Child and Adult Care Food Program

Forms & Resource Center

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Administration, Record Keeping & Finance
Income Eligibility
NumberName/DescriptionDateFormat
The following forms are for Fiscal Year 2020.
NS-402-GIncome Eligibility Guidelines for FY 2020 – guidelines effective July 1, 2019 – June 30, 2020.6/20192019-2020 IEF Guidelines
NS-100-CIncome Eligibility Form – Child Care Centers – FY 20206/2019NS-100C – Child Income Eligiblity and Enrollment Form FY20
NS-100-C SpanishSpanish Income Eligibility Form – Child Care Centers – FY 2020NS-100C – Child Income Eligibility and Enrollment Form ES-US
NS-101-CIncome Eligibility Form – Instructions – Child Care Centers6/2019NS-101-C FY20 Tip Sheet for Child Enrollment and IEF Final
NS-101-C.aAttachment to Income Eligibility Form to add more enrolled children or household members. This may not be used without NS-101-C.6/2019NS-100-C-a Additional Children FY20
NS-200-AIncome Eligibility Form – Adult Care Centers – FY 20206/2019NS-200A – Adult Income Eligibility Enrollment FY20
NS-201-AIncome Eligibility Form – Instructions – Adult Care Centers4/2016IEF Adult Centers
NS-204-AInstructions to Households – Adult Care Centers – FY 20204/2016Instructions to Households- Adult Care Centers – FY 2020
Alternate Translations of USDA Income Eligibility Form4/5/2017Alternate Translations of USDA Income Eligibility Form
Spanish translation – Income Eligibility Form5/2011Spanish translation – 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.
Enrollment in CACFP
NS-105-CChild Enrollment Form – sample
children must be enrolled in CACFP annually
4/2015Child Enrollment Form
NS-106-CChild Enrollment Form – instructions to centers4/2015Child Enrollment Form 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) 471-248808/2006Blue and White Sheets

11″ x 27″

NS-401-GMonthly Claim for Reimbursement Worksheet04/2009NS-401-G Claim Worksheet
NDE 28-017Claim for Reimbursement – Child Care Centers01/2011Reimbursement Claim_Child Care Centers
NDE 28-018Claim for Reimbursement – Adult Care Centers04/2009Reimbursement Claim_Adult Day Centers
Online Application and Claims
NDE 01-033Computer Access Application and Agreement (application for ID and password)06/2018NDE-01-033computer-access-application-final
Training Registration Instruction Manual03/2015CNP Training Registration Manual
W-9/ACHIRS W-9 and enrollment for direct deposit of claim reimbursement04/2014W9/ACH Form
NS-407-GCACFP Agreement, Part II04/2018NS-407-G Program Application Permanent Agreement Part II 
Informational brochures and handouts
Getting Started on the CACFP – new sponsors/centers09/2018Getting Started on CACFP_web
Getting Started on CACFP_pdf
What to Expect – Getting ready for a compliance review or audit07/2006What to Expect
Signature Pages
NDE 01-017
Page 7
Certificate of Authority (change in responsible individuals/principals)06/2019NDE01-017-Cert-of-Authority FY20
NDE 01-017
Page 8
Organization Representatives Signature Page06/2019NDE01-017-Organization-Statement FY20
NDE 01-033Computer Access Application and Agreement (application for ID and password)04/2018NDE-01-033computer-access-application-final
Food Service Contracts – procurement
NS-404-GFood Service Contract Fillable Form – Complete package – instructions, contract, regulations, all attachments06/2018Coming Soon
NS-404-GFood Service Contract – Complete package – instructions, contract, regulations, all attachments08/2019FSMC Contract Packet Complete 
NS-404-GFood Service Contract Attachment D- Addendum04/2019FSMC Contract Amendment Form fillable PDF
NEW! Sample Delivery Ticket04/2019Updated Sample Meal Delivery Ticket
Small Purchase Procurement (done annually)05/2014Small Purchase Procurement
Approved Vendor List06/2017Approved Vendor List
Federal RegulationsFederal Regulations
IMPORTANT: All contracts in excess of $150,000 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 manual for FY 201907/2018Child care center-coming soon

Adult Care Center – Coming soon

NS-405-GTime Certification Worksheet – use this to document time worked in CACFP if needed to prove nonprofit food service operation04/2009Time Certification Worksheet_pdf
Time Certification Worksheet_excel
NS-406-GSample Site Review form – for sponsors of multiple sites04/2018NS-406-G Affiliated Site Review Form 
NS-409-GAdministrative Review procedures – steps for submitting an administrative review (appeal) regarding NDE actions06/2017Administrative Review Procedures
Nebraska Household Contact System (for sponsors of more than one site)04/2005NE Household Contract System
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)04/2005Survey Letter and Form Sample
 NS-413-GCACFP Monthly Expenditures (use to track expenses)04/2017NS-413-G Monthly Expense Worksheet Rev March 17
CACFP Administrative Handbook – has your center participated on CACFP for several years? Is your CACFP 3-ring binder or part of it missing?12/2011Handbook Web Link
CACFP Handbook for Sponsors of Multiple Sites11/2008Multiple Sites Handbook
Financial Viability Document4/2016Financial Viability
Family Day Care Home Sponsors
Applications, forms and resources for sponsors of family day care homesDCH Web Resources
Locate a sponsor – find out which home sponsors serve your countyDCH Locator
Food & Nutrition
NumberName/DescriptionFormat
Crediting Handbook for CACFP (Effective July 1, 2014) – does not include infants04/2014Crediting Handbook for CACFP
NS-408-GCrediting Foods in the Child and Adult Care Food Program (Nebraska) – does include infants04/2008Crediting Handbook for CACFP_infants
Grains ChartFormat
Grain Chart08/2017Grain Chart
NEW! Sample MenusFormat
1 & 2 year olds08/20171 & 2 Year Old Sample Menu
3 – 5 year olds08/20173 – 5 Year Old Sample Menu
6 – 12 year olds & 13 – 18 year olds08/20176 – 12 & 13- 18 Year Old Sample Menu
Adults08/2017Adult Sample Menu
Food Charts
Meal pattern for children, ages 1 – 12 06/2017Child Meal Pattern
Meal pattern for adults  06/2017Adult Meal Pattern
Meal pattern for infants (birth up to first birthday)  06/2017Infant Meal Pattern
Approved Milk Substitutes
Updated list of milk substitutes approved for use in CACFP 06/2017Milk Substitutes
What’s Cookin’ II cookbook for family day care homes
What’s Cookin’ II – recipesRecipes_pdf
Farm to Preschool Network
Seasonal Crop Tunnel Systems (clickable link)Seasonal Crop Tunnel Systems PDF
Buying Local Guide (clickable link)Buying Local Guide PDF
Farm to Preschool Network (clickable link)Farm to Preschool Network
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 snack03/2017Daily 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 snack03/2017Daily Production Record Ver. B
Cycle menu planner – requires 8 1/2″ x 14″ paper to print01/2005Cycle Menu Planner_Word
Cycle Menu Planner_PDF
Feeding Infants
Obligation to offer infant meals05/2002Infant Meal Offer Obligation
Infant Meal Pattern06/2017Infant Meal Pattern
NEW! Infant Feeding Records03/2019Infant Feeding Records
Developmental Readiness Form06/2018Infant Formula Selection & Solid Foods
NEW! SPANISH Developmental Readiness Form06/2019Infant 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 infantsInfant Feeding Resources
Breastfeeding Resources
What’s in Breastmilk10/2016
Breastfeeding Facts4/2015
Medical Statement Form
Medical Statement4/2018Use for medical conditions requiring meal substitute.
Req Meal Accommodation4/2018Use for creditable meals substitutes based on personal preference
Managing Food Allergies
CDC Toolkit (clickable link)5/2015CDC Toolkit_web version
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.12/2011Infant Meal Records Ver. A
Set Two: NS-502-B Daily Infant Meal Records – Meals served to several infants may be recorded for a full day.12/2011Infant Meal Records Ver. B
Training Resources
NEW! Infant FY2017 New Meal Pattern Training PPT06/2017Infant 2017 Meal Pattern Training
NEW! FY2017 New Meal Pattern06/20172017 Meal Pattern Training
Introduction to the CACFP – training manual for adult care centers08/2015Adult Care Centers Training Manual
CACFP Training Log – this may be used to document your CACFP staff training04/2007CACFP Training Log
Civil Rights Training2/2015Civil Rights Training
USDA Resources
 USDA Food Buying Guide USDA Food Buying Guide_pdf
Child Care Recipes from USDAChild Care Recipes from USDA_pdf
Nibbles for Health – from USDANibbles for Health_pdf
USDA Regulation & Policy
 Code of Federal Regulations01/2011Code of Federal Regulations
USDA FNS CACFP Program Policy Memos08/2014USDA Program Policy Memos
USDA Food & Nutrition Services InstructionsUSDA Food & Nutrition Services Instructions
Questions and Answers – consolidated Q & A’s from the U.S. Department of Agriculture Mountain Plains Regional OfficeUSDA FAQ
WIC Resources
 WIC Brochure (English) – 2 pages English WIC Brochure_pdf
WIC Brochure (Spanish) – 2 pagesSpanish WIC Brochure_pdf

You may download files by right-clicking your mouse and selecting “Save Target As…”

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.
NS-402-G-Income-Guidelines-2019

NS-100-C
Income Eligibility Form – Child Care Centers – FY 2020       6/2019
NS-100C – Child Income Eligibility and Enrollment Form FY20 Final

NS-105-C
Child Enrollment Form – sample children must be enrolled in CACFP annually
NS-105-C pdf

NS-106-C
Child Enrollment Form – instructions for centers
NS-106-C pdf

Updated August 7, 2019 4:35pm