CCNI Provider Forms
Below you’ll find all of CCNI’s printable CACFP forms and documents. Please contact our office with questions. If you do not have access to a printer and would like forms mailed to you, click here to contact us!
Child Enrollment Form
Use this form to enroll all children participating in the Child and Adult Care Food Program with CCNI. Parents must sign and date within the month that participation is to begin. Additionally, children must be re-enrolled annually which takes place in September. Enrollment forms can be submitted to CCNI a couple different ways, but we must receive the form prior to or with the submission of your claim.
Please submit an enrollment one of the following ways:
1. Mail the original form to the CCNI office (keep the yellow copy for your records and the pink copy can be given to the parent)
2. Email a copy of the completed enrollment form to email@example.com. You will receive a reply to notify you that we have received it. You are responsible for keeping the original form on file with your records.
Read and follow instructions for the 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!
Use this form for extra clarification on claims (children schedules, split shift schedules, adding meal services, etc)
License Continuation Form
Your county childcare licenser should complete this form if your childcare address changes or if your re-licensing is taking longer than expected.
Special Diet Statement
Children who need special dietary accommodations including specialty formulas and non-creditable food substitutes must have this form completed by the appropriate licensed medical authority. Contact our office with further questions.
Request for Non Dairy
Certain soy milks are credible as a substitution for cow’s milk. Only the soy milk listed specifically on the Request for Non-Dairy form may be substituted without a Special Diet Statement on file.
If for any reason, a parent does not want their child to participate on the CACFP they can fill out the decline form and discuss with their provider meal options for when the child is in care.
Use this form when you need a formula statement but not a whole new enrollment.
HIS Provider Jul22-Jun23
This form is used for providers to apply for Tier I rates, and/or claiming their own children on the CACFP when other enrolled non-residential daycare children are present for a meal. If a provider qualifies according to these guidelines, all meals served in the home are at the higher Tier I rates.
HIS – Participating Families 2022-23
*Due to the extension of USDA’s Area Eligibility Waiver (now through June 30, 2023) there will be no need for this form. It will be updated again for July 2023 – June 2024. This form will qualify families with children enrolled in a family childcare home so their providers can receive the higher Tier I reimbursement rate for meals & snacks their children consume in the childcare home.
Use this form when submitting request for the licensing start up grant. Must be accompanied by receipts for expenses as well as the HIS Provider 2022-23 form.
Infant Menu PDF
Fill out this form with the infant(s) information and meal components served. Be sure to keep a copy for your records!
Regular Menu PDF
Fill out this form with the meal components served. Be sure to keep a copy for your records!
Meal Count PDF
Fill out this form with the children(s) information as well as meals served. Remember to only claim two meals and one snack per child per day OR two snacks and one meal per child per day. Be sure to keep a copy for your records!
CCNI Provider Appeal Procedure
In the event that you would need to appeal a determination proposed by CCNI follow the procedure in the link above.