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Form Name	Form Number	Program Name
Amendment 2 to Permanent Agreement Between Sponsoring Organization and Child Care Site - Sponsoring Organization Provides Meals/Snacks	AMEND 2	CACFP - At-Risk Afterschool
Annual Audit	AUDIT	CACFP - At-Risk Afterschool
Application for Texas Identification Number	AP-152	CACFP - At-Risk Afterschool
Building for the Future - Black and White		CACFP - At-Risk Afterschool
Building for the Future - Color		CACFP - At-Risk Afterschool
CACFP - Centers Claim for Reimbursement - Site Level		CACFP - At-Risk Afterschool
CACFP Invitation for Bid (IFB) and Contract for Purchased Meals	IFB - CCC AND DCH	CACFP - At-Risk Afterschool
CACFP Medical Statement Form		CACFP - At-Risk Afterschool
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts	H2048	CACFP - At-Risk Afterschool
Certification Regarding Federal Lobbying	H2049	CACFP - At-Risk Afterschool
Child Nutrition Programs Waiver Request		CACFP - At-Risk Afterschool
Claim for Reimbursement Worksheet - Meals	H4502	CACFP - At-Risk Afterschool
Contracting Entity Request for Waiver of 15% Limit for Allowable Administrative Costs		CACFP - At-Risk Afterschool
Daily Meal Count and Attendance Record (At-Risk)	H1535-AT	CACFP - At-Risk Afterschool
Daily Meal Production Record - Child Care	H1530	CACFP - At-Risk Afterschool
Direct Deposit Authorization	74-176	CACFP - At-Risk Afterschool
Documentation of Meals Claimed - At-Risk	H1540-AT	CACFP - At-Risk Afterschool
F&N Complaint Form - English		CACFP - At-Risk Afterschool
F&N Complaint Form - Spanish		CACFP - At-Risk Afterschool
Food Service Management Company/Vendor Monitor Review	H1529	CACFP - At-Risk Afterschool
Gender Separation Exception Request Form		CACFP - At-Risk Afterschool
Governing Body Awareness	GBA	CACFP - At-Risk Afterschool
Payee Change Request	74-157	CACFP - At-Risk Afterschool
Performance Bond	BOND	CACFP - At-Risk Afterschool
Permanent Agreement Between Sponsoring Organization and Child Care Site		CACFP - At-Risk Afterschool
Permanent Agreement Between Sponsoring Organization and Child Care Site - Sponsoring Organization Provides Meals/Snacks		CACFP - At-Risk Afterschool
Permanent Agreement Contracting Entity Specific Amendment - Name		CACFP - At-Risk Afterschool
Permanent Agreement Contracting Entity Specific Amendment - Programs		CACFP - At-Risk Afterschool
Pre-Approval Visit	H1606-AT-P	CACFP - At-Risk Afterschool
Pre-Award Civil Rights Compliance Review		CACFP - At-Risk Afterschool
Racial/Ethnic Participant Data Collection Prototype		CACFP - At-Risk Afterschool
Record of Leftover/Recycled Food	H1568	CACFP - At-Risk Afterschool
Review	H1606-AT	CACFP - At-Risk Afterschool
SFSP and At-Risk Invitation for Bid (IFB) and Contract for Purchased Meals	IFB - SFSP AND AT-RISK	CACFP - At-Risk Afterschool
Sponsoring Organization Disbursement Record	H4503	CACFP - At-Risk Afterschool
Texas Department of Agriculture Food and Nutrition Division Permanent Agreement		CACFP - At-Risk Afterschool
Milk Flexibility for Emergency Conditions Notification		CACFP - At-Risk Afterschool
Good Cause Transfer Request Form		CACFP - At-Risk Afterschool
Micro-Purchase Log		CACFP - At-Risk Afterschool
Valid At-Risk Unaffiliated Site Questionnaire/Attestation		CACFP - At-Risk Afterschool
Small Purchase Log		CACFP - At-Risk Afterschool
Excess Net Cash Resources Plan for CACFP/SFSP		CACFP - At-Risk Afterschool
CACFP Serious Deficiency Process Notification Template Letters		CACFP - At-Risk Afterschool
CACFP Serious Deficiency Process Notification Form		CACFP - At-Risk Afterschool
2025 Income Eligibility Guidelines for Determining Free and Reduced Price Benefits	H1625-A	CACFP - Adult Day Care
2024 Income Eligibility Guidelines for Determining Free and Reduced-Price Benefits	H1625-A	CACFP - Adult Day Care
Addendum - Option to Renew IFB and Contract for Purchased Meals ADC	IFB - RENEW ADC	CACFP - Adult Day Care
Amendment 1 to Permanent Agreement Between Sponsoring Organization and Adult Day Care Site	AMEND 1	CACFP - Adult Day Care
Annual Audit	AUDIT	CACFP - Adult Day Care
Application for Texas Identification Number	AP-152	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.