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Form Name	Form Number	Program Name
Pre-Approval Visit	H1602-P	CACFP - Adult Day Care
Review	H1602	CACFP - Adult Day Care
Request for Emergency USDA Foods	H1579	CSFP Forms
Request for Emergency USDA Foods	H1579	FDP Forms
Request for Emergency USDA Foods	H1579	TEFAP Forms
Record of Leftover/Recycled Food	H1568	CACFP - Adult Day Care
Record of Leftover/Recycled Food	H1568	CACFP - At-Risk Afterschool
Record of Leftover/Recycled Food	H1568	CACFP - Child Care Center
Record of Leftover/Recycled Food	H1568	CACFP - Day Care Home
Record of Leftover/Recycled Food	H1568	SFSP Forms
Household Application for USDA Foods-Alternate	H1555B	TEFAP Forms
Household Application for USDA Foods-Alternate (Spanish)	H1555B	TEFAP Forms
Household Application for USDA Foods/Solicitud domestica de los alimentos del USDA	H1555	TEFAP Forms
Documentation of Meals Claimed - At-Risk	H1540-AT	CACFP - At-Risk Afterschool
Documentation of Meals Claimed	H1540	CACFP - Adult Day Care
Documentation of Meals Claimed	H1540	CACFP - Child Care Center
Daily Meal Count, Attendance, and Meal Production Record (H1539)	H1539	CACFP - Day Care Home
Daily Meal Count and Attendance Record (At-Risk)	H1535-AT	CACFP - At-Risk Afterschool
Daily Meal Count and Attendance Record (At-Risk)	H1535-AT	CACFP - Child Care Center
Daily Meal Count and Attendance Record (Centers and Emergency Shelters)	H1535	CACFP - Adult Day Care
Daily Meal Count and Attendance Record (Centers and Emergency Shelters)	H1535	CACFP - Child Care Center
Documentation of Meals Claimed	H1534	CACFP - Day Care Home
Daily Meal Production Record - Infants	H1530-A	CACFP - Child Care Center
Daily Meal Production Record - Infants	H1530-A	CACFP - Day Care Home
Daily Meal Production Record - Child Care	H1530	CACFP - At-Risk Afterschool
Daily Meal Production Record - Child Care	H1530	CACFP - Child Care Center
Food Service Management Company/Vendor Monitor Review	H1529	CACFP - Adult Day Care
Food Service Management Company/Vendor Monitor Review	H1529	CACFP - At-Risk Afterschool
Food Service Management Company/Vendor Monitor Review	H1529	CACFP - Child Care Center
Annual Inventory Report (USDA Foods)	H1526	CSFP Forms
Participant Rights and Responsibilities	H1516	CSFP Forms
Application Notification	H1515	CSFP Forms
TEFAP Site Information	H1510	TEFAP Forms
Temporary Certification	H1509	CSFP Forms
Certification Expiration Notice	H1507	CSFP Forms
Additional Assurances for Camps, Conditional Non-Congregate Sites, and Other Enrollment Programs that Charge Separately for Meals; Collection of Payment Options for Programs that Charge Separately for Meals	H1506-A	SFSP Forms
Agreement Between Contracting Entity and Subdistributing Agency	H1505	CSFP Forms
Participant Application	H1504	CSFP Forms
Site Information	H1503	CSFP Forms
Agreement Between Contracting Entity and Texas Department of Agriculture	H1502	CSFP Forms
Agreement Between Contracting Entity and Site	H1501	CSFP Forms
Voucher Receipt Log	H1451	SFMNP Forms
Farmers' Market Nutrition Program Allowed-Disallowed Foods	H1442	FMNP Forms
Senior Farmers' Market Nutrition Program Allowed-Disallowed Foods	H1440	SFMNP Forms
Participant Application - Spanish	H1430S	SFMNP Forms
Participant Application - English	H1430	SFMNP Forms
S/FMNP Farmers' Market, Roadside Stand, and Certification/Issuance Site Information Form	H1420	FMNP Forms
S/FMNP Farmers' Market, Roadside Stand, and Certification/Issuance Site Information Form	H1420	SFMNP Forms
Plan of Operation	H1406	FMNP Forms
Governing Body Awareness	GBA	CACFP - Adult Day Care

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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

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

This institution is an equal opportunity provider.