CACFP General Forms
Claims, Corrective Actions, Meal Documentation, Recordkeeping, Sponsoring Organization Documents, Sponsoring Organization Review Tools, and Closeout Documents
Tab/Accordion Items
- Claim Submission 60-Day Deadlines 2024
- Supplier Electronic Payment Form for CACFP
- Monthly Claim Form and Instructions - Independent Centers - Child or Adult Centers
- Monthly Claim Form and Instructions - Sponsored Adult Care Centers
- Monthly Claim Form and Instruction - Sponsored Child Care - At Risk Center
- Monthly Claim Form and Instruction - Sponsored Child Center
- Monthly Claim Form and Instruction - Sponsored Day Care Home
Catered Meals
Donated or Harvested Food
Meal Counts and Monthly Summaries
- At-Risk Afterschool Daily Roster and Meal Count Worksheet
- CACFP Daily Meal Count - 5 Day
- CACFP Daily Meal Count - 5 Day with Monthly Totals
- CACFP Daily Meal Count - 7 Day
- CACFP Daily Meal Count - 7 Day with Monthly Totals
- CACFP Daily Meal Count - Adult Day Care Centers
- Monthly Meal Count Summary - At-Risk Afterschool
- Monthly Meal Count Summary - Children
- Monthly Meal Count Summary - Sponsoring Organizations
Medical Statement
Budget
Ethnic and Racial Data Collection
Monthly Checklists and Worksheets
- At-Risk Afterschool Monthly Meal Summary Record
- Free Reduced Paid Monthly Worksheet
- Monthly Meal Count Summary - Children
- Monthly Meal Count Summary - Sponsoring Organizations
- Monthly Totals for Free, Reduced, and Denied Classification
Time Sheets
Training Documentation
- Add Drop Change Form
- Adding an Affiliated Facility
- Administrative Review Appeal Procedures for Sponsoring Organizations of Day Care Homes
- Administrative Review Policy and Procedures of Day Care Home Providers
- Application Process Checklist for Adding New Providers/Centers
- Corrective Action Document
- Facility Pre-Qualification Application Form
- New Providers Checklist - SOs of Unaffiliated Centers
- Preoperational Site Visit Form
- Report of Disqualification from Participation FDCH
- Sample Notices/Prototypes
- Index of Sample Notices
- Prototype 15: Notice of Serious Deficiency Notice for Providers
- Prototype 16: Notice of Successful Corrective Action and Temporary (Deferment of Serious Deficiency for Providers)
- Prototype 17: Notice of Proposed Termination and Proposed Disqualification for Providers
- Prototype 18: Notice of Termination and Disqualification for Providers (Provider does not appeal)
- Prototype 19: Notice Termination and Disqualification for Provider (After sponsoring organization wins appeal/prevails/is upheld)
- Prototype 20: Notice of Temporary Deferment of Serious Deficiency and Proposed Termination and Disqualification for Providers (After provider wins appeal/prevails/is upheld)
- Prototype 21: Notice of Serious Deficiency, Suspension, and Proposed Termination and Disqualification for Providers (Combined notice, health threat)
- Prototype 22: Notice of Termination and Disqualification - Suspension for Providers (Provider does not appeal)
- Prototype 23: Notice of Termination and Disqualification for DCHs (Imminent threat to health or safety, after sponsoring organization wins appeal/prevails/is upheld)
- Prototype 24: Notice of Temporary Deferment of Serious Deficiency, Suspension, Proposed Termination and Proposed Disqualification for Providers (Health threat, after provider wins appeal/prevails/is upheld)