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Form Name	Form Number	Program Name
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts	H2048	School Nutrition Program Forms
Certification Regarding Federal Lobbying	H2049	School Nutrition Program Forms
Child Nutrition Programs Waiver Request		School Nutrition Program Forms
Community Eligibility Provision (CEP) Calculation Worksheet for Identified Student Percentage (ISP) and Claiming		School Nutrition Program Forms
Competitive Food (Smart Snacks) Worksheet		School Nutrition Program Forms
Cooler or Freezer Temperature Recording Form		School Nutrition Program Forms
Daily Food Production Record for Central Kitchen, Receiving Kitchen, and Onsite Kitchen		School Nutrition Program Forms
Daily Record of Income - NSLP and SBP		School Nutrition Program Forms
Daily Record/Accuclaim Form \| Afterschool Programs		School Nutrition Program Forms
Daily Record/Accuclaim Form \| Community Eligibility Provision (CEP) and Lunch Attendance Factor Calculator		School Nutrition Program Forms
Daily Record/Accuclaim Form \| Provision 2 (P2), Non-Base Year and Lunch Attendance Factor Calculator		School Nutrition Program Forms
Daily Record/Accuclaim Form and Lunch Attendance Factor Calculator		School Nutrition Program Forms
Direct Deposit Authorization	74-176	School Nutrition Program Forms
Excess Net Cash Resources Plan		School Nutrition Program Forms
F&N Complaint Form - English		School Nutrition Program Forms
F&N Complaint Form - Spanish		School Nutrition Program Forms
Fluid Milk Substitute Worksheet		School Nutrition Program Forms
Food Service Management Company (FSMC) Contract Review Form		School Nutrition Program Forms
Food Service Pro-Rata Share of Exclusive Beverage Contract Form		School Nutrition Program Forms
Gender Separation Exception Request Form		School Nutrition Program Forms
Hazard Analysis Critical Control Point (HACCP) Checklist	FND-104	School Nutrition Program Forms
Hiring Program Director Checklist		School Nutrition Program Forms
Income and Categorical Application Checklist		School Nutrition Program Forms
Income from Food Service Operations Form		School Nutrition Program Forms
Informal Small Purchase Log		School Nutrition Program Forms
Instructions for Authorization to Transfer USDA Foods	H4529	School Nutrition Program Forms
Letter to Household - Eligibility Determination - Multiple Templates		School Nutrition Program Forms
Letter to Household - Eligibility Determination - Multiple Templates (SPANISH)		School Nutrition Program Forms
Local Wellness Policy (LWP) Checklist		School Nutrition Program Forms
Meal Accommodation Tracking Form		School Nutrition Program Forms
NSLP/SBP Media Release Prototypes		School Nutrition Program Forms
NSLP/SBP Media Release Prototypes (SPANISH)		School Nutrition Program Forms
Medical Statement Sample Form		School Nutrition Program Forms
Micro-Purchase Log		School Nutrition Program Forms
Monthly by Classroom Coded List Form		School Nutrition Program Forms
Onsite Monitoring Form \| Afterschool Care Program (ASCP) and Child and Adult Care Food Program At-Risk (CACFP At-Risk)		School Nutrition Program Forms
Onsite Monitoring Form \| Community Eligibility Provision (CEP)		School Nutrition Program Forms
Onsite Monitoring Form \| National School Lunch Program (NSLP)		School Nutrition Program Forms
Onsite Monitoring Form \| Provision 2 (P2) Year 2 and Following Years		School Nutrition Program Forms
Onsite Monitoring Form \| School Breakfast Program (SBP)		School Nutrition Program Forms
Onsite Monitoring Form \| Seamless Summer Option (SSO)		School Nutrition Program Forms
Payee Change Request	74-157	School Nutrition Program Forms
Permanent Agreement Contracting Entity Specific Amendment - Name		School Nutrition Program Forms
Permanent Agreement Contracting Entity Specific Amendment - Programs		School Nutrition Program Forms
Physical Inventory of Food Purchased Form		School Nutrition Program Forms
Pre-Award Civil Rights Compliance Review		School Nutrition Program Forms
Product Formulation Statement for Fruit Products – Sample Template		School Nutrition Program Forms
Product Formulation Statement for Grains 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 Vegetable Products – Sample Template		School Nutrition Program 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.