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CACFP Forms

Forms and completed sample forms for use by Child and Adult Care Food Program (CACFP) sponsors.

Eligibility Materials

Adult Component Eligibility Materials
Participant eligibility materials for the adult component of the Child and Adult Care Food Program (CACFP).

Child Care Center Eligibility Materials
Participant eligibility materials for the child care component of the CACFP.

Day Care Home Eligibility Materials
Provider and participant eligibility materials for the day care home component of the CACFP.

Forms

Center Site Monitoring Report (DOC)
NSD 2071: Form used to monitor program operations in centers at least three times each year, with no more than six months between monitoring visits. (See Management Bulletin 05-207 for more information.)

Certification of Principals and Board Members (DOC)
Form used to gather information from principals in organizations applying or reapplying to participate in the Child and Adult Care Food Program. (See Management Bulletin 04-201 for more information.)

Day Care Home Provider Drop/Transfer Form (DOC)
Provider form to terminate agreement with current sponsor and be dropped from the CACFP.

Disclosure of Lobbying Activities External link opens in new window or tab. (PDF)
U.S. Office of Management and Budget Standard Form LLL. Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352.

Emergency Shelter Daily Roster (DOC)
Used to record the meals served to the eligible shelter residents.

Emergency Shelter Monthly Roster (DOC)
Used to document adults with disabilities that may be served and claimed, provided that the shelter serves a majority of residents 18 years of age or younger.

Medical Statement to Request Special Meals and/or Accommodations (DOC)
CNP 925 - This form is used by parents/guardians to have a medical authority prescribe special meals, or accommodations during meals, which are necessary because of a disability or medical reason.
Available Translations of the Medical Statement to Request Special Meals and/or Accommodations

Parental Request for a Fluid Milk Substitution for Children in Child Care (DOC)
Used by parents to request a fluid milk substitute due to a medical or other special dietary need; see MB USDA-CACFP-20-2011 for more information.

Training Report (DOC)
Form used to report annual training that, at minimum, meets federal program requirements for staff at all of sponsored centers. (See Management Bulletin 05-207 for more information.)

Questions:   Nutrition Services Division | 800-952-5609
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