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Form Name	Form Number	Program Name
CACFP Meal Benefit Income Eligibility Form (Child Care) in Spanish		CACFP - Child Care Center
CACFP Meal Benefit Income Eligibility Form Letter to Households (Child Care Centers)		CACFP - Child Care Center
CACFP Meal Benefit Income Eligibility Form Letter to Households (Child Care Centers) in Spanish		CACFP - Child Care Center
CACFP Medical Statement Form		CACFP - Child Care Center
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts	H2048	CACFP - Child Care Center
Certification Regarding Federal Lobbying	H2049	CACFP - Child Care Center
Child Care Food Program Collection Procedures	H4515-A	CACFP - Child Care Center
Child Nutrition Programs Waiver Request		CACFP - Child Care Center
Claim for Reimbursement Worksheet - Meals	H4502	CACFP - Child Care Center
Contracting Entity Request for Waiver of 15% Limit for Allowable Administrative Costs		CACFP - Child Care Center
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 - Child Care Center
Daily Meal Production Record - Child Care	H1530	CACFP - Child Care Center
Daily Meal Production Record - Infants	H1530-A	CACFP - Child Care Center
Direct Deposit Authorization	74-176	CACFP - Child Care Center
Documentation of Meals Claimed	H1540	CACFP - Child Care Center
F&N Complaint Form - English		CACFP - Child Care Center
F&N Complaint Form - Spanish		CACFP - Child Care Center
Food Service Management Company/Vendor Monitor Review	H1529	CACFP - Child Care Center
Free and Reduced-Priced Meal Policy Statement (For Contractors that Charge Separately for Meals)	H4515	CACFP - Child Care Center
Gender Separation Exception Request Form		CACFP - Child Care Center
Governing Body Awareness	GBA	CACFP - Child Care Center
Household Contact		CACFP - Child Care Center
Payee Change Request	74-157	CACFP - Child Care Center
Performance Bond	BOND	CACFP - Child Care Center
Permanent Agreement Between Sponsoring Organization and Child Care Site		CACFP - Child Care Center
Permanent Agreement Between Sponsoring Organization and Child Care Site - Sponsoring Organization Provides Meals/Snacks		CACFP - Child Care Center
Permanent Agreement Contracting Entity Specific Amendment - Name		CACFP - Child Care Center
Permanent Agreement Contracting Entity Specific Amendment - Programs		CACFP - Child Care Center
Pre-Approval Visit	H1606-P	CACFP - Child Care Center
Pre-Award Civil Rights Compliance Review		CACFP - Child Care Center
Racial/Ethnic Participant Data Collection Prototype		CACFP - Child Care Center
Record of Leftover/Recycled Food	H1568	CACFP - Child Care Center
Review	H1606	CACFP - Child Care Center
Shared Eligibility Form		CACFP - Child Care Center
Sponsoring Organization Disbursement Record	H4503	CACFP - Child Care Center
Texas Department of Agriculture Food and Nutrition Division Permanent Agreement		CACFP - Child Care Center
Milk Flexibility for Emergency Conditions Notification Form		CACFP - Child Care Center
Good Cause Transfer Request Form		CACFP - Child Care Center
Micro-Purchase Log		CACFP - Child Care Center
Small Purchase Log		CACFP - Child Care Center
Excess Net Cash Resources Plan for CACFP/SFSP		CACFP - Child Care Center
CACFP Serious Deficiency Process Notification Template Letters		CACFP - Child Care Center
CACFP Serious Deficiency Process Notification Form		CACFP - Child Care Center
2023 - 2024 School Data for Area Eligibility	SCHOOL DATA	CACFP - At-Risk Afterschool
2022 - 2023 School Data for Area Eligibility	SCHOOL DATA	CACFP - At-Risk Afterschool
Addendum - Option to Renew IFB and Contract for Purchased Meals CCC & DCH	IFB - RENEW CCC & DCH	CACFP - At-Risk Afterschool
Addendum - Option to Renew IFB and Contract for Purchased Meals SFSP & At-Risk	IFB - RENEW SFSP & AT-RISK	CACFP - At-Risk Afterschool
Amendment 1 to Permanent Agreement Between Sponsoring Organization and Child Care Site	AMEND 1	CACFP - At-Risk Afterschool
Amendment 2 to Permanent Agreement Between Sponsoring Organization and Child Care Site	AMEND 2	CACFP - At-Risk Afterschool

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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.