Appendix A: Certification/Renewal Chart

Forms to Distribute/Complete

Type of Household or Income

Length of Period

PA 600

PA 600R

PA 564 (SAR FORM)

PA 253

PA 239SP

PA 10SFSP

PA 772* & PA 1530*

Earned and/or unearned income

12 months

C

R

Yes

C & R

C & R

R

C & R

Migrant or seasonal farmworker

6 months

C

R

Yes

C & R

C & R

R

C & R

Unearned only and all adults are elderly/disabled

12 months

C

R

No

C & R

C & R

R

C & R

Zero-income households

6 months

C

R

Yes

C & R

C & R

R

C & R

ABAWDs

6 months or less

C

R

Yes

C & R

C & R

R

C& R

C = Certification
R = Renewal
* = For clients who are nonexempt or volunteer for ETP

NOTE:  Other specialized forms may be necessary.

Reissued March 1, 2015, replacing April 11, 2007