Policy Memo 149C

DOH-CACFP: Number 149C (10/10)

TO: CACFP Sponsors of Day Care Centers

FROM: Lynne Oudekerk, State Director, Child and Adult Care Food Program

SUBJECT: Claim for Reimbursement - Revised Form (DOH-3703)

I. Purpose and Scope

The Child and Adult Care Food Program has contracted with Colyar Consulting Group to develop an internet-based Sponsor management and payment system which will allow CACFP Sponsors to submit monthly claims via the internet. The new system is called CIPS - CACFP Information and Payment System. CIPS is in the final stages of development and we expect that Sponsors will be brought online early in 2011. Sponsors that do not have internet access may continue to complete and mail the paper Claim for Reimbursement.

II. Background Information

CACFP has re-designed the Claim for Reimbursement for Sponsors of Day Care Centers (DOH-3703) to speed the entry of claim data into CIPS. Beginning with your October 2010 claim, please use the enclosed form to submit your claims for reimbursement. In the future, Sponsors will be able to enter their claim data into CIPS using screens that follow this general format. The new form looks very different from the previous version because:

  1. It was designed to be completed from top to bottom rather than from left to right. Instead of entering the information about each center horizontally across a row, it is entered vertically down a column.
  2. It reports claim data for three centers, instead of six, on one form. If you have more than three centers, use additional pages.
  3. It does not require you to report Average Daily Attendance. Instead, you report the Total Attendance. The attached example shows how to determine the Total Attendance and where to report it on the claim.

III. Summary of Changes

The instructions for completing the claim form are printed on the back of the DOH-3703. If you have any questions about the new claim form please call 1-800-942-3858, ext. 27103 and ask to speak with your Calculations Clerk.

Additional copies of the claim form may be obtained by contacting CACFP at 1-800-942-3858, ext. 27262 or by e-mail at cacfp@health.state.ny.us. The forms may also be photocopied or downloaded from www.health.ny.gov/nutrition. In order for the form to print correctly, you must download the free Adobe reader, if you do not already have it. Please dispose of existing copies of the old claim form.


Claim for Reimbursement for Sponsors of Day Care Centers (DOH-3703)

How to Determine the Total Attendance