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
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 H1534 Download File Download File CACFP - Day Care Home
Documentation of Meals Claimed - At-Risk H1540-AT Download File Download File CACFP - At-Risk Afterschool
Excess Net Cash Resources Plan for CACFP/SFSP Download File CACFP - Adult Day Care
Excess Net Cash Resources Plan for CACFP/SFSP Download File CACFP - At-Risk Afterschool
Excess Net Cash Resources Plan for CACFP/SFSP Download File CACFP - Child Care Center
Excess Net Cash Resources Plan for CACFP/SFSP Download File CACFP - Day Care Home
F&N Complaint Form - English Download File Download File CACFP - Adult Day Care
F&N Complaint Form - English Download File Download File CACFP - At-Risk Afterschool
F&N Complaint Form - English Download File Download File CACFP - Child Care Center
F&N Complaint Form - English Download File Download File CACFP - Day Care Home
F&N Complaint Form - Spanish Download File Download File CACFP - Adult Day Care
F&N Complaint Form - Spanish Download File Download File CACFP - At-Risk Afterschool
F&N Complaint Form - Spanish Download File Download File CACFP - Child Care Center
F&N Complaint Form - Spanish 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
Free and Reduced Price Meal Policy Statement (For Contractors that Charge Separately for Meals) H1667 Download File Download File CACFP - Adult Day Care
Free and Reduced-Priced Meal Policy Statement (For Contractors that Charge Separately for Meals) H4515 Download File CACFP - Child Care Center
Gender Separation Exception Request Form Download File CACFP - Adult Day Care
Gender Separation Exception Request Form Download File CACFP - At-Risk Afterschool
Gender Separation Exception Request Form Download File CACFP - Child Care Center
Gender Separation Exception Request Form Download File CACFP - Day Care Home
Good Cause Transfer Request Form Download File Download File CACFP - Adult Day Care
Good Cause Transfer Request Form Download File Download File CACFP - At-Risk Afterschool
Good Cause Transfer Request Form Download File Download File CACFP - Child Care Center
Good Cause Transfer Request Form Download File 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
Household Contact Download File CACFP - Child Care Center
Household Contact Download File CACFP - Day Care Home
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
List of Eligible Federal/State Funded Assistance Programs (Tier II Day Care Homes) H1660 Download File Download File Download File CACFP - Day Care Home
Micro-Purchase Log Download File Download File CACFP - Adult Day Care
Micro-Purchase Log Download File Download File CACFP - At-Risk Afterschool
Micro-Purchase Log Download File Download File CACFP - Child Care Center
Micro-Purchase Log Download File Download File CACFP - Day Care Home
Milk Flexibility for Emergency Conditions Notification Download File CACFP - At-Risk Afterschool
Milk Flexibility for Emergency Conditions Notification Form Download File CACFP - Adult Day Care
Milk Flexibility for Emergency Conditions Notification Form Download File CACFP - Child Care Center
Milk Flexibility for Emergency Conditions Notification Form Download File CACFP - Day Care Home
Notice to Providers of Tier Determination (Child and Adult Care Food Program-Day Care Homes) H1659 Download File 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
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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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