Administration and Forms for CACFP

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FNS Instruction 796-2 and Tip Sheet

FNS Instruction 796-2 Financial Management - Child and Adult Care Food Program (CACFP)
Tip Sheet - Assessing Costs in the Child and Adult Care Food Program (CACFP)

CACFP Forms

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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 (Child Care) in Spanish		CACFP - Day Care Home
CACFP Meal Benefit Income Eligibility Form Letter to Households - Tier II Day Care Homes		CACFP - Day Care Home
CACFP Meal Benefit Income Eligibility Form Letter to Households - Tier II Day Care Homes - in Spanish		CACFP - Day Care Home
CACFP Meal Benefit Income Eligibility Form Letter to Households (Adult Day Care)		CACFP - Adult Day Care
CACFP Meal Benefit Income Eligibility Form Letter to Households (Adult Day Care) in Spanish		CACFP - Adult Day Care
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 Meal Benefit Income Eligibility Form Letter to Provider - Tier I or Provider's Own Children		CACFP - Day Care Home
CACFP Meal Benefit Income Eligibility Form Letter to Provider Tier I or Provider's Own Children in Spanish		CACFP - Day Care Home
CACFP Medical Statement Form		CACFP - Adult Day Care
CACFP Medical Statement Form		CACFP - At-Risk Afterschool
CACFP Medical Statement Form		CACFP - Child Care Center
CACFP Medical Statement Form		CACFP - Day Care Home
CACFP Serious Deficiency Process Notification Form		CACFP - Adult Day Care
CACFP Serious Deficiency Process Notification Form		CACFP - At-Risk Afterschool
CACFP Serious Deficiency Process Notification Form		CACFP - Child Care Center
CACFP Serious Deficiency Process Notification Form		CACFP - Day Care Home
CACFP Serious Deficiency Process Notification Template Letters		CACFP - Adult Day Care
CACFP Serious Deficiency Process Notification Template Letters		CACFP - At-Risk Afterschool
CACFP Serious Deficiency Process Notification Template Letters		CACFP - Child Care Center
CACFP Serious Deficiency Process Notification Template Letters		CACFP - Day Care Home
CACFP Sponsor Offsite Monitoring Implementation Plan – Program Year 2024-2025		CACFP - Adult Day Care
CACFP Sponsor Offsite Monitoring Implementation Plan – Program Year 2024-2025		CACFP - Child Care Center
CACFP Sponsor Offsite Monitoring Implementation Plan – Program Year 2024-2025		CACFP - Day Care Home
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts	H2048	CACFP - Adult Day Care
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts	H2048	CACFP - At-Risk Afterschool
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts	H2048	CACFP - Child Care Center
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts	H2048	CACFP - Day Care Home
Certification Regarding Federal Lobbying	H2049	CACFP - Adult Day Care
Certification Regarding Federal Lobbying	H2049	CACFP - At-Risk Afterschool
Certification Regarding Federal Lobbying	H2049	CACFP - Child Care Center
Certification Regarding Federal Lobbying	H2049	CACFP - Day Care Home
Child Nutrition Programs Waiver Request		CACFP - Adult Day Care
Child Nutrition Programs Waiver Request		CACFP - At-Risk Afterschool
Child Nutrition Programs Waiver Request		CACFP - Child Care Center
Child Nutrition Programs Waiver Request		CACFP - Day Care Home
Claim for Reimbursement Worksheet - Meals	H4502	CACFP - Adult Day Care
Claim for Reimbursement Worksheet - Meals	H4502	CACFP - At-Risk Afterschool
Claim for Reimbursement Worksheet - Meals	H4502	CACFP - Child Care Center
Contracting Entity Request for Waiver of 15% Limit for Allowable Administrative Costs		CACFP - Adult Day Care
Contracting Entity Request for Waiver of 15% Limit for Allowable Administrative Costs		CACFP - At-Risk Afterschool
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 - At-Risk Afterschool
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 - Adult Day Care
Daily Meal Count and Attendance Record (Centers and Emergency Shelters)	H1535	CACFP - Child Care Center
Daily Meal Count, Attendance, and Meal Production Record (H1539)	H1539	CACFP - Day Care Home
Daily Meal Production Record - Adult Day Care	H1654	CACFP - Adult Day Care
Daily Meal Production Record - Child Care	H1530	CACFP - At-Risk Afterschool

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, 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.

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