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Child & Adult Care Food Program (CACFP)

Forms & Resource Center

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Administration, Record Keeping & Finance

Food & Nutrition

Training Resources

USDA Resources

Administration, Record Keeping & Finance
Income Eligibility
Number Name/Description Date Format
  The following forms are for Fiscal Year 2015.
NS-402-G Income Eligibility Guidelines for FY 2015 - guidelines effective July 1, 2014 - June 30, 2015. 4/2014 Adobe pdf
NS-100-C Income Eligibility Form - Child Care Centers - FY 2015 4/2014 Adobe pdf
NS-101-C Income Eligibility Form - Instructions - Child Care Centers 4/2014 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. 4/2014 Adobe pdf
NS-102-C Cover Letter to Households - Child Care Centers - FY 2015 4/2014 Adobe pdf
NS-104-C Instructions to Households - Child Care Centers - FY 2015 4/2014 Adobe pdf
NS-200-A Income Eligibility Form - Adult Care Centers - FY 2015 4/2014 Adobe pdf
NS-201-A Income Eligibility Form - Instructions - Adult Care Centers 4/2014 Adobe pdf
NS-202-A Cover Letter to Households - Adult Care Centers - FY 2015 4/2014 Adobe pdf
NS-204-A Instructions to Households - Adult Care Centers - FY 2015 4/2014 Adobe pdf
  Spanish translation - Income Eligibility Form 5/2011 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
4/2014 Adobe pdf
NS-106-C Child Enrollment Form - instructions to centers 4/2014 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

Adobe pdf

11" x 27"

NS-401-G Monthly Claim for Reimbursement Worksheet 04/2009

Adobe pdf 
Microsoft Word
Microsoft Excel

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
FY2015
  Requires use ID
New system
  Claim for Reimbursement
FY2014
  Requires user ID
Old CNP System
  State Treasurer ACH Enrollment Form (application for direct deposit) 03/2014 Adobe pdf
Online Application and Claims
NDE 01-033 Computer Access Application and Agreement (application for ID and password) 08/2014 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

Web

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

Web
Adobe pdf

  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 04/2013 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 04/2013 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 04/2014 Adobe pdf
Signature Pages
NDE 01-017
Page 7
Certificate of Authority (change in responsible individuals/principals) 04/2013 Adobe pdf
NDE 01-017
Page 8
Organization Representatives Signature Page 04/2013 Adobe pdf
NDE 01-033 Computer Access Application and Agreement (application for ID and password) 08/2014

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
  Small Purchase Procurement (done annually) 05/2014 Adobe pdf
  Approved vendor list found here 04/2014  
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

Adobe pdf
Excel

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
  Financial Viability Document 4/2014 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
  NEW! Crediting Handbook for CACFP (Effective July 1, 2014) - does not include infants 04/2014 Adobe pdf
NS-408-G Crediting Foods in the Child and Adult Care Food Program (Nebraska) - does include infants 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
Approved Milk Substitutes
  Updated list of milk substitutes approved for use in CACFP   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

Microsoft Word 
Adobe PDF

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
Medical Statement Form
  Request for Special Meals and/or Accomodations 4/2014  
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

Adobe pdf

  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 FNS CACFP Program Policy 08/2014 Web
  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

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