Forms

All Program Forms

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Form Name Form Number Form Download Form Download (Alternative Format) Instructions Download Program Name
Record of Leftover/Recycled Food H1568 Download File Download File SFSP Forms
Request for Emergency USDA Foods H1579 Download File Download File Download File CSFP Forms
Request for Emergency USDA Foods H1579 Download File Download File Download File FDP Forms
Request for Emergency USDA Foods H1579 Download File Download File Download File TEFAP Forms
Review H1602 Download File Download File CACFP - Adult Day Care
Pre-Approval Visit H1602-P Download File Download File CACFP - Adult Day Care
Review H1606 Download File Download File CACFP - Child Care Center
Review H1606-AT Download File Download File CACFP - At-Risk Afterschool
Pre-Approval Visit H1606-AT-P Download File Download File CACFP - At-Risk Afterschool
Pre-Approval Visit H1606-P Download File Download File CACFP - Child Care Center
Review H1607 Download File Download File CACFP - Day Care Home
Pre-Approval Visit H1607-P Download File Download File CACFP - Day Care Home
2025 Income Eligibility Guidelines for Determining Free and Reduced Price Benefits H1625-A Download File CACFP - Adult Day Care
2024 Income Eligibility Guidelines for Determining Free and Reduced-Price Benefits H1625-A Download File CACFP - Adult Day Care
2025 Income Eligibility Guidelines for Determining Free and Reduced Price Benefits H1625-A Download File CACFP - Child Care Center
2024 Income Eligibility Guidelines for Determining Free and Reduced-Price Benefits H1625-A Download File CACFP - Child Care Center
2025 Income Eligibility Guidelines for Determining Free and Reduced Price Benefits H1625-A Download File CACFP - Day Care Home
2024 Income Eligibility Guidelines for Determining Free and Reduced-Price Benefits H1625-A Download File CACFP - Day Care Home
Report of Loss of USDA Foods H1638 Download File CSFP Forms
Report of Loss of USDA Foods H1638 Download File Download File FDP Forms
Report of Loss of USDA Foods H1638 Download File Download File TEFAP Forms
Temperature Record H1639 Download File Download File Download File CSFP Forms
Temperature Record H1639 Download File Download File Download File FDP Forms
Temperature Record H1639 Download File Download File Download File SFSP Forms
Temperature Record H1639 Download File Download File Download File TEFAP Forms
2024-2025 TEFAP Income Eligibility Guidelines H1640 Download File Download File TEFAP Forms
2023-2024 TEFAP Income Eligibility Guidelines H1640 Download File Download File TEFAP Forms
Daily Meal Production Record - Adult Day Care H1654 Download File Download File CACFP - Adult Day Care
Notice to Providers of Tier Determination (Child and Adult Care Food Program-Day Care Homes) H1659 Download File Download File CACFP - Day Care Home
List of Eligible Federal/State Funded Assistance Programs (Tier II Day Care Homes) H1660 Download File Download File Download File CACFP - Day Care Home
Letter of Determination - Pricing Programs H1663 Download File Download File CACFP - Adult Day Care
2024 Income Eligibility Guidelines for the Elderly H1666 Download File Download File CSFP Forms
Free and Reduced Price Meal Policy Statement (For Contractors that Charge Separately for Meals) H1667 Download File Download File CACFP - Adult Day Care
2024-2025 SFMNP Income Eligibility Guidelines H1668 Download File Download File SFMNP Forms
2023-2024 SFMNP Income Eligibility Guidelines H1668 Download File Download File SFMNP Forms
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File CACFP - Adult Day Care
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File CACFP - At-Risk Afterschool
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File CACFP - Child Care Center
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File CACFP - Day Care Home
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File CSFP Forms
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File FDP Forms
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File FMNP Forms
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File School Nutrition Program Forms
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File SFMNP Forms
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File SFSP Forms
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File Special Milk Program Forms
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File TEFAP Forms
Certification Regarding Federal Lobbying H2049 Download File Download File CACFP - Adult Day Care
Certification Regarding Federal Lobbying H2049 Download File Download File CACFP - At-Risk Afterschool
Certification Regarding Federal Lobbying H2049 Download File Download File CACFP - Child Care Center
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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/ad-3027.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
This institution is an equal opportunity provider.
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