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
Small Purchase Log Download File Download File CACFP - Day Care Home
Excess Net Cash Resources Plan for CACFP/SFSP Download File CACFP - Day Care Home
Payee Change Request 74-157 Download File CACFP - Adult Day Care
Payee Change Request 74-157 Download File CACFP - At-Risk Afterschool
Payee Change Request 74-157 Download File CACFP - Child Care Center
Payee Change Request 74-157 Download File CACFP - Day Care Home
Direct Deposit Authorization 74-176 Download File CACFP - Adult Day Care
Direct Deposit Authorization 74-176 Download File CACFP - At-Risk Afterschool
Direct Deposit Authorization 74-176 Download File CACFP - Child Care Center
Direct Deposit Authorization 74-176 Download File CACFP - Day Care Home
Amendment 1 to Permanent Agreement Between Sponsoring Organization and Adult Day Care Site AMEND 1 Download File Download File CACFP - Adult Day Care
Amendment 1 to Permanent Agreement Between Sponsoring Organization and Child Care Site AMEND 1 Download File Download File CACFP - At-Risk Afterschool
Amendment 1 to Permanent Agreement Between Sponsoring Organization and Child Care Site AMEND 1 Download File Download File CACFP - Child Care Center
Amendment 2 to Permanent Agreement Between Sponsoring Organization and Child Care Site AMEND 2 Download File Download File CACFP - At-Risk Afterschool
Amendment 2 to Permanent Agreement Between Sponsoring Organization and Child Care Site - Sponsoring Organization Provides Meals/Snacks AMEND 2 Download File Download File CACFP - At-Risk Afterschool
Application for Texas Identification Number AP-152 Download File CACFP - Adult Day Care
Application for Texas Identification Number AP-152 Download File CACFP - At-Risk Afterschool
Application for Texas Identification Number AP-152 Download File CACFP - Child Care Center
Application for Texas Identification Number AP-152 Download File CACFP - Day Care Home
Annual Audit AUDIT Download File Download File CACFP - Adult Day Care
Annual Audit AUDIT Download File Download File CACFP - At-Risk Afterschool
Annual Audit AUDIT Download File Download File CACFP - Child Care Center
Annual Audit AUDIT Download File Download File CACFP - Day Care Home
Performance Bond BOND Download File CACFP - Adult Day Care
Performance Bond BOND Download File CACFP - At-Risk Afterschool
Performance Bond BOND Download File CACFP - Child Care Center
Performance Bond BOND Download File CACFP - Day Care Home
Governing Body Awareness GBA Download File Download File CACFP - Adult Day Care
Governing Body Awareness GBA Download File Download File CACFP - At-Risk Afterschool
Governing Body Awareness GBA Download File Download File CACFP - Child Care Center
Governing Body Awareness GBA Download File Download File CACFP - Day Care Home
Food Service Management Company/Vendor Monitor Review H1529 Download File Download File Download File CACFP - Adult Day Care
Food Service Management Company/Vendor Monitor Review H1529 Download File Download File Download File CACFP - At-Risk Afterschool
Food Service Management Company/Vendor Monitor Review H1529 Download File Download File Download File CACFP - Child Care Center
Daily Meal Production Record - Child Care H1530 Download File Download File CACFP - At-Risk Afterschool
Daily Meal Production Record - Child Care H1530 Download File Download File CACFP - Child Care Center
Daily Meal Production Record - Infants H1530-A Download File Download File CACFP - Child Care Center
Daily Meal Production Record - Infants H1530-A Download File Download File CACFP - Day Care Home
Documentation of Meals Claimed H1534 Download File Download File CACFP - Day Care Home
Daily Meal Count and Attendance Record (Centers and Emergency Shelters) H1535 Download File Download File CACFP - Adult Day Care
Daily Meal Count and Attendance Record (Centers and Emergency Shelters) H1535 Download File Download File CACFP - Child Care Center
Daily Meal Count and Attendance Record (At-Risk) H1535-AT Download File Download File CACFP - At-Risk Afterschool
Daily Meal Count and Attendance Record (At-Risk) H1535-AT Download File Download File CACFP - Child Care Center
Daily Meal Count, Attendance, and Meal Production Record (H1539) H1539 Download File Download File CACFP - Day Care Home
Documentation of Meals Claimed H1540 Download File Download File CACFP - Adult Day Care
Documentation of Meals Claimed H1540 Download File Download File CACFP - Child Care Center
Documentation of Meals Claimed - At-Risk H1540-AT Download File Download File CACFP - At-Risk Afterschool
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
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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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