Nutrition Services
Nutrition Services Home
School Meals Program
Child and Adult Care Food Program
- Forms & Resources
- Training
- CACFP News
- Family Day Care Home Sponsors
- Integrity
- Infant Feeding
- At-Risk Meals and Snacks
Summer Food Service Program
Quick Links
Nebraska Department of Education
Nutrition Services
301 Centennial Mall South
PO Box 94987
Lincoln, NE 68509-9487
(800) 731-2233 (Nebraska Only)
or (402) 471-2488
EMAIL
Child & Adult Care Food Program (CACFP)
Forms & Resource Center
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Administration, Record Keeping & Finance
- Income Eligibility
- Enrollment in CACFP
- Meal Counts & Claims
- Online Application & Claims
- Information brochures and handouts
- New Sponsor/Center Applications
- Signature Pages
- Food Service contracts - procurement
- Administrative tools
- Family Day Care Home sponsors
- Crediting Foods in the CACFP
- Food Charts
- Food Buying Guide (USDA)
- What's Cookin' II
- Child Care Recipes
- Menu Production Records
- Feeding Infants
- Infant Production Records
- Special Diet Statements
| Administration, Record Keeping & Finance | |||
| Income Eligibility | |||
| Number | Name/Description | Date | Format |
| The following forms are for Fiscal Year 2013. If you need FY 2012 forms, contact Nutrition Services | |||
| NS-402-G | Income Eligibility Guidelines for FY 2013 - guidelines effective July 1, 2012 - June 30, 2013. | 4/2012 | Adobe pdf |
| NS-100-C | Income Eligibility Form - Child Care Centers - FY 2013 | 4/2012 | Adobe pdf |
| NS-101-C | Income Eligibility Form - Instructions - Child Care Centers | 4/2012 | Adobe pdf |
| NS-101-C.a. | Attachment to Income Eligibility Form to add more enrolled children or household members. This may not be used without NS-101-C. | 4/2012 | Adobe pdf |
| NS-102-C | Cover Letter to Households - Child Care Centers - FY 2013 | 4/2012 | Adobe pdf |
| NS-104-C | Instructions to Households - Child Care Centers - FY 2013 | 4/2011 | Adobe pdf |
| NS-200-A | Income Eligibility Form - Adult Care Centers - FY 2013 | 4/2012 | Adobe pdf |
| NS-201-A | Income Eligibility Form - Instructions - Adult Care Centers | 4/2012 | Adobe pdf |
| NS-202-A | Cover Letter to Households - Adult Care Centers - FY 2013 | 4/2012 | Adobe pdf |
| NS-204-A | Instructions to Households - Adult Care Centers - FY 2013 | 4/2011 | Adobe pdf |
| Pricing Programs: If you have a separate charge for meals, contact Nutrition Services for a different set of income eligibility letters & instructions. | |||
| Enrollment in CACFP | |||
| NS-105-C | Child Enrollment Form - sample children must be enrolled in CACFP annually |
4/2009 | Adobe pdf |
| NS-106-C | Child Enrollment Form - instructions to centers | 4/2012 | Adobe pdf |
| Meal Counts & Claims | |||
| Record of Meals and Supplements Served (RMSS) - commonly referred to as "blue and white sheets" - 11" x 17" - request from Nutrition Services by email or phone (800) 731-2233 or (402) 471-2488 | 08/2006 |
11" x 27" |
|
| NS-401-G | Monthly Claim for Reimbursement Worksheet | 04/2009 | |
| NDE 28-017 | Claim for Reimbursement - Child Care Centers | 01/2011 | Adobe pdf |
| NDE 28-018 | Claim for Reimbursement - Adult Care Centers | 04/2009 | Adobe pdf |
| Claim for Reimbursement - Submit claim online | Web requires user ID |
||
| State Treasurer ACH Enrollment Form (application for direct deposit) | 07/2009 | Adobe pdf | |
| Online Application and Claims | |||
| NDE 01-033 | Computer Access Application and Agreement (application for ID and password) | 03/2010 | Adobe pdf |
| Online Application Instruction Manual - for centers and sponsors with user ID | 04/2009 | Adobe pdf | |
| Online Claims Instruction Manual - for centers and sponsors with user ID | 09/2005 | Adobe pdf | |
| Training Registration Instruction Manual | 08/2005 | Adobe pdf | |
| NDE 01-017 NDE 01-018 |
Application for CACFP - Submit application and updates online (existing sponsors and centers) | 06/2009 |
requires user ID |
| NS-407-G | CACFP Agreement, Parts II and III | 04/2011 | Adobe pdf |
| Informational brochures and handouts | |||
| Getting Started on the CACFP - new sponsors/centers | 05/2006 | ||
| What to Expect - Getting ready for a compliance review or audit | 07/2006 | Adobe pdf | |
| New Sponsor/Center Applications | |||
| NDE 01-017 | Application for CACFP - new sponsors | 04/2012 | Adobe pdf |
| NDE 01-018 | Application for CACFP - center site information application (must be submitted with NDE 01-017); one per site | 04/2012 | Adobe pdf |
| NDE 01-032 | Preaward Compliance | 10/2011 | Adobe pdf |
| NDE 01-030 | Proprietary For Profit Statement - submit one for each new for-profit center | 05/2005 | Adobe pdf |
| NDE 01-026 | Adult Center attachment - adult centers only | 06/2007 | Adobe pdf |
| NS-407-G | CACFP Agreement, Part II | 04/2012 | Adobe pdf |
| W-9 | Internal Revenue Service W-9 - submit with all new applications | 12/2011 | Adobe pdf |
| Signature Pages | |||
| NDE 01-017 Page 7 |
Certificate of Authority (change in responsible individuals/principals) | 04/2012 | Adobe pdf |
| NDE 01-017 Page 8 |
Organization Representatives Signature Page | 04/2012 | Adobe pdf |
| NDE 01-033 | Computer Access Application and Agreement (application for ID and password) | 03/2011 | Adobe pdf |
| Food Service Contracts - procurement | |||
| NS-404-G | Food Service Contract (no attachments) | 04/2011 | Fillable Adobe pdf |
| NS-404-G | Food Service Contract - Complete package - instructions, contract, regulations, all attachments | 10/2011 | Adobe pdf |
| Food Service Contract and all attachments are also available individually - click here | |||
| Administrative Tools | |||
| Introduction to the CACFP - training manual for child care centers FY 2012 | 07/2012 | Adobe pdf | |
| NS-405-G | Time Certification Worksheet - use this to document time worked in CACFP if needed to prove nonprofit food service operation | 04/2009 | |
| NS-406-G | Sample Site Review form - for sponsors of multiple sites | 04/2010 | Adobe pdf |
| Five Day Reconciliation worksheet | 04/2010 | Adobe pdf | |
| NS-409-G | Administrative Review procedures - steps for submitting an administrative review (appeal) regarding NDE actions | 06/2011 | Adobe pdf |
| Nebraska Household Contact System (for sponsors of more than one site) | 04/2005 | Adobe pdf | |
| Sample household survey letter and form (for sponsors of more than one site - this letter could also be used as a basis for telephone contacts) | 04/2005 | Microsoft Word | |
| NS-413-G | CACFP Monthly Expenditures (use to track expenses) | 04/2012 | Adobe pdf |
| CACFP Administrative Handbook - has your center participated on CACFP for several years? Is your CACFP 3-ring binder or part of it missing? Current contents may be downloaded here | 12/2011 | Web | |
| CACFP Handbook for Sponsors of Multiple Sites | 11/2008 | Adobe pdf | |
| Family Day Care Home Sponsors | |||
| Applications, forms and resources for sponsors of family day care homes | Web | ||
| Locate a sponsor - find out which home sponsors serve your county | Web | ||
| Food & Nutrition | |||
| Number | Name/Description | Format | |
| NS-408-G | Crediting Foods in the Child and Adult Care Food Program (Nebraska) | 04/2008 | Adobe pdf |
| Food Charts | |||
| Meal pattern for children, ages 1 - 12 | Adobe pdf | ||
| Meal pattern for adults | Adobe pdf | ||
| Meal pattern for infants (birth up to first birthday) | Adobe pdf | ||
| Meal Requirements Manual | |||
| Meal Requirements manual - child care centers | Adobe pdf | ||
| Meal Requirements manual - adult care centers | Adobe pdf | ||
| What's Cookin' II cookbook for family day care homes | |||
| What's Cookin' II - recipes | Link to Adobe pdf files | ||
| Menu Production Records | |||
| Select the version that best meets the needs of your center. | |||
| Child and Adult Care Centers | |||
| NS-501-A Daily Production Record - This version allows for menu, foods used and quantity prepared for breakfast, morning snack, lunch, afternoon snack, supper and evening snack | 12/2011 | Adobe pdf | |
| NS-501-B Daily Production Record - This version allows for the menu, foods used, and total quantity prepared for breakfast, morning snack, lunch and afternoon snack | 12/2011 | Adobe pdf | |
| Cycle menu planner - requires 8 1/2" x 14" paper to print | 01/2005 | ||
| Feeding Infants | |||
| Obligation to offer infant meals | 05/2002 | Adobe pdf | |
| Meal pattern for infants (birth up to first birthday) - charts may be printed for your use - each will open in a new window. | Web | ||
| Instructions for claiming infant meals in Nebraska CACFP (includes infant feeding/formula selection form and sample meal records) | 06/2010 | Adobe pdf | |
| Infant Formula/Infant Feeding Selection form Use this version if you are not using NDE's child enrollment form. | 05/2005 | Adobe pdf | |
| USDA List of approved infant formulas | Web | ||
| View our PowerPoint Slide Presentation - feel free to view, download and use this for training center staff and providers about CACFP Infant Feeding and Meal Requirements. Includes speaker notes. | PowerPoint | ||
| Feeding Infants - A Guide for Use in the Child Nutrition Programs (USDA Publication FNS-258) | Adobe pdf | ||
| Additional resources on feeding infants | Web | ||
| Special Diet Statements | |||
| NS-420-G | Alternate milk request | 4/2012 | |
| Special Diet Statement - Disability | 4/2012 | ||
| Special Diet Statement - No Disability | 4/2012 | ||
| Infant Production Records | |||
You may select the set that works best in your child care center. |
|||
| Set One: NS-502-A Weekly Infant Meal Records - Five days of meals may be recorded for an individual infant. | 12/2011 | Adobe pdf | |
| Set Two: NS-502-B Daily Infant Meal Records - Meals served to several infants may be recorded for a full day. | 12/2011 | Adobe pdf | |
| Training Resources | |||
| PowerPoint slide shows - feel free to download and use for staff training | Web | ||
| Introduction to the CACFP - training manual for child care centers | 08/2012 | Adobe pdf | |
| Introduction to the CACFP - training manual for adult care centers | 09/2012 | ||
| Training Registration Instruction Manual - how to register for training using the online system | 08/2005 | Adobe pdf | |
| CACFP Training Log - this may be used to document your CACFP staff training | 04/2007 | Adobe pdf | |
| USDA Resources | |||
| USDA Food Buying Guide | Link to Adobe pdf files | ||
| Child Care Recipes from USDA | Link to Adobe pdf files | ||
| Nibbles for Health - from USDA | Link to Adobe pdf files | ||
| USDA Regulation & Policy | |||
| Federal Regulations | 01/01/2011 | Adobe pdf | |
| USDA Food & Nutrition Services Instructions | Web | ||
| USDA Policy Memos - from the Mountain Plains Region of USDA | Web | ||
| Questions and Answers - consolidated Q & A's from the U.S. Department of Agriculture Mountain Plains regional office | Web | ||