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Child and Adult Care Food Program - Adult Day Care Handbook

Forms Table of Contents

Note: Most of the following forms are available in Adobe Acrobat PDF format. They are provided as a convenience to users; however, they cannot be completed online or submitted electronically to the agency. To view and print the forms, you must download the free Adobe Acrobat reader. You may also download the free Acrobat Accessibility Reader for PDFs. A few forms are offered in Microsoft Word. If you have questions or comments regarding forms, instructions, or their related handbooks, please contact us at squaremeals@tda.state.tx.us.

Number	Effective Date	Title
74-176	1/2008	Vendor Direct Deposit Authorization
AP-152	1/2008	Texas Application for Payee Identification Number
H1520	9/2007	Sponsoring Organization Monitoring Staff Information
H1522	9/2006	Eligibility of For-Profit Adult Day Care Centers
H1529	9/2007	Food Service Management Company/Vendor Monitor Review
H1532	7/2008	Claim for Reimbursement
H1535	3/2007	Daily Meal Count and Attendance Record (Centers and Emergency Shelters)
H1548	9/2007	Application/Management Plan Change
H1568	9/2007	Record of Recycled Food
H1569	12/2007	Single Audit Identification Data
H1602	9/2007	Monitor Review
H1605	12/2007	Changes in Adult Day Care Facility
H1625-A	6/2008	Income Eligibility Guidelines For Determining Free and Reduced-Price Benefits July 1, 2008 - June 30, 2009
H1651	7/2008	Application Between Contracting Organization and Adult Day Care Center
H1652	10/2008	Application for Meals in Adult Day Care Center
H1653	7/2007	Permanent Agreement Between Contracting Organization and Adult Day Care Center
H1654	2/2008	Daily Menu Record
H1661	11/2008	Participant Letter - Pricing Programs
H1662	11/2008	Participant Letter - Non-Pricing Programs
H1663	11/2008	Letter of Determination - Pricing Programs
H1667	6/2006	Free and Reduced Price Meal Policy Statement (For Contractors that Charge Separately for Meals)
H2048	1/2008	Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts
H2049	1/2008	Certification Regarding Federal Lobbying
H4502	4/2007	Claim for Reimbursement Worksheet-Meals
H4503	9/2006	Sponsoring Organization Disbursement Record
H4504	6/2008	Income Eligibility Guidelines For Determining Free and Reduced Price Benefits July 1, 2008 - June 30, 2009
H4505	7/2007	Free and Reduced-Price Policy Statement for the Child and Adult Food Program (Nonpricing Only)
H4508	7/2008	Certificate of Authority
H4526	7/2008	Pre-Award Civil Rights Compliance Review
H4535	7/2008	Title XIX/XX Certification - Adult Day Care
H4536	7/2008	Application and Management Plan for New Adult Day Care Centers
H4536-A	7/2008	Renewal Application and Management Plan for Adult Day Care Centers
H4536-B	7/2007	Annual Update for Adult Day Care Centers/Facilities