Program Forms and Resources CACFP

• CACFP At a Glance Calendar
• Claims Processing Calendar
• Renewal Preparation Checklist

Administrative 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
• Media Release for Non-Pricing Programs
• Free and Reduced-Price Policy Statement for Non-Pricing Programs
• Organization's Certificate of Incorporation
• Civil Rights Pre-Award Compliance
• Procurement Standards and Code of Conduct
• Food Service Contract Document, if applicable – contact [email protected]
• Template Forms:
  • Recordkeeping Policy Template
  • Sample Outside Employment Policy
  • Sample Job Descriptions

Adding a Site:

• 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 the specialist)
• Child Care Standards for Unlicensed Facilities

Household Contact Procedure:

• Household Contact Procedures
• Household Contacts Parent Survey (Phone)

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

• 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

• 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 (Effective July 1, 2025 - June 30, 2026)
• Income Eligibility Guidelines (Effective July 1, 2026 - June 30, 2027)
• Claiming Rosters (PDF) (Excel)

Adult Care Center Enrollment:

• Meal Benefit Income Eligibility Form
• Required Resources to Provide Families: (Instructions) (FAQ)
• Income Eligibility Guidelines (Effective July 1, 2025 - June 30, 2026)
• Income Eligibility Guidelines (Effective July 1, 2026 - June 30, 2027)
• 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
• Grains Ounce Equivalents
  • Exhibit A
  • Using Ounce Equivalents for Grains in the CACFP
• Meal Quality Guidance Tool
• 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)

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:

• Claims Processing Calendar
• Monthly Claims Preparation Worksheet (Sponsor Claim) (Site Claim)
• Request for One-Time Exception Form

Program Calculators:

• Projected Reimbursement Calculator
• Reasonable Budget Range Calculator

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

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
• Child Care Standards for Unlicensed Facilities

• Monitoring Visit Form
• Sample Unannounced Review Policy
• Template Monitoring Visit Schedule