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All Program Forms

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Form Name	Form Number	Program Name
Micro-Purchase Log		CACFP - Day Care Home
Micro-Purchase Log		CSFP Forms
Micro-Purchase Log		School Nutrition Program Forms
Micro-Purchase Log		SFSP Forms
Micro-Purchase Log		TEFAP Forms
Medical Statement Sample Form		School Nutrition Program Forms
Media Release for Free Milk Sample - SPANISH		All Program Forms
Media Release for Free Milk Sample - SPANISH		Special Milk Program Forms
Media Release for Free Milk Sample		Special Milk Program Forms
Meal Accommodation Tracking Form		School Nutrition Program Forms
Local Wellness Policy (LWP) Checklist		School Nutrition Program Forms
List of Eligible Federal/State Funded Assistance Programs (Tier II Day Care Homes)	H1660	CACFP - Day Care Home
Letter to Household, Eligibility Based on Free Milk Application - Spanish		Special Milk Program Forms
Letter to Household, Eligibility Based on Free Milk Application		Special Milk Program Forms
Letter to Household - Eligibility Determination - Multiple Templates (SPANISH)		School Nutrition Program Forms
Letter to Household - Eligibility Determination - Multiple Templates		School Nutrition Program Forms
Letter of Determination - Pricing Programs	H1663	CACFP - Adult Day Care
Invitation for Bid and Contract for Purchased Meals	IFB - ADC	CACFP - Adult Day Care
Instructions for Authorization to Transfer USDA Foods for Further Processing	H4529.1	FDP Forms
Instructions for Authorization to Transfer USDA Foods	H4529	CSFP Forms
Instructions for Authorization to Transfer USDA Foods	H4529	FDP Forms
Instructions for Authorization to Transfer USDA Foods	H4529	School Nutrition Program Forms
Instructions for Authorization to Transfer USDA Foods	H4529	TEFAP Forms
Informal Small Purchase Log		School Nutrition Program Forms
Income from Food Service Operations Form		School Nutrition Program Forms
Income and Categorical Application Checklist		School Nutrition Program Forms
Income and Categorical Application Checklist		Special Milk Program Forms
Household Contact		CACFP - Child Care Center
Household Contact		CACFP - Day Care Home
Household Application for USDA Foods-Alternate (Spanish)	H1555B	TEFAP Forms
Household Application for USDA Foods-Alternate	H1555B	TEFAP Forms
Household Application for USDA Foods/Solicitud domestica de los alimentos del USDA	H1555	TEFAP Forms
Hiring Program Director Checklist		School Nutrition Program Forms
Hazard Analysis Critical Control Point (HACCP) Checklist	FND-104	School Nutrition Program Forms
Governing Body Awareness	GBA	CACFP - Adult Day Care
Governing Body Awareness	GBA	CACFP - At-Risk Afterschool
Governing Body Awareness	GBA	CACFP - Child Care Center
Governing Body Awareness	GBA	CACFP - Day Care Home
Good Cause Transfer Request Form		All Program Forms
Good Cause Transfer Request Form		CACFP - Adult Day Care
Good Cause Transfer Request Form		CACFP - At-Risk Afterschool
Good Cause Transfer Request Form		CACFP - Child Care Center
Good Cause Transfer Request Form		CACFP - Day Care Home
Gender Separation Exception Request Form		CACFP - Adult Day Care
Gender Separation Exception Request Form		CACFP - At-Risk Afterschool
Gender Separation Exception Request Form		CACFP - Child Care Center
Gender Separation Exception Request Form		CACFP - Day Care Home
Gender Separation Exception Request Form		School Nutrition Program Forms
Gender Separation Exception Request Form		SFSP Forms
Further Processing of USDA Foods Roles and Responsibilities		FDP Forms

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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.