The following forms are posted to assist you in your management and administration of the adult and child food program within your business.
General Administrative and Policy Forms
Child Enrollment Form
Use this form to enroll all children participating on the Child and Adult Care Food Program with CCNI. Parents must sign and date within the month that participation is to begin. Send to CCNI with claim.
Annually, children must be re-enrolled. This can be done by mail OR renew enrollments online through this website!
Read and follow instructions for automatic deposit of food program reimbursements right into the bank! No more driving to the bank for deposits, or losing checks before they get to the bank! This is a life-saver!
Administrative Review Appeal Form
Use this form for extra clarification on claims (children schedules, split shift schedules, adding meal services, etc)
License Continuation Form
Use the License Continuation Form form for licenser to sign and send to CCNI. This shows that even though a provider’s license has expired, the licenser has been out and completed relicensing (new license hasn’t yet arrived).
Diet Statement Information
Children may need to deviate from the USDA meal pattern guidelines if they have a food intolerance or allergy. Providers must serve the substitutions prescribed by the licensed physician if the child has a disability.
Children without disabilities can request deviations from the meal pattern guidelines, but the provider is not required to provide those changes. In that case, parents are allowed to sign a decline form and the provider won’t claim their meals. If the provider chooses, he/she can serve and claim meals for the child if they follow the diet statement instructions.
However, certain substitutions or alterations can be made and the meal pattern guidelines will still be met. Additionally, a nutritionally equivalent milk substitute can be supplied by the parent or the provider and the provider can still receive reimbursement for the child. Iron-Fortified Infant Formula may also be provided by the parent if the parent chooses not to use the kind offered by the provider. Click here for information on diet statements in relation to milk substitutes and formula statement guidance. Download the list of approved milk substitutes that can be used.
SDS with Disability Word May 2015
Use this form for diet statements for children with disabilities.
SDS without Disability Word May 2015
Use this form for diet statements for children without disabilities.
Use this form when you need a formula statement but not a whole new enrollment (Formula statements are included in enrollments, too)
NonDairy Parent Request Use this form when a parent requests (and can supply) an approved soy substitute for milk. No medically signed statement needed. Just fill out this form and send it to CCNI (provider keep a copy with your records). Click here for an list of Approved soy substitutes
Household Income Information
2016-17 Provider Household Income Statement
This form is used for providers to apply for Tier I rates. If a provider qualifies according to these guidelines, all meals served in the home are at the higher, Tier I level. It may help qualify a brand new provider for receiving a licensing grant from CCNI to help with costs associated with starting a newly licensed child care home.
2016-17 Participating Family Household Income Statement
This form will qualify families with children enrolled in a family child care home so their providers can receive the higher (Tier I) reimbursement rate for meals & snacks their children consume in the child care home.
Menus & Meal Count Information
Infant Menu Form (temporary)
This form is designed to keep track of foods served until you receive mailed, 2-part forms from the office. Fill out this form with the infant menus. Use this only until a supply from the office can be sent with all the updated, pertinent information.(Keep a copy for your records!)
Infant Meal Pattern Guidelines and Regular Meal Pattern Guidelines
CACFP Meal Pattern Guide
These colorful guides are not used as interactive forms, but are helpful when used to determine portion sizes for different age groups of children in care. Download, print and post in your kitchen. This helpful tool aids in planning and serving the right foods in the right amount for each child.
Regular Menus (temporary)
Use only until you receive a supply from the office. Keep a copy for your records. Record menu items served to children 1-12 in care.
Use this form to claim the meals and snacks served to children in care. Remember to claim two meals and one snack per child per day OR two snacks and one meal per child per day.
No Use Form (CACFP Decline form)
Winter Menu Planners
6 weeks worth of fulfilling hot meals and tasty snacks that make eating fun during this cold time of year. Many of these meals and snacks are designed so the children can help, keeping them involved in these nice, wintery indoor activities.
Download Winter Planner 1 | Download Winter Planner 2
Spring Menu Planners
The menus in the Spring planner contain several ideas for spicing up meals during this time of year, before fresh summer and fall produce is available. Lots of great ideas and easy to follow!
Download Spring Planner 1 | Download Spring Planner 2
Summer Menu Planners
Summer items like fresh watermelon, berries and other fruits/vegetables are included in these menu planners. Use these to plan and follow. There are two menus for 6 weeks of ideas and menus.
Download Summer Planner 1 | Download Summer Planner 2
Fall Menu Planners
Fall menu planner contains seasonal foods and dishes usually served in the autumn months! Don?t forget to download both documents!
Download Fall Planner 1 | Download Fall Planner 2
| October, 2015