Administration and Forms for CACFP

CACFP Forms

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Form Name Form Number Form Download Form Download (Alternative Format) Instructions Download Program Name
Record of Leftover/Recycled Food H1568 Download File Download File CACFP - Day Care Home
Review H1602 Download File Download File CACFP - Adult Day Care
Pre-Approval Visit H1602-P Download File Download File CACFP - Adult Day Care
Review H1606 Download File Download File CACFP - Child Care Center
Review H1606-AT Download File Download File CACFP - At-Risk Afterschool
Pre-Approval Visit H1606-AT-P Download File Download File CACFP - At-Risk Afterschool
Pre-Approval Visit H1606-P Download File Download File CACFP - Child Care Center
Review H1607 Download File Download File CACFP - Day Care Home
Pre-Approval Visit H1607-P Download File Download File CACFP - Day Care Home
2025 Income Eligibility Guidelines for Determining Free and Reduced Price Benefits H1625-A Download File CACFP - Adult Day Care
2024 Income Eligibility Guidelines for Determining Free and Reduced-Price Benefits H1625-A Download File CACFP - Adult Day Care
2025 Income Eligibility Guidelines for Determining Free and Reduced Price Benefits H1625-A Download File CACFP - Child Care Center
2024 Income Eligibility Guidelines for Determining Free and Reduced-Price Benefits H1625-A Download File CACFP - Child Care Center
2025 Income Eligibility Guidelines for Determining Free and Reduced Price Benefits H1625-A Download File CACFP - Day Care Home
2024 Income Eligibility Guidelines for Determining Free and Reduced-Price Benefits H1625-A Download File CACFP - Day Care Home
Daily Meal Production Record - Adult Day Care H1654 Download File Download File CACFP - Adult Day Care
Notice to Providers of Tier Determination (Child and Adult Care Food Program-Day Care Homes) H1659 Download File Download File CACFP - Day Care Home
List of Eligible Federal/State Funded Assistance Programs (Tier II Day Care Homes) H1660 Download File Download File Download File CACFP - Day Care Home
Letter of Determination - Pricing Programs H1663 Download File Download File CACFP - Adult Day Care
Free and Reduced Price Meal Policy Statement (For Contractors that Charge Separately for Meals) H1667 Download File Download File CACFP - Adult Day Care
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File CACFP - Adult Day Care
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File CACFP - At-Risk Afterschool
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File CACFP - Child Care Center
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts H2048 Download File Download File CACFP - Day Care Home
Certification Regarding Federal Lobbying H2049 Download File Download File CACFP - Adult Day Care
Certification Regarding Federal Lobbying H2049 Download File Download File CACFP - At-Risk Afterschool
Certification Regarding Federal Lobbying H2049 Download File Download File CACFP - Child Care Center
Certification Regarding Federal Lobbying H2049 Download File Download File CACFP - Day Care Home
Claim for Reimbursement Worksheet - Meals H4502 Download File Download File Download File CACFP - Adult Day Care
Claim for Reimbursement Worksheet - Meals H4502 Download File Download File Download File CACFP - At-Risk Afterschool
Claim for Reimbursement Worksheet - Meals H4502 Download File Download File Download File CACFP - Child Care Center
Sponsoring Organization Disbursement Record H4503 Download File Download File Download File CACFP - Adult Day Care
Sponsoring Organization Disbursement Record H4503 Download File Download File Download File CACFP - At-Risk Afterschool
Sponsoring Organization Disbursement Record H4503 Download File Download File Download File CACFP - Child Care Center
Free and Reduced-Priced Meal Policy Statement (For Contractors that Charge Separately for Meals) H4515 Download File CACFP - Child Care Center
Child Care Food Program Collection Procedures H4515-A Download File Download File CACFP - Child Care Center
Invitation for Bid and Contract for Purchased Meals IFB - ADC Download File Download File CACFP - Adult Day Care
CACFP Invitation for Bid (IFB) and Contract for Purchased Meals IFB - CCC AND DCH Download File Download File CACFP - At-Risk Afterschool
CACFP Invitation for Bid (IFB) and Contract for Purchased Meals IFB - CCC AND DCH Download File Download File CACFP - Child Care Center
CACFP Invitation for Bid (IFB) and Contract for Purchased Meals IFB - CCC AND DCH Download File Download File CACFP - Day Care Home
Addendum - Option to Renew IFB and Contract for Purchased Meals ADC IFB - RENEW ADC Download File Download File CACFP - Adult Day Care
Addendum - Option to Renew IFB and Contract for Purchased Meals CCC & DCH IFB - RENEW CCC & DCH Download File Download File CACFP - At-Risk Afterschool
Addendum - Option to Renew IFB and Contract for Purchased Meals CCC & DCH IFB - RENEW CCC & DCH Download File Download File CACFP - Child Care Center
Addendum - Option to Renew IFB and Contract for Purchased Meals CCC & DCH IFB - RENEW CCC & DCH Download File Download File CACFP - Day Care Home
Addendum - Option to Renew IFB and Contract for Purchased Meals SFSP & At-Risk IFB - RENEW SFSP & AT-RISK Download File Download File CACFP - At-Risk Afterschool
SFSP and At-Risk Invitation for Bid (IFB) and Contract for Purchased Meals IFB - SFSP AND AT-RISK Download File Download File CACFP - At-Risk Afterschool
2023 - 2024 School Data for Area Eligibility SCHOOL DATA Download File CACFP - At-Risk Afterschool
2022 - 2023 School Data for Area Eligibility SCHOOL DATA Download File CACFP - At-Risk Afterschool
2021 - 2022 School Data for Area Eligibility SCHOOL DATA Download File CACFP - Child Care Center
2022 - 2023 School Data for Area Eligibility SCHOOL DATA Download File 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/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
This institution is an equal opportunity provider.
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