Child and Adult Care Food Program

Forms & Resource Center

The following forms are for Fiscal Year 2021

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

Administration, Record Keeping & Finance

Income Eligibility Guidelines for FY 2020 – guidelines effective July 1, 2020 – June 30, 2021.

Income Eligibility Form (IEF) – Child Care Centers – FY 2021

Spanish Income Eligibility Form (IEF) – Child Care Centers – FY 2021

Income Eligibility Form – Instructions – Child Care Centers

Attachment to Income Eligibility Form to add more enrolled children or household members. This may not be used without NS-101-C.

Income Eligibility Form (IEF) – Adult Care Centers – FY 2021

Income Eligibility Form – Instructions – Adult Care Centers

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.

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

Blue and White Sheets

11″ x 27″

Monthly Claim for Reimbursement Worksheet

Claim for Reimbursement – Child Care Centers

Claim for Reimbursement – Adult Care Centers

Computer Access Application and Agreement (application for ID and password)

Certificate of Authority (change in responsible individuals/principals)

Organization Representatives Signature Page

IRS W-9 and enrollment for direct deposit of claim reimbursement

Pre-Award Compliance Form

Getting Started on the CACFP – New Sponsors/Centers

Food Service Contract – Complete package – instructions, contract, regulations, all attachments

Food Service Contract Attachment D- Addendum

Sample Delivery Ticket

Informal Procurement Log and Policy Instructions (done annually)

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.

Introduction to the CACFP – Training Manuals for FY 2020

Time Certification Worksheet – use this to document time worked in CACFP if needed to prove nonprofit food service operation

Sample Site Review form – for sponsors of multiple sites

Administrative Review procedures – steps for submitting an administrative review (appeal) regarding NDE actions

Nebraska Household Contact System (for sponsors of more than one site)

CACFP Monthly Expenditures (use to track expenses)

CACFP Handbook for Sponsors of Multiple Sites

Coming Soon

Financial Viability Document

Applications, forms and resources for sponsors of family day care homes

Locate a sponsor – find out which home sponsors serve your county

Food & Nutrition

Crediting Handbook for CACFP – does not include infants

1 & 2 year olds

3 – 5 year olds

6 – 12 year olds & 13 – 18 year olds

Meal pattern for children, ages 1 – 12

Meal pattern for adults

Meal pattern for infants (birth up to first birthday)

List of Milk Substitutes Approved for use in CACFP

What’s Cookin’ II – recipes

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

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

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

Cycle menu planner – requires 8 1/2″ x 14″ paper to print

Obligation to offer infant meals

Infant Meal Production Records

Formula Selection and Solid Developmental Readiness Form

SPANISH Formula Selection and Solid Developmental Readiness Form *NEW FORM COMING SOON*

Feeding Infants – A Guide for Use in the Child Nutrition Programs (USDA Publication FNS-258)

Additional resources on feeding infants

Medical Statement- Use for medical conditions requiring meal substitutes

Spanish Medical Statement -Use for medical conditions requiring meal substitutes

Request for Meal Accommodation- Use for creditable meal substitutes based on personal preference

Spanish Request for Meal Accommodation- Use for creditable meal substitutes based on personal preference

Training Resources

CACFP Training Log – this may be used to document your CACFP staff training

USDA Resources

Child Care Recipes from USDA

Nibbles for Health – from USDA

Nibbles for Health_pdf (Dual language resource- English and Spanish)

USDA Regulation & Policy

Code of Federal Regulations

USDA FNS CACFP Program Policy Memos

USDA Food & Nutrition Services Instructions

WIC Resources

WIC Brochure (English) – 2 pages

WIC Brochure (Spanish) – 2 pages

Updated March 18, 2021 8:17am