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
Valid At-Risk Unaffiliated Site Questionnaire/Attestation Download File Download File CACFP - At-Risk Afterschool
Texas Department of Agriculture Food and Nutrition Division Permanent Agreement Download File CACFP - Adult Day Care
Texas Department of Agriculture Food and Nutrition Division Permanent Agreement Download File CACFP - At-Risk Afterschool
Texas Department of Agriculture Food and Nutrition Division Permanent Agreement Download File CACFP - Child Care Center
Texas Department of Agriculture Food and Nutrition Division Permanent Agreement Download File CACFP - Day Care Home
Start Up or Expansion Payments Application Download File Download File CACFP - Day Care Home
Start Up or Expansion Payments Agreement Download File CACFP - Day Care Home
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
Small Purchase Log Download File Download File CACFP - Adult Day Care
Small Purchase Log Download File Download File CACFP - At-Risk Afterschool
Small Purchase Log Download File Download File CACFP - Child Care Center
Small Purchase Log Download File Download File CACFP - Day Care Home
Shared Eligibility Form Download File Download File CACFP - Child Care Center
Shared Eligibility Form Download File Download File CACFP - Day Care Home
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
Review H1602 Download File Download File CACFP - Adult Day Care
Review H1606-AT Download File Download File CACFP - At-Risk Afterschool
Review H1606 Download File Download File CACFP - Child Care Center
Review H1607 Download File Download File CACFP - Day Care Home
Record of Leftover/Recycled Food H1568 Download File Download File CACFP - Adult Day Care
Record of Leftover/Recycled Food H1568 Download File Download File CACFP - At-Risk Afterschool
Record of Leftover/Recycled Food H1568 Download File Download File CACFP - Child Care Center
Record of Leftover/Recycled Food H1568 Download File Download File CACFP - Day Care Home
Racial/Ethnic Participant Data Collection Prototype Download File Download File CACFP - Adult Day Care
Racial/Ethnic Participant Data Collection Prototype Download File Download File CACFP - At-Risk Afterschool
Racial/Ethnic Participant Data Collection Prototype Download File Download File CACFP - Child Care Center
Racial/Ethnic Participant Data Collection Prototype Download File Download File CACFP - Day Care Home
Pre-Award Civil Rights Compliance Review Download File Download File CACFP - Adult Day Care
Pre-Award Civil Rights Compliance Review Download File Download File CACFP - At-Risk Afterschool
Pre-Award Civil Rights Compliance Review Download File Download File CACFP - Child Care Center
Pre-Award Civil Rights Compliance Review Download File Download File CACFP - Day Care Home
Pre-Approval Visit H1602-P Download File Download File CACFP - Adult Day Care
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
Pre-Approval Visit H1607-P Download File Download File CACFP - Day Care Home
Permanent Agreement Contracting Entity Specific Amendment - Programs Download File CACFP - Adult Day Care
Permanent Agreement Contracting Entity Specific Amendment - Programs Download File CACFP - At-Risk Afterschool
Permanent Agreement Contracting Entity Specific Amendment - Programs Download File CACFP - Child Care Center
Permanent Agreement Contracting Entity Specific Amendment - Programs Download File CACFP - Day Care Home
Permanent Agreement Contracting Entity Specific Amendment - Name Download File CACFP - Adult Day Care
Permanent Agreement Contracting Entity Specific Amendment - Name Download File CACFP - At-Risk Afterschool
Permanent Agreement Contracting Entity Specific Amendment - Name Download File CACFP - Child Care Center
Permanent Agreement Contracting Entity Specific Amendment - Name Download File CACFP - Day Care Home
Permanent Agreement Between Sponsoring Organization and Day Care Home Provider(s) Download File Download File Download File CACFP - Day Care Home
Permanent Agreement Between Sponsoring Organization and Child Care Site - Sponsoring Organization Provides Meals/Snacks Download File Download File Download File CACFP - At-Risk Afterschool
Permanent Agreement Between Sponsoring Organization and Child Care Site - Sponsoring Organization Provides Meals/Snacks Download File Download File Download File CACFP - Child Care Center
Permanent Agreement Between Sponsoring Organization and Child Care Site Download File Download File Download File CACFP - At-Risk Afterschool
Permanent Agreement Between Sponsoring Organization and Child Care Site Download File Download File 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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