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
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
Annual Audit AUDIT Download File Download File CACFP - At-Risk Afterschool
Application for Texas Identification Number AP-152 Download File CACFP - At-Risk Afterschool
Building for the Future - Black and White Download File CACFP - At-Risk Afterschool
Building for the Future - Color Download File CACFP - At-Risk Afterschool
CACFP - Centers Claim for Reimbursement - Site Level Download File 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 - At-Risk Afterschool
CACFP Medical Statement Form 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 - At-Risk Afterschool
Certification Regarding Federal Lobbying H2049 Download File Download File CACFP - At-Risk Afterschool
Child Nutrition Programs Waiver Request Download File Download File CACFP - At-Risk Afterschool
Claim for Reimbursement Worksheet - Meals H4502 Download File Download File Download File CACFP - At-Risk Afterschool
Contracting Entity Request for Waiver of 15% Limit for Allowable Administrative Costs Download File CACFP - At-Risk Afterschool
Daily Meal Count and Attendance Record (At-Risk) H1535-AT Download File Download File CACFP - At-Risk Afterschool
Daily Meal Production Record - Child Care H1530 Download File Download File CACFP - At-Risk Afterschool
Direct Deposit Authorization 74-176 Download File CACFP - At-Risk Afterschool
Documentation of Meals Claimed - At-Risk H1540-AT Download File Download File CACFP - At-Risk Afterschool
F&N Complaint Form - English Download File Download File CACFP - At-Risk Afterschool
F&N Complaint Form - Spanish Download File Download File CACFP - At-Risk Afterschool
Food Service Management Company/Vendor Monitor Review H1529 Download File Download File Download File CACFP - At-Risk Afterschool
Gender Separation Exception Request Form Download File CACFP - At-Risk Afterschool
Governing Body Awareness GBA Download File Download File CACFP - At-Risk Afterschool
Payee Change Request 74-157 Download File CACFP - At-Risk Afterschool
Performance Bond BOND Download File CACFP - At-Risk Afterschool
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 - Sponsoring Organization Provides Meals/Snacks Download File Download File Download File CACFP - At-Risk Afterschool
Permanent Agreement Contracting Entity Specific Amendment - Name Download File CACFP - At-Risk Afterschool
Permanent Agreement Contracting Entity Specific Amendment - Programs Download File CACFP - At-Risk Afterschool
Pre-Approval Visit H1606-AT-P Download File Download File CACFP - At-Risk Afterschool
Pre-Award Civil Rights Compliance Review Download File Download File CACFP - At-Risk Afterschool
Racial/Ethnic Participant Data Collection Prototype Download File Download File CACFP - At-Risk Afterschool
Record of Leftover/Recycled Food H1568 Download File Download File CACFP - At-Risk Afterschool
Review H1606-AT 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
Sponsoring Organization Disbursement Record H4503 Download File Download File Download File CACFP - At-Risk Afterschool
Texas Department of Agriculture Food and Nutrition Division Permanent Agreement Download File CACFP - At-Risk Afterschool
Milk Flexibility for Emergency Conditions Notification Download File CACFP - At-Risk Afterschool
Good Cause Transfer Request Form Download File Download File CACFP - At-Risk Afterschool
Micro-Purchase Log Download File Download File CACFP - At-Risk Afterschool
Valid At-Risk Unaffiliated Site Questionnaire/Attestation Download File Download File CACFP - At-Risk Afterschool
Small Purchase Log Download File 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
2022-2023 WIC Information English and Spanish WIC Download File CACFP - Child Care Center
2025 Income Eligibility Guidelines for Determining Free and Reduced Price Benefits H1625-A Download File CACFP - Child Care Center
2023-2024 WIC Information English and Spanish WIC 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
Addendum - Option to Renew IFB and Contract for Purchased Meals CCC & DCH IFB - RENEW CCC & DCH Download File Download File CACFP - Child Care Center
Amendment 1 to Permanent Agreement Between Sponsoring Organization and Child Care Site AMEND 1 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/USDA-OASCR%20P-Complaint-Form-0508-0002-508-11-28-17Fax2Mail.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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