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CACFP Administrative Handbook

Related Forms
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PDF file links below
MS Word file links below
MS Excel file links below
No.
Name
Program Agreement - PDF
Program Agreement - MS Word
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Program Agreement
Form 3-A - PDF
Form 3-A - MS Word Enterable
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Appointment of a New Authorized Representative - Updated 06/2018
Form 3-B - PDF
Form 3-B - MS Word Enterable
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3-B
Verification of CACFP Training Form - Updated 8/2015
Form 4-A - PDF
Form 4-A - MS Word Enterable
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4-A
Infant Meal Offer Form - Updated 03/2017
Form 4-B - PDF
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4-B
Medical Statement to Request Meal Modification - Updated 07/2017
Form 4-D - PDF
Form 4-D - MS Word Enterable
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4-D
Daily Infant Meal Record - Updated 03/2017
Form 4-E - PDF
Form 4-E - MS Word Enterable
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4-E
Individual Weekly Infant Meal Record - Updated 03/2017
Form 6-A - PDF
Form 6-A - MS Word Enterable
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6-A
Building for the Future Poster
Form 6-A Spanish - PDF
Form 6-A Spanish - MS Word Enterable
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6-A
Building for the Future Poster - Spanish
Form 6-B - PDF
Form 6-B - MS Word Enterable
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6-B
Building for the Future Letter - Updated 09/2014
Form 6-B Spanish - PDF
Form 6-B Spanish - MS Word Enterable
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6-B
Building for the Future Letter - Spanish, Updated 09/2014
Form 6-C - PDF
Form 6-C - MS Word Enterable
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6-C
Civil Rights Complaint Form - Updated 3/2014
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USDA website with link to USDA Program Discrimination Complaint Form
Form 6-D - PDF
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6-D
Annual Civil Rights Training Documentation - Updated 10/2016
Annual Civil Rights Training Documentation - Spanish
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6-D
Annual Civil Rights Training Documentation - Spanish, Updated 10/2016
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KSDE Online Civil Rights Compliance in Child Nutrition Programs Training
Form 6-E - PDF
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6-E
Ethnic and Race Classifications
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Form 7A CACFP Ledger for Food Service Fund
7-A
CACFP Ledger for Food Service Fund - 04/30/18
Form 7-B - PDF
Form 7-B - MS Word Enterable
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7-B
CACFP Time & Task Form for Centers
Form 7-C - PDF
Form 7-C - MS Word Enterable
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7-C
Mileage Record for the CACFP
Form 7-D - PDF
Form 7-D - MS Word
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7-D
Price Quotation Record
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Prototype Purchasing Plan
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Prototype Purchasing Plan - Updated 06/2018
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Prototype Written Standard of Conduct
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Prototype Written Standards of Conduct
Form 8-A - PDF
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8-A
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
Form 9-A - PDF
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9-A
CACFP Enrollment Form - Updated 10/2016
CACFP Enrollment Form - Spanish - PDF
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9-A
CACFP Enrollment Form - Spanish, Updated 10/2016
Form 9-B - PDF
Form 9-B - MS Word
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9-B
Automatic Eligibility Summary Form
Enrollment and Income Eligibility Guidance - PDF
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9-C
Enrollment and Income Eligibility Guidance - Updated 06/2018
Form 10-A - PDF
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Form 10-A - MS Excel
10-A
Daily Attendance and Meal Count Roster (3 meals/day for a week)
Form 10-B - PDF
Form 10-B - MS Word
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10-B
Daily Attendance and Meal Count Roster (4 meals/day for a week)
Form 10-C - PDF
Form 10-C - MS Word
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10-C
Daily Attendance and Meal Count Roster by Meal Type
Form 10-D - PDF
Form 10-D - MS Word
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10-D
Daily Attendance and Meal Count Roster by Meal Type for Saturday/Sunday
At-Risk Afterschool Meals Daily Attendance amd Meal Count Roster
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At-Risk Afterschool Meals Daily Attendance and Meal Count Roster
10-E
At-Risk Afterschool Meals Daily Attendance and Meal Count Roster - New 03/2016
Form 11-A - PDF
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11-A
Center Site Review Form - Updated 05/2018
Form 11-C - PDF
Form 11-C - MS Word Enterable
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11-C
Center Site Application - Updated 05/2017
Form 11-D - PDF
Form 11-D - MS Word Enterable
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11-D
Demonstration of Need Form
Form 11-E - PDF
Form 11-E - MS Word
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11-E
Corrective Action Plan
Form 12-A - PDF
Form 12-A - MS Word Enterable
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12-A
Center Reimbursement Claim Form - Updated 3/2014
Form 12-B - PDF
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12-B
Center Claim Instructions - Updated 3/2014
Form 12-C - PDF
Form 12-C - MS Word
Form 12C - MS Excel
12-C
Income Eligibility Categories Summary Form - Updated 09/2017
Form 12-D - PDF
Form 12-D - MS Word Enterable
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12-D
For-Profit Free/Reduced Price Meal Summary Form
Form 12-E - PDF
Form 12-E - MS Word Enterable
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12-E
For-Profit Medicaid Payment Summary Form
Form 12-E - PDF
Form 12-F - MS Word Enterable
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12-F
For-Profit Child Care Subsidies Summary Form - Updated 3/2014
Form 12-G - PDF
Form 12-G - MS Word Enterable
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12-G
Worksheet for Calculating CACFP Reimbursement
Corrective Action Plan - PDF
Corrective Action Plan - MS Word
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12-H
Corrective Action Plan to Accompany a Written Request for a One-Time Exception
Form 13-A - PDF
Form 13-A - MS Word Enterable
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13-A
At-Risk Afterschool Meals Program Application (formerly AEP) - Updated 8/2014

 
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