Documents
For FY2024 (effective starting July 1, 2023)
- Meal Benefit Income Eligibility Form (Adult Care)
- Meal Benefit Income Eligibility Form (Child Care)
- Meal Benefit Income Eligibility Form Family Letter (Adult Care)
- Meal Benefit Income Eligibility Form Family Letter (Child Care)
- Meal Benefit Income Eligibility Form Instructions (Adult Care)
- Meal Benefit Income Eligibility Form Instructions (Child Care)
- Income Eligibility Forms in Other Languages
- FY2024 Meal Benefit Income Eligibility Guidelines
Monthly Attendance Records
- Agreement to Furnish Food Service
- Food Delivery Receipt (age 1-2)
- Food Delivery Receipt (ages 3-5)
- Food Delivery Receipt (ages 6-12)
- Food Donation Tracking
- Food Production Record
- Food Production Record Templates (fillable electronically)
- Infant Feeding Schedule
- Meal Participation Record
- Meal Participation Record Instructions
- Medical Statement to Request Special Meals or Accommodations
- Menu Template
- Milk Calculation Form
- Parent Declines Food Form
- Parent Declines Formula Form
- Supervisory Visits for Centers with Multiple Facilities
Serious Deficiency, Suspension, and Termination Letter Templates for State Agency and Sponsoring Organizations
- Notice of Serious Deficiency Notice for Providers
- Notice of Successful Corrective Action and Temporary Deferment of Serious Deficiency for Provider
- Notice of Proposed Termination and Disqualification for Providers - No Corrective Action Submitted
- Notice of Proposed Termination and Disqualification for Providers - Required Corrective Action Not Acceptable
- Notice of Termination and Disqualification for Providers - Provider does not appeal
- Notice Termination and Disqualification for Provider - Sponsoring Organization prevails in appeal
- Notice of Temporary Deferment of Serious Deficiency and Termination and Disqualification – Provider prevails in appeal
- Termination and Disqualification for Providers - Combined Notice for Imminent Threat to Health and Safety
- Notice of Termination and Disqualification - Suspension, and Proposed Termination and Disqualification - Provider does not appeal
- Notice of Termination and Disqualification - Imminent Threat to Health or Safety after sponsoring organization prevails in appeal
- Notice of Rescission of Suspension, Proposed Termination and Disqualification - Imminent Threat to Health or Safety after provider prevails in appeal
All posters are available by request from the CACFP office.
- Building for the Future
- Federal Relay Service
- Hand Washing
- Justice for All
- Meal Pattern Chart for Children
- Meal Pattern Chart for Adults
- WIC (Current Fiscal Year Guidelines)
Also required to be posted:
- Current and following weeks' menus
- Current license
FY2023 Income Eligibility Information (effective beginning July 1, 2022)
- FY23 Income Eligibility Guidelines by Tier
- Income Eligibility Form (Child Care)
- Tier 1 Income Eligibility Letter to Provider
- Tier 2 Income Eligibility Letter to Households
Forms