Child and Adult Care Food Program (CACFP)
Forms, Documents, and Resources
Adding a New Site
Instructions
for Adding a New Site 
Documentation of For-Profit Eligibility—for-profit child care institutions ONLY) (ISBE 67-91)
Household Income
Eligibility
CACFP Household Eligibility
Booklet (for Centers), Effective July 1, 2008
Spanish Household Eligibility Application and Spanish Annual Enrollment Forms are now included in the Household Eligibility Application booklet above
CACFP Household Eligibility Application No Shading Effective July 1, 2008
Application
Materials in Other Languages
When you click the link above
you will be connected to the USDA website which lists different
translations for the household
application (meal benefits) documents. Regardless of the
language you select, you must print the following four
documents for the parents.
• CACFP Parent Letter
• Meal Benefit Form
• Meal Benefit Form Instructions
• Eligibility Disclosure Letter
to Parents (SCHIP Declination)
Annual Enrollment Form
CACFP Annual
Enrollment Documentation
Food Vendor Agreements, Renewal, and Certification Regarding
Debarment
School Agreement
to Furnish Food Service
(ISBE 68-62)
Sponsors use this document when purchasing meals from a school
district.
Small Purchase
Agreement for Procurement of Vended Meals (ISBE 67-89)
For-profit sponsor with annual vended meal purchases less
than $10,000 OR
not for-profit sponsors with annual vended meal purchases
less than $100,000 may use this agreement. Also complete the
Certification Regarding Debarment form.
Renewal of Competitively
Bid Vended Meal Contracts (ISBE 67-90)
For-profit sponsor with annual vended meal purchases greater
than $10,000 OR not for-profit sponsors with annual vended
meal purchases greater than $100,000 are allowed to renew
their contract for four consecutive years after the original
year of the contract. After operating with the same contract
for five years, the contract cannot be renewed and must be
rebid. Also complete the Certification Regarding Debarment
form.
Certification Regarding Debarment,
Suspension, Ineligibility, and Voluntary Exclusion Lower Tier
Cover Transitions (ISBE 85-34)
Sponsors who purchase vended meals must have the food vendor
sign this document each year. School districts are exempt
from completing this document.
Invitation to Competitively Bid Food Vendor Contract
Sponsors must e-mail or call to request a copy of the Invitation
to Bid packet. For-profit sponsor with annual vended meal
purchases greater than $10,000 OR not for-profit sponsors
with annual vended meal purchases greater than $100,000 must
competitively bid the contract.
Vendor Listing
The Vendor Listing provides known food vendors having an interest in providing vended meals for Child Nutrition Programs in Illinois. The Illinois State Board of Education does not endorse these companies in any way.
Monthly Forms to Operate CACFP
Monthly Milk Purchase
Summary (ISBE 67-94)
Sponsors should complete form monthly to ensure enough milk
is purchased for number of meals claimed.
Edit Checks 1 and
2 (ISBE 65-09)
Prior to submitting a monthly claim, a sponsoring organization must complete two different edit checks for each
facility.
Monthly
Profit (or Loss) Summary (ISBE 67-93)
Sponsors should complete form monthly to ensure food
service operates annually
at a non-profit status.
Monthly Profit
(or Loss) Summary Detail Instructions
AFR
Data Collection Spreadsheet (Federal Fiscal Year 2007) 
AFR
Data Collection Spreadsheet (Federal Fiscal Year 2008)
Meal
Participation Record (ISBE 68-75)
This form is recommended to be used to record children’s
meals for a specific meal service. One Meal Participation
Record should be used for each meal. The form also provides
a method for sponsoring organizations to check for block
claiming.
You can also type on this form. To save a copy your computer
must have the full version of Adobe Acrobat Reader. Even
though
you probably won't be able to save the form, you can enter
the type of meal service, site name, month and year, days
of the month, and the names of the children; then print the
form. You may want to keep a clean completed copy to use
as
a master copy.
Meal
Participation Record for Homeless/Emergency Shelter (ISBE
69-04)
Total
Meals Recap (ISBE 67-22)
Program
and Nonprogram Adult Food Service Participation Form (ISBE 68-31)
At-Risk
After-School Snack/Supper Program Daily Meal Count Form (ISBE
69-14)
Master List of Eligible
Children (ISBE 67-95)
This document will help you maintain a list of the children
eligible for free and reduced-price meals.
Head Start Master List
(ISBE 65-10)
Master
List for Homeless Shelter
This document will help you create
a list of eligible CACFP participants, including children
birth through 18 years and
disabled adults.
Cash Disbursements
Form (ISBE 67-24)
This form can be used to easily document all monthly expenses
associated with the food service.
Cash
Disbursements Journal
This is a Microsoft Excel worksheet designed to calculate
totals as the spreadsheet is populated each month with all
monthly expenses associated with the food service. Use this
form if you have Microsoft Excel. Use form ISBE 67-24 above
if you do not have Microsoft Excel.
Personnel
Activity Report
Monthly
Documents Checklist (ISBE 69-03)
Annual
Documents Checklist (ISBE 69-02)
Other Important Documents
Meal Chart for Children 1 to 12 Years
Sponsor must use to plan menus and ensure menus meet requirements.
Infant Meal Pattern and Requirements
Sponsor must use to plan menus and ensure menus meet
requirements.
Infant
Formula/Food Waiver Notification
Sponsor must have parent complete when enrolling infant.
Infant—Are These
Infant Meals Reimbursable?
This chart is a useful tool to determine when an infant’s
meal is reimbursable.
Documentation of
Training Form
(ISBE 67-25)
All institutions must conduct CACFP training for key staff
from every facility prior to beginning CACFP operations and
annually thereafter. Also, all institutions are required
to conduct Civil Rights training annually for all supervisors
of frontline staff and for all frontline staff who interact
with children and their parents.
Preapproval Form for
Sponsors (ISBE 67-60)
Sponsoring organizations with more than one site should use
this form when adding a new site to the CACFP.
Monitor Review Form
for Sponsors (ISBE 67-59)
Sponsoring organizations with more than one site should use
this form to complete three monitoring reviews each year for
child care centers, Head Start, outside school hour programs
and homeless shelters. This document includes the 5 day reconciliation
requirements.
At-Risk Monitor Form
for Sponsors (ISBE 67-77)
Sponsoring organizations with more than one site should use
this form to complete three monitoring visits each year for
At-Risk After-School Snack/Supper Programs. This document
includes the 5 day reconciliation requirements.
Fact Sheets for Various Programs
Checklist
for At-Risk After-School Snack/Supper Program—This
list of responsibilities must be followed
when participating in the At-Risk After-School Snack/Supper
Program.
CACFP Program Review
Checklist
For Profit Audit Checklist
Medical Exception
Statement for Food Substitution (ISBE 67-44)
This form should be used when a child needs specific changes
made to their meal(s) for medical reasons.
Summary of
Civil Right Requirements
All institutions must document civil rights requirements every
year.
Building for
the Future (Tri-fold Brochure)
All institutions must provide parents at enrollment a copy
of this brochure or display it on a bulletin board or in a
noticeable location.
Household Contact
System for Sponsoring Organizations
These forms should be used if a sponsoring organization needs
to contact households as part of a monitoring review due to
meal count inconsistencies with attendance or problems found
from a block claiming edit system
Procedure for an Administrative
Review (formerly called Appeal Procedure)
This procedure must be followed when an institution does not
agree with actions taken by the Illinois State Board of Education.
Menu Planning Forms
Sample Menus
- Sample
Snack Menus
Ten weeks of sample snack menus that meet the Child and
Adult Care Food Program Meal Pattern Requirements recommended
for children ages 3-5 years old.
- 21-Day Sample
Cycle Menu
A sample cycle menu for breakfast, lunch, and snack that
meets the Child and Adult Care Food Program Meal Pattern
requirements for children ages 3-5 years.
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