COVID-19 Intake Forms

FandN Resources > Coronavirus Update for Contracting Entities > Intake Forms

Use the information below to complete the appropriate intake form.

Transitional Operations Intake Forms
Use the following chart to identify the form you need to submit:
Name and URL for Form	Applicable CE	Description
SY 2022-2023 Non-congregate, Meal Service Times, Parent Pick-up, and Offer vs Serve in Senior High School Waiver Request Form	NSLP	NSLP operators may request non-congregate, meal service times, parent pick-up, and OVS in high school waivers under one of the following conditions: Mandated quarantine of an entire classroom/select population due to COVID-19 exposure Justification of non-congregate service based on nutrition staffing issues caused by a COVID-19 outbreak.
SY 2022-2023 Offsite Monitoring Opt-in Form	NSLP	NSLP operators may use offsite monitoring flexibilities for the duration of SY 2022-23 but must notify TDA via this form.
Waiver of Paid Lunch Equity (PLE) Requirements for CEs with a negative balance in their food service account	NSLP	CEs with a negative food service account balance must submit notice via this form if they do not intend to raise paid lunch prices in SY 2022-2023.
CACFP Non-congregate, Meal Service Times, and Parent Pick-up Request Form	CACFP	CACFP operators may request non-congregate, meal service times, and parent pick-up waivers under one of the following conditions: Closure of facility due specifically to a COVID-19 outbreak. Mandated quarantine of an entire classroom/select population due to COVID-19 exposure Justification of non-congregate service based on nutrition staffing issues caused by a COVID-19 outbreak.
CACFP Offsite Monitoring Waiver Opt-In Form	CACFP	CACFP operators may use offsite monitoring flexibilities through June 30, 2023, but must notify TDA via this form.

Assistance available in English and Spanish. Please call 877-TEX-MEAL (877-839-6325) for help. Additional translations services available as well.

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-0508-0002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:

1. Mail:

U.S. Department of Agriculture

Office of the Assistant Secretary for Civil Rights

1400 Independence Avenue, SW

Washington, D.C. 20250-9410; or

2. Fax: (833) 256-1665 or (202) 690-7442; or

3. Email: program.intake@usda.gov.

This institution is an equal opportunity provider.