Independent Centers and Sponsors of Centers

Annual Administrative Forms

• Administrative Cost Waiver
• Annual CACFP Staff Training Checklist
• Annual CACFP Staff Training Sign-In Sheet
• Prototype Organization Chart
• Ethnicity and Racial Beneficiary Form & Instructions
• Statewide Media Release
• Income Eligibility Guidelines - Current & Historical
• Supporting Documents

Center Attendance

• Center Attendance Record

Claiming

• Center Claim for Reimbursement Instructions
• Center Claim Submission Instructions
• Center Claim Amendment Instructions
• Reimbursement Rates for Centers
• Allowable & Non-Allowable Expenses
• Food Costs
• Time & Attendance/Time Distribution Instructions
• Time & Attendance/Time Distribution Form
• Sample Time & Attendance/Time Distribution Form
• Summary of Costs
• Record of Milk Purchases
• Food Donation Form

Handbooks

• Independent Child Care Centers Handbook
• Serious Deficiency, Suspension, & Appeals Handbook

Income Eligibility Information 

• Income Eligibility Guidelines 
• Household Income Eligibility Statement
• Instructions for Parent/Participants/Guardians
• Instructions for Institutions 
• Dear Parent Guardian Letter
• Dear Parent Guardian Letter (pricing)
• Meal Benefit Income Eligibility

Infant Menu Information

• Infant Meal Pattern Requirements
• Infant Menu Record Instructions
• Menu Record 0-5 Months
• Menu Record 6-11 Months with no supper
• Menu Record 6-11 Months with supper
• Non-Creditable Infant Foods
• Infant Formula/Food Sign-off Statement

Meal Attendance 

• All Category C & Emergency Shelter Children by Date
• All Category C & Emergency Shelter Children by Name
• Meal Attendance (daily)
• Meal Attendance Summary Record
• All Meals and Snacks 
• Weekly Record - Breakfast/Lunch/Snack
• Staff Meal Attendance
• Summary Record Instructions
• Meal Pattern Checklist

Menu Information 

Meal Pattern Flexibility Waiver (SY 2021-2022)

CACFP Meal Pattern Flexibility Waiver (SY 2021-2022) - This waiver request form is for Child and Adult Care Food Program for whole grain-rich, ounce equivalents for grains implementation and flavored milk.

• Menu Record Instructions
• Menu Record BALP
• Menu Record BALPSE
• Meal Pattern Requirements - Ages 1-12
• Menu Substitution Log Instructions
• Menu Substitution Log
• Special Diet Form
• Special Diet Accommodations Guide
• Food Allergy Guidelines
• Creditable Non-Dairy Beverage Chart

Sample Menus:

• CACFP 6-Week Sample Menu
• Pre-K Breakfast Menu (Cold)
• Pre-K Breakfast Menu (Hot and Cold)
• Pre-K Lunch (Cold)
• Pre-K Lunch (Hot)

Parent Forms 

• Participant Enrollment Form
• Infant Formula/Food Sign-off Statement
• Special Diet Form
• Special Diet Accommodations Guide
• Building the Future with CACFP Flyer

Sponsors of Centers

• Permanent Agreement - Sponsor or Unaffiliated Center for CACFP

For questions regarding the following forms, please contact your Program Analyst:

• Monitoring Form for Sponsors of Centers

(Use this for the following program or when you have combination programming: Child Care - including GSRP and Head Start, Emergency Shelter, At-Risk Afterschool)

• Monitoring Form for Sponsors of Centers with Adult Day Services

(Use this for the following program or when you have combination programming: Child Care - including GSRP and Head Start, Emergency Shelter, At-Risk Afterschool, Adult Day Services)

• Monitoring Form for Sponsors of At-Risk Afterschool Programs ONLY

(If you have a facility that operates both a child care program and at-risk program at the same facillity then you should NOT use this form)

• Additional Room Worksheet for Meal Observation

(Use this form if the site you are reviewing has additional rooms that need to be reviewed as part of your monitoring review)

• Five-Day Meal Count Reconciliation Attachment A

(Use this form if enrollment is higher than 70 participants)

• Monitoring Tracking Tool is available upon request.  

Word versions of forms are available by emailing MDE-CACFP@michigan.gov.