CCNI Resource Center: Form Library

The Form Library section of our web site gives you tools for use in your business.

Downloadable Forms

Pre-Plan Menus
Instructions for Use:
1. Download and print
2. Follow the menus and date the top of each day that you pertains to the menu used for the day.
3. Make substitutions in the blank days on the upper left portion of the page if you wish to change a menu for the day.
4. Mail AT THE END of each month with a corresponding meal count
5. You may pick and choose any of the menus for any day, just record the date and meal used. For example, you may want to use a supper menu for a lunch, just write the date and the word, "LUNCH" over the supper menu idea. The same can go for evening snacks. Just re-identify any changed meal that you want to use for a different meal or day.
6. You ARE NOT required to use the Menu Planners. You can download and use for ideas, activities, parent information, etc.

Winter Pre-Plan Menu 1
Winter Pre-Plan Menu 2
Spring Pre-Plan Menu 1
Spring Pre-Plan Menu 2
Fall Pre-Plan Menu 1
Fall Pre-Plan Menu 2
Summer Pre-Plan Menu 1
Summer Pre-Plan Menu 2

Provider FSIDS
Provider Family Size and Income Data Sheet--This is the form a provider submits to apply for Tier I rates for her/his own children and all the daycare children enrolled in the home. Most providers also need to submit supporting documentation of their income, including their Tax form 1040, Schedule C, and any other schedules listed on the first page of the 1040. Also, any current pay stub from any household member currently employed. Submit the form to CCNI prior to the end of the month in which you would like to apply for the Tier I rates. Providers must keep a completed copy for own records

Parent Family Size and Income Data Sheet
This can be filled out by parents to report their income and family size. Each family may individually qualify for Tier I rates if the entire Daycare home does not qualify. This form is used only by parents and sent directly to CCNI. If providers would like to distribute this form to parents, they should also give parents an enveloped pre-addressed to CCNI (a stamp would be nice, too.)

Formula Statement
Statement that parents sign IF they wish to supply their own Iron-Fortified Infant Formula and by-pass the brand offered by the daycare provider. Providers must keep a completed copy for own records

Child Enrollment Form
A form used to enroll children into the Child and Adult Care Food Program. Enrolls new children and yearly updates children on the Child and Adult Care Food Program. Remember to fill in USUAL days, hours and meals in care. Provider must keep a copy in home as the Regional Director will check these on every home visit.

Forms and Resources

CCNI Provider Notes
If you need to let CCNI know things about your claims, please use this form and submit with the claim. It will let office know about plans for days off, school aged children claimed during the day while school is in session, Holidays that are claimed, changes to application, and other general information that helps CCNI process your claim and helps the office so much. So, if you need to let us know something special happening on your claim, please submit a "Provider Note".

Direct Deposit Form
No more lost checks in the mail. No more special trips to the bank to deposit your check. With Direct Deposit, we will automatically deposit your reimbursement into your bank and all you have to do is sit back and relax! We will send you a mail notification letting you know when your funds were sent to the bank and how much $$.

Meal Count
Individual children and meals recorded. This form is verified and meals and snacks are paid from the amounts requested day by day, meal by meal. Providers must keep a completed copy for own records

Regular Menu
Records menus of children and foods served. Providers must keep a completed copy for own records

Infant Menu
Records meals that infants consume. Providers must keep a completed copy for own records

Infant Menu Planner
The Infant Menu Planner has pre-planned meals. Using this form means dating, and filling the pertinent information in the boxes. Then, daily, date the form, follow the menu plans and fill in extra foods served. Then, sign and send to CCNI at the end of the month. Nothing could be easier! Be sure to keep a copy for your records!

CACFP Decline Form/Policy
USDA policy insists that all enrolled children have access to the Child and Adult Care Food Program and its benefits. If a parent declines use of the program for their children, they must indicate they have received information regarding the program, but are declining using it for their children.

The CACFP Non-Use Form will document that the parents have received information and access to the program, but do not wish their children to participate.

This form must be filled out by parents and kept in the home if their wish is NOT to have their child(ren) participate on the Child and Adult Care Food Program."