Day Care Homes
(All Brochures, Forms, Informational Charts, and Sample Menus are available below in PDF Format or may be requested by contacting the Child and Adult Care Food Program at our Toll Free Number: 1-800-942-3858). To view or print PDF Documents, Adobe Acrobat Reader must be installed on your computer.
Brochures
- Building For the Future - Notification to parents about CACFP and its Benefits
- (English) (PDF, 371KB, 2pg.)
- (Spanish Version) (PDF, 357KB 2pg.)
- (Arabic Version) (PDF, 308KB, 2pg.)
- (Bengali Version) (PDF, 327KB, 2pg.)
- (Bosnian) (PDF, 442KB, 2pg.)
- (Chinese Version) (PDF, 314KB, 2pg.)
- (French Version) (PDF, 375KB, 2pg.)
- (Haitian Creole Version) (PDF, 374KB, 2pg.)
- (Hebrew Version) (PDF, 295KB, 2pg.)
- (Hmong Version) (PDF, 381KB, 2pg.)
- (Japanese Version) (PDF, 326KB, 2pg.)
- (Karen) (PDF, 319KB, 2pg.)
- (Khmer Version) (PDF, 321KB, 2pg.)
- (Lao Version) (PDF, 308KB, 2pg.)
- (Maay Maay) (PDF, 351KB, 2pg.)
- (Portuguese Version) (PDF, 377KB, 2pg.)
- (Russian Version) (PDF, 335KB, 2pg.)
- (Thai Version) (PDF, 322KB, 2pg.)
- (Vietnamese Version) (PDF, 321KB, 2pg.)
- (Yiddish Version) (PDF, 321KB, 2pg.)
- Funding to Feed Children - County Outreach Flyer
- Good Nutrition Pays in Day Care Homes (CACFP-4364) (PDF, 1.64MB, 2pg.)
- Homes Outreach Advertisement (Large) (PDF, 84.8KB, 1pg.)
- Homes Outreach Advertisement (Smaller Sizes) (PDF, 5.78MB, 1pg.)
Forms
- Account Request for HCS (DOH-5039) (PDF, 34KB, 1pg.)
- Download Account Request for HCS (DOH-5039) (RTF, 1.27MB, 1pg.)
- Agreement Between the State and Sponsoring Organizations of Day Care Homes (DOH-3841) (PDF, 634KB, 2pg.)
- Annual Update of CACFP Manual for Sponsoring Organizations of Day Care Homes (CACFP-3979H) (PDF, 123KB, 2pg.)
- Download CACFP-3979H (RTF, 131MB, 2pg)
- Application for Close Out Payments for Sponsoring Organizations of Day Care Homes (DOH-5063) PDF FILL-IN FORMAT (PDF, 856KB, 4pg.)
- Download (DOH-5063) (RTF, 1.38MB, 4pg.)
- Authorization for Online Health Commerce System (HCS) Account Creation (CACFP-179) (PDF, 33.8KB, 1pg.)
- Download Authorization (CACFP-179) (RTF, 1.27MB, 1pg.)
- Board of Directors (CACFP-4217) PDF FILL-IN FORMAT (PDF, 270KB, 2pg.)
- Download Board of Directors (CACFP-4217) (RTF, 801KB, 2pg.)
- Certificate of Authority Form (CACFP-3671H) PDF FILL-IN FORMAT (PDF, 44KB, 2pg.)
- Download CACFP-3671H (RTF, 1.28MB, 2pg.)
- Child Enrollment Form for Day Care Homes (DOH-4419) (PDF, 260KB, 1pg.)
- Download DOH-4419 (RTF, 703KB, 1pg.)
- Child Meal Disallowance (CACFP-172) (PDF, 74KB, 1pg.)
- Download CACFP-172 (RTF, 685KB, 1pg.)
- Spanish Version CACFP-172es (PDF, 74KB, 1pg.)
- Download Spanish Version CACFP-172es (RTF, 677KB, 1pg.)
- Child Meal Disallowance - Regular (CACFP-173) (PDF, 67KB, 1pg.)
- Download CACFP-173 (RTF, 683KB, 1pg.)
- Spanish Version CACFP-173es (PDF, 68KB, 1pg.)
- Download Spanish Version CACFP-173es (RTF, 675KB, 1pg.)
- Continuous Application and Agreement for Day Care Home Participation (CACFP-3705) (PDF, 87KB, 2pg.)
- Download CACFP-3705 (RTF, 940KB, 2pg.)
- Spanish Version of DOH-3705 (PDF, 95KB, 2pg.)
- Download Spanish Version of DOH-3705 (RTF, 1.00MB, 2pg.)
- Day Care Home Menu (CACFP-171) (PDF, 104KB, 1pg.)
- Download CACFP-171 (RTF, 822KB, 1pg.)
- Spanish Version of CACFP-171es (PDF, 227KB, 1pg.)
- Download Spanish Version of CACFP-171es (RTF, 826KB,1pg.)
- Expansion Grant Application with Instructions - Homes (DOH-3805) PDF FILL-IN FORMAT (PDF, 156KB, 13pg.)
- Download DOH-3805 (RTF, 5.03MB, 13pg.)
- Income Eligibility Guidelines - Provider Eligibility for Tier 1, Provider's Own, Foster Children and Participant Eligibility in Tier 2 Homes (CACFP-3977) (PDF, 28KB, 1pg.)
- Letter to Households - Income Eligibility Form Tier II Day Care Home Participant (DOH-4160) (PDF, 328KB, 4pg.)
- Download DOH4160 (RTF, 1.38MB, 4pg.)
- Versión en español (PDF, 64KB, 4pg.)
- Descargar versión en español (RTF, 2.58MB, 4pg.)
- Russian DOH-4160ru (PDF, 171KB, 4pg.)
- Download Russian DOH-4160ru (RTF, 1.41MB, 4pg.)
- Chinese DOH-4160zh (PDF, 273KB, 4pg.)
- Download Chinese DOH-4160zh (RTF, 2.65MB, 4pg.)
- Letter to Households - Income Eligibility Form Family Day Care Home Provider (DOH-4161) (PDF, 242KB, 4pg.)
- Download DOH4161 (RTF, 1.37MB, 4pg.)
- Versión en español (PDF, 65KB, 4pg.)
- Descargar versión en español (RTF, 3.92MB, 4pg.)
- Russian DOH-4161ru (PDF, 164KB, 4pg.)
- Download Russian DOH-4161ru (RTF, 4.09MB, 4pg.)
- Chinese DOH-4161zh (PDF, 319KB, 4pg.)
- Download Chinese DOH-4161zh (RTF, 21.5MB, 4pg.)
- Monitor Check List for Day Care Homes with Instructions (CACFP-4118) (PDF, 96KB, 2pg.)
- Download CACFP-4118 (RTF, 853KB, 2pg.)
- On-Site Provider Addendum (CACFP-160) (PDF, 74KB, 2pg.)
- Download CACFP-160 (RTF, 822KB, 2pg.)
- Order Form for CACFP Day Care Homes (CACFP-3978) PDF FILL-IN FORMAT (PDF, 388KB, 2pg.)
- Download CACFP-3978 (RTF, 854KB, 2pg.)
- Outside Employment Policy - Sample
- Download Outside Employment Policy (RTF, 12.7KB, 1pg.)
- Pre-Approval Checklist for Enrolled Caregivers and Day Care Home Providers (CACFP-106) (PDF, 78KB, 1pg.)
- Provider Transfer Form (DOH-4219) (PDF, 264KB, 1pg.)
- Download Provider Transfer Form (DOH-4219) (RTF, 679KB, 1pg.)
- Reimbursement Rates For Day Care Homes (CACFP-124H) (PDF, 36KB, 1pg.)
- Serious Deficiency Process for Providers - Handouts (English and Versión en español)
Sample letters may be downloaded and are also available on CD or diskette by request. - Suspension Handouts - Providers (English and Versión en español)
Sample letters may be downloaded and are also available on CD or diskette by request.
Informational Charts and Guides
- 60/90 Day Claims Submission Calendar (PDF, 42KB, 2pg.)
- 2010 Census Data for New York State (PDF, 64KB, 2pg.)
- Crediting Foods in CACFP (PDF, 1.96MB, 56pg.)
- FNS Core Nutrition Messages
USDA - Food and Nutrition Service (FNS), provides nutrition messages designed to deliver consistent and accurate information to help develop healthy eating patterns in young children. - Healthy Child Meal Pattern (CACFP-102) (PDF, 229KB, 1pg.)
- Arabic Version (PDF, 592KB, 1pg.)
- Chinese Version (PDF, 392KB, 1pg.)
- Haitian-Creole Version (PDF, 225KB, 1pg.)
- Korean Version (PDF, 102KB, 1pg.)
- Russian Version (PDF, 444KB, 1pg.)
- Spanish Version (PDF, 226KB, 1pg.)
- Healthy Child Meal Pattern Requirements and Recommendations (CACFP-178) (PDF, 103KB, 2pg.)
- Healthy Infant Meal Pattern (CACFP-103) (PDF, 287KB, 1pg.)
- Arabic Version (PDF, 589KB, 1pg.)
- Chinese Version (PDF, 315KB, 1pg.)
- Haitian-Creole Version (PDF, 221KB, 1pg.)
- Korean Version (PDF, 276KB, 1pg.)
- Russian Version (PDF, 443KB, 1pg.)
- Spanish Version (PDF, 221KB, 1pg.)
- Tier 1 Eligible Public Schools Outside of NYC - March 2012 (PDF, 762KB, 93pg.)
- Tier 1 Eligible Public Schools in NYC - March 2012 (PDF, 532KB, 32pg.)
- Zip Code Areas Served - Listing by Family Day Care Home Sponsor (PDF, 382KB, 88pg.)
Sample Menus
- Sample Child Care Menus (CACFP-182) (PDF, 533KB, 5pg.)
- Sample Infant Lunch Menus (CACFP-109) (PDF, 100KB, 1pg.)
- Sample Menus (CACFP-107) (PDF, 92KB, 1pg.)
