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Administration and Forms for CACFP

CACFP - Adult Day Care

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Documentation of Meals Claimed  H1540 Download File  Download File      CACFP - Adult Day Care
F&N Complaint Form - English    Download File    Download File    CACFP - Adult Day Care
F&N Complaint Form - Spanish    Download File    Download File    CACFP - Adult Day Care
Food Service Management Company/Vendor Monitor Review  H1529 Download File  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
Gender Separation Exception Request Form    Download File        CACFP - Adult Day Care
Governing Body Awareness  GBA Download File  Download File      CACFP - Adult Day Care
Invitation for Bid and Contract for Purchased Meals  IFB - ADC Download File  Download File      CACFP - Adult Day Care
Letter of Determination - Pricing Programs  H1663 Download File  Download File      CACFP - Adult Day Care
Payee Change Request  74-157 Download File        CACFP - Adult Day Care
Performance Bond  BOND Download File        CACFP - Adult Day Care
Permanent Agreement Between Sponsoring Organization and Adult Day Care Site    Download File  Download File  Download File    CACFP - Adult Day Care
Permanent Agreement Contracting Entity Specific Amendment - Name    Download File        CACFP - Adult Day Care
Permanent Agreement Contracting Entity Specific Amendment - Programs    Download File        CACFP - Adult Day Care
Pre-Approval Visit  H1602-P Download File  Download File      CACFP - Adult Day Care
Pre-Award Civil Rights Compliance Review    Download File  Download File      CACFP - Adult Day Care
Racial/Ethnic Participant Data Collection Prototype    Download File  Download File      CACFP - Adult Day Care
Record of Leftover/Recycled Food  H1568 Download File  Download File      CACFP - Adult Day Care
Review  H1602 Download File  Download File      CACFP - Adult Day Care
Sponsoring Organization Disbursement Record  H4503 Download File  Download File  Download File    CACFP - Adult Day Care

CACFP - Child Care Center

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2020 - 2021 School Data for Area Eligibility  SCHOOL DATA Download File        CACFP - Child Care Center
2021 - 2022 School Data for Area Eligibility  SCHOOL DATA Download File        CACFP - Child Care Center
2021-2022 WIC Information English and Spanish  WIC Download File        CACFP - Child Care Center
2022 Income Eligibility Guidelines for Determining Free and Reduced-Price Benefits  H1625-A Download File        CACFP - Child Care Center
2022-2023 WIC Information English and Spanish  WIC Download File        CACFP - Child Care Center
2023 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
Annual Audit  AUDIT Download File  Download File      CACFP - Child Care Center
Application for Texas Identification Number  AP-152 Download File        CACFP - Child Care Center
Building for the Future - Black and White    Download File        CACFP - Child Care Center
Building for the Future - Color    Download File        CACFP - Child Care Center
CACFP - Centers Claim for Reimbursement - Site Level    Download File  Download File  Download File    CACFP - Child Care Center
CACFP Infant Feeding Preference    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 - Child Care Center
CACFP Meal Benefit Income Eligibility Form (Child Care)    Download File  Download File      CACFP - Child Care Center
CACFP Meal Benefit Income Eligibility Form (Child Care) in Spanish    Download File  Download File      CACFP - Child Care Center
CACFP Meal Benefit Income Eligibility Form Letter to Households (Child Care Centers)    Download File        CACFP - Child Care Center
CACFP Meal Benefit Income Eligibility Form Letter to Households (Child Care Centers) in Spanish    Download File        CACFP - Child Care Center
CACFP Medical Statement Form    Download File  Download File      CACFP - Child Care Center

CACFP - Day Care Home

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 49 items in 3 pages
2020 - 2021 School Data for Area Eligibility  SCHOOL DATA Download File        CACFP - Day Care Home
2021 - 2022 School Data for Area Eligibility  SCHOOL DATA Download File        CACFP - Day Care Home
2021-2022 WIC Information English and Spanish  WIC Download File        CACFP - Day Care Home
2022 Income Eligibility Guidelines for Determining Free and Reduced-Price Benefits  H1625-A Download File        CACFP - Day Care Home
2022-2023 WIC Information English and Spanish  WIC Download File        CACFP - Day Care Home
2023 Income Eligibility Guidelines for Determining Free and Reduced Price Benefits  H1625-A Download File        CACFP - Day Care Home
Addendum - Option to Renew IFB and Contract for Purchased Meals CCC & DCH  IFB - RENEW CCC & DCH Download File  Download File      CACFP - Day Care Home
Annual Audit  AUDIT Download File  Download File      CACFP - Day Care Home
Application for Texas Identification Number  AP-152 Download File        CACFP - Day Care Home
Building for the Future - Black and White    Download File        CACFP - Day Care Home
Building for the Future - Color    Download File        CACFP - Day Care Home
CACFP - DCH Claim for Reimbursement - Provider Level    Download File  Download File  Download File    CACFP - Day Care Home
CACFP Infant Feeding Preference    Download File  Download File      CACFP - Day Care Home
CACFP Invitation for Bid (IFB) and Contract for Purchased Meals  IFB - CCC AND DCH Download File  Download File      CACFP - Day Care Home
CACFP Meal Benefit Income Eligibility Form (Child Care)    Download File  Download File      CACFP - Day Care Home
CACFP Meal Benefit Income Eligibility Form (Child Care) in Spanish    Download File  Download File      CACFP - Day Care Home
CACFP Meal Benefit Income Eligibility Form Letter to Households - Tier II Day Care Homes    Download File        CACFP - Day Care Home
CACFP Meal Benefit Income Eligibility Form Letter to Households - Tier II Day Care Homes - in Spanish    Download File        CACFP - Day Care Home
CACFP Meal Benefit Income Eligibility Form Letter to Provider - Tier I or Provider's Own Children    Download File        CACFP - Day Care Home
CACFP Meal Benefit Income Eligibility Form Letter to Provider Tier I or Provider's Own Children in Spanish    Download File        CACFP - Day Care Home

CACFP - At-Risk Afterschool

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2020 - 2021 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 - At-Risk Afterschool
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 SFSP & At-Risk  IFB - RENEW SFSP & AT-RISK 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 - At-Risk Afterschool
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

Assistance available in English and Spanish. Please call 877-TEX-MEAL (877-839-6325) for help.

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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