Information to Gather from All Smart Start Programs 

• Child’s name^a
• Child’s social security number^a
• Child’s date of birth^a
• Child’s sex^a
• Household income (in categories listed below)
• Household size
• Mother’s name^b
• Mother’s social security number^b

^a  For programs that primarily serve parents, rather than children (e.g., literacy programs), obtain the above information for all children under 6 years.  You may want to consider developing a form that has places for the child-related information to be obtained on up to 5 children, instead of having a family complete a separate form for each of their young children. 

^b  Information about mothers will be used to link children with families.

Income Categories: 
$0-4,999 
$5,000-9,999 
$10,000-12,499 
$12,500-14,999 
$15,000-17,499 
$17,500-19,999 
$20,000-22,499 
$22,500-24,999 
$25,000-27,499 
$27,500-29,999 
$30,000-34,499 
$35,000 and above