Program Forms and Resources CACFP

The following are program forms and resources for operators of the Child and Adult Care Food Program.

Administration Forms

• Permanent Agreement
  • Manual Permanent Agreement (print, sign 1 original, mail to ADE for approval)
  • Electronic Permanent Agreement (complete CACFP Initiation Form, agreement is emailed to signers directly by AdobeSign, electronic signature) 
• Unique Entity Identifier (UEI) lookup or request a UEI
• Administrative Review Procedures
• Procedures for Complaints of Discrimination
• State of Arizona W-9
• State of Arizona ACH Authorization Form
• ADEConnect Request for Entity Administrator
• Computer Software Agreement

Required Postings

• Building for the Future Flyer
• Current WIC Flyer (English) (Spanish) 
• To order And Justice for All posters email [email protected]

Training Staff

• Civil Rights Compliance for Child Nutrition Operators (English) (Spanish)
• Annual Staff CACFP Training Presentation Template
• CACFP Trainer’s Tools: Feeding Infants
• Template Training Agenda and Sign-In Sheet

Adding a Site

• Instructions: How to Add a New Site (Center) (At-Risk)
• Add/Change/Delete Form
  • HelpDesk Add/Change/Delete
    • Log into ADEConnect
    • Click 'Help'
    • Click 'HelpDesk'
    • Click 'New Request'
    • Locate Health and Nutrition Services templates
    • Select 'HNS Add/Change/Delete form
    • Complete all required fields and applicable optional fields within HelpDesk's Add/Change/Delete form
    • *Use/Requestor submitting Add/Change/Delete form must be submitted by an Authorized Signer listed on the Food Permanent Service Agreement
  • Manual (print, sign, scan, and email to specialist)
• Child Care Standards for Unlicensed Facilities

Participant Enrollment and Eligibility

• Participant Menu Modification Form
• Child Care Center Enrollment 
  • DHS Emergency, Information, and Immunization Record Card (Blue Card)
  • Meal Benefit Income Eligibility Form (English) (Spanish)
  • Required Resources to Provide Families:
    • Instructions (English) (Spanish)
    • Letter to Household (English) (Spanish)
  • Income Eligibility Guidelines PY 24-25
  • Claiming Rosters (PDF) (Excel)
• Adult Care Center Enrollment
  • Meal Benefit Income Eligibility Form
  • Required Resources to Provide Families: (Instructions) (FAQ)
  • Income Eligibility Guidelines
  • Claiming Rosters (PDF) (Excel)

Building a Menu

• Child and Adult Meal Pattern Requirements
• Menu Template
  • 7-Days: All Meals and Snacks
  • 5-Days: All Meals and Snacks
  • 5-Days: Breakfast, Lunch, AM and PM Snack
  • 5-Days: Breakfast, Lunch, Snack
• ADE Sample Menu
• Menu Self-Assessment

Identifying and Preparing Nutritious and Creditable Foods

• Creditable Foods Guide
• Team Nutrition Training Worksheets
• WIC Foods Database
• Grains Ounce Equivalents
  • Exhibit A
  • Using Ounce Equivalents for Grains in the CACFP
• Meal Quality Guidance Tool (USDA)
• Food Buying Guide for Child Nutrition Programs Interactive Web-Based Tool
• Production Worksheet Template
• Milk Purchasing Calculator 
• Temperature Log

Preparing for the Meal Service

• Family Style Meal Service in Arizona (Arizona Early Childhood Education Association)
• Offer Versus Serve in the CACFP Only Applicable for At-Risk and Adults

Counting and Totaling Meals Served

• Child and Adult Point of Service Meal Count Forms
  • 7-Days: All Meals and Snacks
  • 5-Days: All Meals and Snacks
  • 5-Days: Breakfast, Lunch, AM and PM Snack
  • 5-Days: Breakfast, Lunch, Snack
• Meal Count Summary Sheet (PDF) (Excel)

Feeding Infants

• Forms:
  • Infant Point of Service Meal Count Sheet
  • Infant Feeding Preference Form (English) (Spanish)
  • DHS Solid Food Introduction Form
• Resources:
  • Infant Meal Pattern Chart
  • Feeding Infants in the CACFP Guide
  • Breastfed Babies Welcome Here

Operating At-Risk

• Forms:
  • At-Risk Point of Service Meal Counts
  • At-Risk 5-Day Reconciliation Form
  • At-Risk Monitoring Form
• Resources:
  • Operating At-Risk in a Childcare Center

Monitoring Sites

• Monitoring Visit Form

Tracking Program Expenses

• Forms:
  • Food Service Cost Report (PDF) (Excel)
  • Time Distribution Report Form
  • Monthly Expense Worksheet (PDF) (Excel)
  • Equipment Pre-Approval Request Form
• Resources:
  • Allowable Expenses in the CACFP

Submitting a Claim

• Reimbursement Rates PY 23-24
• Claims Processing Calendar
• Monthly Claims Preparation Worksheet (Sponsor Claim) (Site Claim)
• Request for One-Time Exception Form