CACFP Forms
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Order Forms | Meal Pattern and Menu Resources | Brochures and Handouts | Forms and Resources (all) - Centers-only or Homes-onlyOrder Forms
To order a supply of printed forms, shipped to your organization free of charge.
- Order Form for Sponsoring Organizations of Day Care Centers (CACFP-3718) PDF FILL-IN FORMAT (PDF)
- Order Form for Sponsors of Day Care Homes (CACFP-3978) PDF FILL-IN FORMAT (PDF)
Meal Patterns and Menu Resources
Meal pattern, food crediting, and sample menu resources for compliance and menu planning.
- Adult Meal Pattern (Publication No. 1258) - Chart indicating required components and minimum quantities of food for adults in care. (PDF)
- Child Meal Pattern (Publication No. 1259) - Chart indicating required components and minimum quantities of food for children in care between ages 1-18 years old. (PDF)
- Infant Meal Pattern (Publication No. 1260) - Chart indicating required components and minimum quantities of food for infants in care up to their first birthday. (PDF)
- Crediting Foods in CACFP (Publication No. 1377) (PDF)
- Food Buying Guide for Child Nutrition Programs - Team Nutrition USDA Food and Nutrition Service - providing a guide to plan, purchase, prepare and serve nourishing meals.
- Sample Child and Adult Care Menus (CACFP-182) (PDF)
- Sample Infant Menus (CACFP-109) (PDF)
Brochures and Handouts
Publications for outreach to parents, participants, and new day care centers or homes.
- At-risk After-school Snack/Supper Program (Publication No. 4363) (PDF)
- [Spanish]
- Building for the Future (FNS-317) (PDF)- (Notification to parents about CACFP and its benefits.
- Good Nutrition Pays (Publication No. 4359) (PDF)
- Good Nutrition Pays in Day Care Homes (Publication No. 4364) (PDF)
- Together We Can Raise Healthy Children Brochure (Publication No. 4421) (PDF)
Forms and Resources
- Claim Submission Deadlines (CACFP-127) - (for October 2023-September 2024) (PDF)
- Health Commerce System (HCS) Account Request (DOH-5158) PDF FILL-IN FORMAT
- Outside Employment Policy - Sample (CACFP-187) (PDF)
- Substitute Form W-9 - NYS Office of the State Comptroller Substitute Form W-9 Request for Taxpayer Identification Number and Certification.
Centers-Only
- Agreement Between the State and Sponsoring Organizations of Day Care Centers (DOH-3840) (PDF)
- Application for Participation of Individual Centers (DOH-3682) (PDF)
- At-Risk Eligible Public Schools in NYC (PDF)
- At-Risk Eligible Public Schools Outside NYC (PDF)
- Board of Directors (DOH-5165) Formerly CACFP-4217 (PDF)
- Certificate of Authority Form (DOH-5168C) Formerly CACFP-3671C (PDF)
- Claim for Reimbursement for Sponsors of Day Care Centers (DOH-3703) PDF FILL-IN FORMAT - To submit monthly data for payment. (PDF)
- Meal Counts:
- Daily Meal Count Record (CACFP-116) - Sample daily meal count sheet (PDF)
- Daily Meal Count - Snack and Supper (CACFP-128) - Sample daily meal count sheet for Snack and Supper (PDF)
- Food Production Records:
- Income Eligibility:
- Letter to Households (CACFP-3673) - Mandatory annual letter explaining the income eligibility applications and participant rights. (PDF)
- Income Eligibility Application for Children (DOH-3688) - To determine eligibility for free or reduced priced meals for children in care. (PDF)
- (adult programs) Income Eligibility Application for Adult Day Care Centers (DOH-3834) To determine eligibility for free or reduced priced meals for adults in care.(PDF)
- Income Guidelines for Day Care Centers (CACFP-3687) Chart indicating income criteria to qualify for free or reduced price meal reimbursement. FOR SPONSORING ORGANIZATION USE ONLY. (PDF)
- Infant Feeding Statement (CACFP-121) (PDF)
- Monitoring Checklist for Day Care Centers (CACFP-4259) - Checklist used by sponsoring organizations to document required monitoring of centers. (PDF)
- Participant Data Form (CACFP-3854C) - To annually collect racial-ethnic information of the children in care. (PDF)
- Reimbursement Rates for Day Care Centers (PDF)
- Vendor Contracts:
- Extension of Vendor Contract to Provide Meals and/or Snacks (CACFP-141) (PDF)
- Invitation for Bid and Vendor Contract Packet (CACFP-143) - When vended meal purchases will be more than $250,000 (PDF)
- Vendor Contract $250,000 or Less (CACFP-142) - When vended meal purchases will be $250,000 or less (PDF)
Homes-Only
- Area Eligibility Mapper
- Agreement Between the State and Sponsoring Organizations of Day Care Homes (DOH-3841) (PDF)
- Application for Close Out Payments for Sponsoring Organizations of Day Care Homes (DOH-5063) PDF FILL-IN FORMAT (PDF)
- Application for Start-Up or Expansion Payments for Day Care Home Sponsors (DOH-3805) PDF FILL-IN FORMAT (PDF)
- Child Enrollment Form for Day Care Homes (DOH-4419) (PDF)
- [Spanish]
- Child Meal Disallowance (CACFP-173) (PDF)
- [Spanish]
- Continuous Application and Agreement for Day Care Home Participation (DOH-5160) Formerly CACFP-3705 (PDF)
- Day Care Home Child Menu (CACFP-171) (PDF)
- [Spanish]
- Day Care Home Infant Menu 6 Months to 1st Birthday (CACFP-199) PDF FILL-IN FORMAT (PDF)
- Five-Day Reconciliation Worksheet for Day Care Homes (Publication No. 19226) (PDF)
- [Spanish]
- Letter to Households - Income Eligibility Form Tier II Day Care Home Participant (DOH-4160) (PDF)
- [Spanish]
- Letter to Households - Income Eligibility Form Family Day Care Home Provider (DOH-4161) (PDF)
- [Spanish]
- Monitoring Checklist for Day Care Homes (DOH-5166) (PDF)
- On-Site Provider Addendum (DOH-5155) formerly CACFP-160 (PDF)
- Pre-Approval Checklist for Enrolled Caregivers and Day Care Home Providers (CACFP-106) (PDF)
- Provider Transfer Form (DOH-4219) (PDF)
- Reference Chart for Provider Updates/Changes in CIPS (PDF)
- Reimbursement Rates for Day Care Homes (PDF)
- Serious Deficiency Process for Providers - Handouts
Sample letters are available in RTF and are available by request. - Suspension Handouts - Providers
Sample letters are available in RTF and are available by request. - Tier 1 Eligible Public Schools Outside of NYC - March 2023 (PDF)
- Tier 1 Eligible Public Schools in NYC - March 2023 (PDF)
