Policy Memo 166

DOH-CACFP: Number 166 (04/13), Supersedes Number 115 (10/07)

TO: CACFP Sponsoring Organizations of Day Care Homes

FROM: Sandra J. Rhoades, Director, CACFP Homes Administration, Obesity Prevention and Outreach

SUBJECT: Requirement for Collection of Annual Enrollment Forms; Forms are Now Available from the State

I. Purpose and Scope

The purpose of this memorandum is to remind Sponsoring Organizations of Day Care Homes (Sponsors) of the requirement to collect annual enrollment information for each child in child care homes. This may be accomplished through the use of a CACFP-issued form or a Sponsor-developed form that meets the requirements.

II. Background Information

  1. The requirement to collect annual enrollment information was contained in the 2nd interim federal regulations governing CACFP that was published on September 1, 2004. CACFP Sponsors received a copy of the interim rule in conjunction with Sponsors Policy Memo DOH-CACFP Number 101H (1/05), CACFP 2nd Interim Federal Regulations: Improving Management and Program Integrity. The effective date for this change was September 30, 2005.
  2. The enrollment form to be used by Sponsors must meet the following criteria:
    1. It must be completed, signed and dated by the child's parent or legal guardian.
    2. It must include information on the child's normal days and hours of care, as well as the normal meals received while in care.
    3. A new enrollment form must be completed annually.
  3. CACFP developed a sample enrollment form (DOH-4419) for use by Sponsors and recently printed it as a 2-part NCR form. Please refer to the attached sample and order quantities as needed for your program operations.
  4. Remember, children who are missing current enrollment forms are not payable and cannot be included on the Provider's monthly claim.
  5. CACFP recommends Sponsors develop a process for tracking the receipt and expiration of enrollment forms. For users of CIPS, Report 10501 can be used to identify children with expiring enrollment dates. It is important that monthly changes in enrollment information, such as changes in the days or hours of care, or added and dropped children, are updated in CIPS. Updating the system will enable Sponsors to efficiently track children's enrollment expiration dates.

III. Summary of Changes

All CACFP Sponsors of family day care homes must collect enrollment forms for each child in the care of participating family child care homes. Sponsors must not include children in Providers' claims when annual enrollment forms have not been received by the Sponsor. Sponsors may use the enclosed 2-part NCR form for collection of annual enrollment information. The DOH-4419 form will be translated into Spanish, Russian and simplified Chinese. Other languages may be requested as needed. You may contact a CACFP Homes Unit Nutritionist at 1-800-942-3858, Option 3 if you have further questions about the requirement for annual enrollment information.

Enclosure: DOH-4419, Day Care Home Enrollment Form (03/12)