Adult Care Guidance Memorandums

Table of Contents

CACFP Recordkeeping Resources
 
GM 1A: Income Statements
GM 2: Reimbursement Rates
GM 3A: Claims
GM 4: Procurement
GM 5A: Sponsoring Organizations
GM 6A: Enrollment
GM 8A: Civil Rights
GM 9A: Recordkeeping
GM 11: Financial Management
GM 12A: Meal Requirements
Meal Planning and Production Records
Crediting Foods
Menus
Meal Service Styles
Food Safety
Drinking Water
GM 12A: Special Dietary Needs

CACFP Recordkeeping Resources
 

CACFP Recordkeeping Resources: Webinar summarizing below Recordkeeping Resources
 
Requirements Checklist
 
Required Documents List
 
New Staff Responsible for CACFP

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1A: Household Size-Income Statements and Determining Eligibility
 

Household Letter
 
Household Size-Income Statement

• Instructions for Determining Income Statements
• How to Use the Household Member Signature Date

Household Size-Income Scale, July 1, 2020 - June 30, 2021
 
Household Size-Income Record
 
Household Size-Income Record

• Household Size Income Record Reminders

Monthly HSIS/HSIR Checklists

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  2: CACFP Reimbursement – Effective July 1, 2020
 

2020-21 Reimbursement Calculation Worksheet

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3A: Claims
 

Instructions for Completing the Claim Form - Adult Care Component PI-1489-A
 
CACFP Claim Form - Adult Care Component PI-1489-A
 
Meal Edit Check (Sponsoring Organizations Only)

• Meal Edit Checks - 2 Sites (Sponsoring Organizations Only)

Monthly Claim Checklist

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4: Procurement and Vendor Agreements
 

CACFP Vendor Agreement to Provide Meals/Snacks - (Fillable PDF)
 
Vendor Meals Delivery Slip
 
Record of Potential Vendors Contacted ($10,000 - $250,000)
 
Methods of Procurement

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5A: Sponsoring Organization Requirements
 

Monitoring
 

CACFP Site Pre-operational Visit Form
 
CACFP Monitoring Form
 
Monitoring Tracking Form
 
Imminent Threat & Serious Deficiencies
 
Household Contact Procedure

Training
 

CACFP Training Checklist for Sponsoring Organizations
 
CACFP Training Agenda

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6A: Enrollment
 

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8A: Civil Rights
 

And Justice for All Poster To order a poster, complete this order form
 
Annual Ethnic/Racial Data Collection Form
 
Nondiscrimination statement with Complaint Filing Procedure
 
2020-2021 Statewide Media Release
 
CACFP Information Sheet

Civil Rights Training
 

• Civil Rights Training PowerPoint
• Civil Rights Training Handout
• Civil Rights Training Attendance Sheet

New Agency Only
 

• Instructions for Letter to Minority and Grassroots Organizations
• Letter to Minority and Grassroots Organizations

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9A: Recordkeeping
 

Meal Count Forms
 

• Daily Participation and Meal Count Record
• Record-by-Name Meal Count Form
• Greater than Three Meals Record

CACFP Training Agenda
 
Electronic Storage of CACFP Records and Data - Policies and Procedures

Corrective Action Plan Form
 

• Corrective Action Plan Form
• Sample Corrective Action Plan Form

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11: Financial Management
 

Independent Centers
 

How to Submit the Annual CACFP Financial Report

• Annual Financial Report (paper form)

CACFP General Ledger for Independent Centers
 
CACFP Daily Time Log for Independent Centers

Sponsoring Organizations
 

How to Submit the Quarterly CACFP Financial Report

• Quarterly Financial Report for Sponsors of Affiliated Sites (paper form)
• Quarterly Financial Report for Sponsors of Unaffiliated Sites (paper form)

CACFP General Ledger for Sponsoring Organizations
 
CACFP Time Log for Sponsoring Organization

Financial Management Resources - FOR ALL AGENCIES:
 

Frequent CACFP Costs
 
USDA Assessing Costs in the CACFP
 
CACFP Financial Management Regulations (796-2, rev. 4)
 
Local Food Purchase Log
 
Donated Food Log

Other Resources - FOR ALL AGENCIES:
 

CACFP Appeal Procedure and Request Form

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12A: Meal Requirements
 

Adult Day Center Meal Pattern

Meal Planning and Production Records
 

• Meal Requirements Calculator
• Food Buying Guide Calculator
  • Food Buying Guide Calculator Instructions
• Production Records
  • Breakfast, Lunch/Supper, Snack (Weekly)
  • All Meals (Daily)
  • Instructions for Production Records

Crediting Foods
 

• USDA Crediting Handbook for the CACFP
• New Creditable Foods
  (Shelf-stable meat, poultry, and seafood products; Tempeh; Corn masa, masa harina, nixtamalized corn flour/cornmeal; Hominy; Popcorn; Coconut; Surimi seafood; Pasta products made of vegetable flour)
• CACFP Reference Guide (Whole-grains, cereal, and yogurt)

Grains

• Wisconsin WIC Approved Whole Grains
• Whole Grain-Rich Flow Chart
• Grains Chart
• Cereals that Meet CACFP Requirements
• Is it a Grain-Based Dessert?

Meat and Meat Alternates

• Crediting Store-bought Combination Foods
• Creditable and Non-Creditable Cheese
• Cheese Slices and Nut/Seed Butters
• Local Meats, Poultry, and Eggs
• Tofu Recipes

Fruit and Vegetables

• Additional Creditable Fruits and Vegetables
• Smoothies
• Visual Portion Size Guide: Fruit
• Visual Portion Size Guide: Vegetables

Menus
 

• Menu Checklist

Meal Service Styles
 

Food Safety
 

• Food Safety & Sanitation
• Safe Food Storage
• CACFP Food Storage Chart

Drinking Water
 

• Drinking Water
• Lead Exposure
• Federal Nutrition Programs: Reducing the Impact of Lead Exposure

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12A: Special Dietary Needs
 

CACFP Special Dietary Needs Tracking Form
 
Special Dietary Needs and the CACFP
 
Determining if Meal Modifications Are Required Flowchart
 
Statement for Special Dietary Need Request Flowchart
 
Medical Statement Template
 
Creditable Non-Dairy Beverages

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