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Form Name	Form Number	Program Name
Policy Statement for Special Milk Program, Attachment B: Milk Count/Collection Procedure(s)		Special Milk Program 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
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
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
Professional Standards Tracking Sheet		School Nutrition Program Forms
Program/Nonprogram Cost and Revenue Proportion Calculation Worksheet		School Nutrition Program Forms
Prototype Letter: Health Department Notification		SFSP Forms
Provision 2 (P2) Feasibility Worksheet		School Nutrition Program Forms
Proxy Form		CSFP Forms
PY23 Sample Size Calculator for Verification		School Nutrition Program 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
Record of Leftover/Recycled Food	H1568	CACFP - Adult Day Care
Record of Leftover/Recycled Food	H1568	CACFP - At-Risk Afterschool
Record of Leftover/Recycled Food	H1568	CACFP - Child Care Center
Record of Leftover/Recycled Food	H1568	CACFP - Day Care Home
Record of Leftover/Recycled Food	H1568	SFSP Forms
Record of Program Expenditures Form		School Nutrition Program Forms
Report of Loss of USDA Foods	H1638	CSFP Forms
Report of Loss of USDA Foods	H1638	FDP Forms
Report of Loss of USDA Foods	H1638	TEFAP Forms
Request for Emergency USDA Foods	H1579	CSFP Forms
Request for Emergency USDA Foods	H1579	FDP Forms
Request for Emergency USDA Foods	H1579	TEFAP Forms
Request to Provide Non-Congregate Feeding during Extreme Heat		SFSP Forms
Review	H1602	CACFP - Adult Day Care
Review	H1606-AT	CACFP - At-Risk Afterschool
Review	H1606	CACFP - Child Care Center
Review	H1607	CACFP - Day Care Home
S/FMNP Farmers' Market, Roadside Stand, and Certification/Issuance Site Information Form	H1420	FMNP Forms
S/FMNP Farmers' Market, Roadside Stand, and Certification/Issuance Site Information Form	H1420	SFMNP Forms
Sample First Two Weeks Site Visit Form		SFSP Forms
Sample Pre-Operational Visit Form		SFSP Forms
Sample Site Review Form - Congregate Site		SFSP Forms
Sample Site Review Form - Non-Congregate/Hybrid Sites		All Program Forms
Sample Site Review Form - Non-Congregate/Hybrid Sites		SFSP 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.