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
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
Child Nutrition Programs Waiver Request Download File Download File CACFP - Child Care Center
Contracting Entity Request for Waiver of 15% Limit for Allowable Administrative Costs Download File CACFP - Child Care Center
F&N Complaint Form - English Download File Download File CACFP - Child Care Center
F&N Complaint Form - Spanish Download File Download File CACFP - Child Care Center
Gender Separation Exception Request Form Download File CACFP - Child Care Center
Household Contact Download File CACFP - Child Care Center
Permanent Agreement Between Sponsoring Organization and Child Care Site Download File Download File Download File CACFP - Child Care Center
Permanent Agreement Between Sponsoring Organization and Child Care Site - Sponsoring Organization Provides Meals/Snacks Download File Download File Download File CACFP - Child Care Center
Permanent Agreement Contracting Entity Specific Amendment - Name Download File CACFP - Child Care Center
Permanent Agreement Contracting Entity Specific Amendment - Programs Download File CACFP - Child Care Center
Pre-Award Civil Rights Compliance Review Download File Download File CACFP - Child Care Center
Racial/Ethnic Participant Data Collection Prototype Download File Download File CACFP - Child Care Center
Shared Eligibility Form Download File Download File CACFP - Child Care Center
Texas Department of Agriculture Food and Nutrition Division Permanent Agreement Download File CACFP - Child Care Center
Milk Flexibility for Emergency Conditions Notification Form Download File CACFP - Child Care Center
Good Cause Transfer Request Form Download File Download File CACFP - Child Care Center
Micro-Purchase Log Download File Download File CACFP - Child Care Center
Small Purchase Log Download File Download File CACFP - Child Care Center
Excess Net Cash Resources Plan for CACFP/SFSP Download File CACFP - Child Care Center
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 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 Medical Statement Form Download File Download File CACFP - Day Care Home
Child Nutrition Programs Waiver Request Download File Download File CACFP - Day Care Home
F&N Complaint Form - English Download File Download File CACFP - Day Care Home
F&N Complaint Form - Spanish Download File Download File CACFP - Day Care Home
Gender Separation Exception Request Form Download File CACFP - Day Care Home
Household Contact Download File CACFP - Day Care Home
Permanent Agreement Between Sponsoring Organization and Day Care Home Provider(s) Download File Download File Download File CACFP - Day Care Home
Permanent Agreement Contracting Entity Specific Amendment - Name Download File CACFP - Day Care Home
Permanent Agreement Contracting Entity Specific Amendment - Programs Download File CACFP - Day Care Home
Pre-Award Civil Rights Compliance Review Download File Download File CACFP - Day Care Home
Racial/Ethnic Participant Data Collection Prototype Download File Download File CACFP - Day Care Home
Shared Eligibility Form Download File Download File CACFP - Day Care Home
Start Up or Expansion Payments Agreement Download File CACFP - Day Care Home
Start Up or Expansion Payments Application Download File Download File CACFP - Day Care Home
Texas Department of Agriculture Food and Nutrition Division Permanent Agreement Download File CACFP - Day Care Home
Milk Flexibility for Emergency Conditions Notification Form Download File CACFP - Day Care Home
Good Cause Transfer Request Form Download File Download File CACFP - Day Care Home
Micro-Purchase Log Download File Download File CACFP - Day Care Home
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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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