10 business days
SACC Financial Information Form
Office for Children • School Age Child Care Program • 12011 Government Center Pkwy., Suite 930 • Fairfax, VA 22035
SACC Registration
Families must meet eligibility requirements as outlined on the Financial Explanation Sheet and in the parent handbook.
Please refer to the SACC Financial Explanation Sheet for directions on how to complete this form. Additional documentation may be required based on information submitted. This form is not required if your household income is above $48,000 per year.
Mother’s Name __________________________________ Father’s Name _____________________________________
Guardian/Contributing Household Member (Name & Relationship) _____________________________________________________
Child’s Name(s) _________________________________________________________ Home # ____________________________
Cell # _______________________________ Work #’s ____________________________/_______________________________
(Mother)(Father)
Billing Address ______________________________________________________________________________________________
SACC Account # _______________________________
Household Income Information Worksheet
Per pay period (gross) |
Gross Annual Total |
(Circle one) |
|
Mother’s/Guardian’s (Salary)
Father’s/Guardian’s (Salary)
Alimony/Child Support
weekly
weekly
weekly
$___________________ $ ___________________
$___________________ $ ___________________
$___________________ $ ___________________
Other Income (please explain) _______________________________________________ |
$ ____________________ |
||
Gross Annual Household Total |
|
(line 1) |
$ ____________________ |
Deductions: |
|
|
|
Number of children under the age of 18 in the household X $3,150.00 |
(line 2) |
||
Adjusted Income: |
(line 1 minus line 2) |
(=) $ ____________________ |
|
I certify that this income information is a true and accurate statement of the financial status and composition of my household.
I understand that giving inaccurate or erroneous information may result in loss of SACC services. I will notify SACC Registration within 10 days if any information changes. I understand that any fee reduction resulting from changes in the household income information will become effective from the point of receipt forward, and will not be retroactive.
I certify that I meet all the eligibility requirements for the SACC program.
Parent/Guardian Signature ________________________________________ Date ______________________________
|
Questions? Call SACC Registration at (703) |
|
www.fairfaxcounty.gov/childcare/sacc.htm |
Rev. 5/05 |
(vea el reverso) |