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Form Name	Form Number	Program Name
Record of Leftover/Recycled Food	H1568	CACFP - Day Care Home
Record of Leftover/Recycled Food	H1568	SFSP Forms
Racial/Ethnic Participant Data Collection Prototype		CACFP - Adult Day Care
Racial/Ethnic Participant Data Collection Prototype		CACFP - At-Risk Afterschool
Racial/Ethnic Participant Data Collection Prototype		CACFP - Child Care Center
Racial/Ethnic Participant Data Collection Prototype		CACFP - Day Care Home
Racial/Ethnic Participant Data Collection Prototype		SFSP Forms
PY23 Sample Size Calculator for Verification		School Nutrition Program Forms
Proxy Form		CSFP Forms
Provision 2 (P2) Feasibility Worksheet		School Nutrition Program Forms
Prototype Letter: Health Department Notification		SFSP Forms
Program/Nonprogram Cost and Revenue Proportion Calculation Worksheet		School Nutrition Program Forms
Professional Standards Tracking Sheet		School Nutrition Program Forms
Product Formulation Statement for Vegetable Products – Sample Template		School Nutrition Program Forms
Product Formulation Statement for Meat/Meat Alternate (M/MA) Products – Sample Template		School Nutrition Program Forms
Product Formulation Statement for Grains Products – Sample Template		School Nutrition Program Forms
Product Formulation Statement for Fruit Products – Sample Template		School Nutrition Program Forms
Pre-Award Civil Rights Compliance Review		CACFP - Adult Day Care
Pre-Award Civil Rights Compliance Review		CACFP - At-Risk Afterschool
Pre-Award Civil Rights Compliance Review		CACFP - Child Care Center
Pre-Award Civil Rights Compliance Review		CACFP - Day Care Home
Pre-Award Civil Rights Compliance Review		School Nutrition Program Forms
Pre-Award Civil Rights Compliance Review		SFSP Forms
Pre-Approval Visit	H1602-P	CACFP - Adult Day Care
Pre-Approval Visit	H1606-AT-P	CACFP - At-Risk Afterschool
Pre-Approval Visit	H1606-P	CACFP - Child Care Center
Pre-Approval Visit	H1607-P	CACFP - Day Care Home
Policy Statement for Special Milk Program, Attachment B: Milk Count/Collection Procedure(s)		Special Milk Program Forms
Plan of Operation	H1406	FMNP Forms
Physical Inventory of Food Purchased Form		School Nutrition Program Forms
Permanent Agreement Contracting Entity Specific Amendment - Programs		CACFP - Adult Day Care
Permanent Agreement Contracting Entity Specific Amendment - Programs		CACFP - At-Risk Afterschool
Permanent Agreement Contracting Entity Specific Amendment - Programs		CACFP - Child Care Center
Permanent Agreement Contracting Entity Specific Amendment - Programs		CACFP - Day Care Home
Permanent Agreement Contracting Entity Specific Amendment - Programs		FFVP Forms
Permanent Agreement Contracting Entity Specific Amendment - Programs		School Nutrition Program Forms
Permanent Agreement Contracting Entity Specific Amendment - Programs		SFSP Forms
Permanent Agreement Contracting Entity Specific Amendment - Programs		Special Milk Program Forms
Permanent Agreement Contracting Entity Specific Amendment - Name		CACFP - Adult Day Care
Permanent Agreement Contracting Entity Specific Amendment - Name		CACFP - At-Risk Afterschool
Permanent Agreement Contracting Entity Specific Amendment - Name		CACFP - Child Care Center
Permanent Agreement Contracting Entity Specific Amendment - Name		CACFP - Day Care Home
Permanent Agreement Contracting Entity Specific Amendment - Name		School Nutrition Program Forms
Permanent Agreement Contracting Entity Specific Amendment - Name		SFSP Forms
Permanent Agreement Contracting Entity Specific Amendment - Name		Special Milk Program Forms
Permanent Agreement Between Sponsoring Organization and Day Care Home Provider(s)		CACFP - Day Care Home
Permanent Agreement Between Sponsoring Organization and Child Care Site - Sponsoring Organization Provides Meals/Snacks		CACFP - At-Risk Afterschool
Permanent Agreement Between Sponsoring Organization and Child Care Site - Sponsoring Organization Provides Meals/Snacks		CACFP - Child Care Center
Permanent Agreement Between Sponsoring Organization and Child Care Site		CACFP - At-Risk Afterschool
Permanent Agreement Between Sponsoring Organization and Child Care Site		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/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.