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
Daily Meal Production Record - Adult Day Care	H1654	CACFP - Adult Day Care
Daily Meal Production Record - Child Care	H1530	CACFP - At-Risk Afterschool
Daily Meal Production Record - Child Care	H1530	CACFP - Child Care Center
Daily Meal Production Record - Infants	H1530-A	CACFP - Child Care Center
Daily Meal Production Record - Infants	H1530-A	CACFP - Day Care Home
Direct Deposit Authorization	74-176	CACFP - Adult Day Care
Direct Deposit Authorization	74-176	CACFP - At-Risk Afterschool
Direct Deposit Authorization	74-176	CACFP - Child Care Center
Direct Deposit Authorization	74-176	CACFP - Day Care Home
Documentation of Meals Claimed	H1540	CACFP - Adult Day Care
Documentation of Meals Claimed	H1540	CACFP - Child Care Center
Documentation of Meals Claimed	H1534	CACFP - Day Care Home
Documentation of Meals Claimed - At-Risk	H1540-AT	CACFP - At-Risk Afterschool
Excess Net Cash Resources Plan for CACFP/SFSP		CACFP - Adult Day Care
Excess Net Cash Resources Plan for CACFP/SFSP		CACFP - At-Risk Afterschool
Excess Net Cash Resources Plan for CACFP/SFSP		CACFP - Child Care Center
Excess Net Cash Resources Plan for CACFP/SFSP		CACFP - Day Care Home
F&N Complaint Form - English		CACFP - Adult Day Care
F&N Complaint Form - English		CACFP - At-Risk Afterschool
F&N Complaint Form - English		CACFP - Child Care Center
F&N Complaint Form - English		CACFP - Day Care Home
F&N Complaint Form - Spanish		CACFP - Adult Day Care
F&N Complaint Form - Spanish		CACFP - At-Risk Afterschool
F&N Complaint Form - Spanish		CACFP - Child Care Center
F&N Complaint Form - Spanish		CACFP - Day Care Home
Food Service Management Company/Vendor Monitor Review	H1529	CACFP - Adult Day Care
Food Service Management Company/Vendor Monitor Review	H1529	CACFP - At-Risk Afterschool
Food Service Management Company/Vendor Monitor Review	H1529	CACFP - Child Care Center
Free and Reduced Price Meal Policy Statement (For Contractors that Charge Separately for Meals)	H1667	CACFP - Adult Day Care
Free and Reduced-Priced Meal Policy Statement (For Contractors that Charge Separately for Meals)	H4515	CACFP - Child Care Center
Good Cause Transfer Request Form		CACFP - Adult Day Care
Good Cause Transfer Request Form		CACFP - At-Risk Afterschool
Good Cause Transfer Request Form		CACFP - Child Care Center
Good Cause Transfer Request Form		CACFP - Day Care Home
Governing Body Awareness	GBA	CACFP - Adult Day Care
Governing Body Awareness	GBA	CACFP - At-Risk Afterschool
Governing Body Awareness	GBA	CACFP - Child Care Center
Governing Body Awareness	GBA	CACFP - Day Care Home
Household Contact		CACFP - Child Care Center
Household Contact		CACFP - Day Care Home
Invitation for Bid and Contract for Purchased Meals	IFB - ADC	CACFP - Adult Day Care
Letter of Determination - Pricing Programs	H1663	CACFP - Adult Day Care
List of Eligible Federal/State Funded Assistance Programs (Tier II Day Care Homes)	H1660	CACFP - Day Care Home
Male/Female Separation Exception Request Form		CACFP - Adult Day Care
Male/Female Separation Exception Request Form		CACFP - At-Risk Afterschool
Male/Female Separation Exception Request Form		CACFP - Child Care Center
Male/Female Separation Exception Request Form		CACFP - Day Care Home
Micro-Purchase Log		CACFP - Adult Day Care
Micro-Purchase Log		CACFP - At-Risk Afterschool
Micro-Purchase Log		CACFP - Child Care Center

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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