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Clearinghouse for Multilingual Documents (CMD)

Instructions for using the CMD System

Document Information

Original English Document:
Household Income Data Collection Sample Form 3
School Funding
Local Control Funding Formula
This form collects information for multiple children in a household. Parents/guardians would select among income ranges, which are presented for various frequencies of payment (weekly, monthly, yearly, etc.). Please note that LEAs need to update the form annually to reflect the Household Size and Income Eligibility data located on the California Department of Education’s School Nutrition Programs Eligibility Materials Web page at
English Document:
Language of Translated Document:
Translator Type:
Translation Service
File Format of Translated Document:
Electronic – Word (.doc)
Font used in translated document (e.g., Arial, Times New Roman, Gulim):
Revised/updated as of:
Translated Document:
Comments about the Translated Document:
Sample 3 form in Korean Revised Oct. 24, 2014
Document Reference ID:
Questions: Clearinghouse for Multilingual Documents | | 916-319-0881

California Department of Education
1430 N Street
Sacramento, CA 95814

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