Child and Adult Care Food Program

Forms & Resource Center

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Administration, Record Keeping & Finance
Income Eligibility
Number Name/Description Date Format
The following forms are for Fiscal Year 2020.
NS-402-G Income Eligibility Guidelines for FY 2020 – guidelines effective July 1, 2019 – June 30, 2020. 6/2019 2019-2020 IEF Guidelines
NS-100-C Income Eligibility Form (IEF) – Child Care Centers – FY 2020 6/2019 NS-100C – Child Income Eligibility and Enrollment Form FY20
NS-100-C Spanish Spanish Income Eligibility Form (IEF) – Child Care Centers – FY 2020 6/2019 NS-100C – Child Income Eligibility and Enrollment Form FY20 Spanish
NS-101-C Income Eligibility Form – Instructions – Child Care Centers 6/2019 NS-101-C Tip Sheet for Child Enrollment and IEF FY20
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. 6/2019 NS-100-C-a Additional Children FY20
NS-200-A Income Eligibility Form (IEF) – Adult Care Centers – FY 2020 6/2019 NS-200A – Adult Income Eligibility and Enrollment Form FY20
NS-201-A Income Eligibility Form – Instructions – Adult Care Centers 6/2019 NS-201-A Tip Sheet for Adult Enrollment and IEF FY20
Alternate Translations of USDA Income Eligibility Form 4/5/2017 Alternate Translations of USDA Income Eligibility Form
Pricing Programs: If you have a separate charge for meals, contact Nutrition Services for a different set of income eligibility letters & instructions.
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 Blue and White Sheets

11″ x 27″

NS-401-G Monthly Claim for Reimbursement Worksheet 04/2009 NS-401-G Claim Worksheet
NDE 28-017 Claim for Reimbursement – Child Care Centers 01/2011 Reimbursement Claim_Child Care Centers
NDE 28-018 Claim for Reimbursement – Adult Care Centers 04/2009 Reimbursement Claim_Adult Day Centers
Online Application and Claims
Training Registration Instruction Manual 03/2015 CNP Training Registration Manual
NS-407-G CACFP Agreement, Part II 04/2018 NS-407-G Program Application Permanent Agreement Part II 
Computer Access Application and Agreement (CNP ID and Password Access)
NDE 01-033 Computer Access Application and Agreement (application for ID and password) 06/2018 NDE-01-033 Computer Access Application
New Center Handouts
NDE 01-017
Page 7
Certificate of Authority (change in responsible individuals/principals) 06/2019 NDE01-017-Cert-of-Authority FY20
NDE 01-017
Page 8
Organization Representatives Signature Page 06/2019 NDE01-017-Organization-Statement FY20
W-9/ACH IRS W-9 and enrollment for direct deposit of claim reimbursement 09/2019 W9/ACH Form
Getting Started on the CACFP – New Sponsors/Centers 09/2018 Getting Started on CACFP_web
Getting Started on CACFP_pdf
Food Service Contracts – procurement
NS-404-G Food Service Contract – Complete package – instructions, contract, regulations, all attachments 10/2019 FSMC Contract Packet Complete 
NS-404-G Food Service Contract Attachment D- Addendum 04/2019 FSMC Contract Amendment Form fillable PDF
NEW! Sample Delivery Ticket 11/2019 Sample Meal Delivery Ticket
Informal Procurement Log and Policy Instructions (done annually) 11/2019 Informal Procurement Log
Approved Vendor List 11/2019 Approved Vendor List
IMPORTANT: All contracts in excess of $50,000 per year must be submitted to and reviewed by Nutrition Services before they can be accepted and signed by the CACFP institution. Allow at least 10 working days for Nutrition Services to review the contract.
Administrative Tools
Introduction to the CACFP – Training Manuals for FY 2020 11/2019 CACFP Child Care Centers Workbook FY20

CACFP Adult Day Centers Workbook FY20

NS-405-G Time Certification Worksheet – use this to document time worked in CACFP if needed to prove nonprofit food service operation 04/2018 Time Certification Worksheet
NS-406-G Sample Site Review form – for sponsors of multiple sites 04/2019 NS-406-G Affiliated Site Review Form 
NS-409-G Administrative Review procedures – steps for submitting an administrative review (appeal) regarding NDE actions 06/2017 Administrative Review Procedures
Nebraska Household Contact System (for sponsors of more than one site) 04/2005 NE Household Contract System
 NS-413-G CACFP Monthly Expenditures (use to track expenses) 04/2017 NS-413-G Monthly Expense Worksheet
CACFP Handbook for Sponsors of Multiple Sites 10/2019 Coming Soon
Financial Viability Document 4/2016 Financial Viability
Family Day Care Home Sponsors
Applications, forms and resources for sponsors of family day care homes DCH Web Resources
Locate a sponsor – find out which home sponsors serve your county DCH Locator
Food & Nutrition
Number Name/Description Format
Crediting Handbook for CACFP (Effective July 1, 2014) – does not include infants 04/2014 Crediting Handbook for CACFP
Grains Chart Format
Grain Chart 08/2017 Grain Chart
NEW! Sample Menus Format
1 & 2 year olds 08/2017 1 & 2 Year Old Sample Menu
3 – 5 year olds 08/2017 3 – 5 Year Old Sample Menu
6 – 12 year olds & 13 – 18 year olds 08/2017 6 – 12 & 13- 18 Year Old Sample Menu
Adults 08/2017 Adult Sample Menu
Meal Pattern Food Charts
Meal pattern for children, ages 1 – 12  06/2019 Child Meal Pattern
Meal pattern for adults   06/2019 Adult Meal Pattern
Meal pattern for infants (birth up to first birthday)   06/2019 Infant Meal Pattern
Approved Milk Substitutes
List of Milk Substitutes Approved for use in CACFP  06/2017 Milk Substitutes
What’s Cookin’ II Cookbook for Family Day Care Homes
What’s Cookin’ II – recipes

*Please note that some of these recipes may no longer be creditable under the current meal pattern.*

Recipes_pdf
Menu Production Records
Select the version that best meets the needs of your center.
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 03/2017 Daily Production Record Ver. A
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 03/2017 Daily Production Record Ver. B
Cycle menu planner – requires 8 1/2″ x 14″ paper to print 01/2005 Cycle Menu Planner_Word
Cycle Menu Planner_PDF
Feeding Infants
Obligation to offer infant meals 05/2002 Infant Meal Offer Obligation
Infant Meal Production Records 03/2019 Infant Meal Production Records
Formula Selection and Solid Developmental Readiness Form 11/2019 Infant Formula Selection & Solid Foods
SPANISH Formula Selection and Solid Developmental Readiness Form 06/2019 Infant Formula Selection & Solid Foods_Spanish
Feeding Infants – A Guide for Use in the Child Nutrition Programs (USDA Publication FNS-258) Feeding Infants in CNP
Additional resources on feeding infants Infant Feeding Resources
Special Diets
Medical Statement- Use for medical conditions requiring meal substitutes 4/2018 Medical Statement 
Request for Meal Accommodation- Use for creditable meal substitutes based on personal preference 4/2018 Request for Meal Accommodation
CDC Toolkit 5/2015 CDC Toolkit_web version
Training Resources
CACFP Training Log – this may be used to document your CACFP staff training 04/2007 CACFP Training Log
USDA Resources
  USDA Food Buying Guide   Online Interactive USDA Food Buying Guide

Downloadable USDA Food Buying Guide

Child Care Recipes from USDA Child Care Recipes from USDA_pdf
Nibbles for Health – from USDA Nibbles for Health_pdf (Dual language resource- English and Spanish)
USDA Regulation & Policy
  Code of Federal Regulations Code of Federal Regulations
USDA FNS CACFP Program Policy Memos USDA Program Policy Memos
USDA Food & Nutrition Services Instructions USDA Food & Nutrition Services Instructions
WIC Resources
  WIC Brochure (English) – 2 pages   English WIC Brochure_pdf
WIC Brochure (Spanish) – 2 pages Spanish WIC Brochure_pdf
Updated December 5, 2019 3:53pm