11110 County Codes by Community Operations Field Office

Section 11000 Resources

Table of Contents

11100 Administration 11110 County Codes by Community Operations Field Office 11120 Food and Nutrition Community Operations Field Offices 11130 Education Service Center Offices 11140 Sample Forms 11141 Time Distribution Report 11141.1 Instructions – Time Distribution Report 11142 Household Contact Form 11143 Daily Infant Food Record 11144 CACFP Infant Feeding Preferences 11145 Shared Income Eligibility Documentation – Form and Instructions 11150 Statement of Child’s Enrollment Examples 11150.1 Even Start Family Literacy Program 11150.2 Head Start Program 11150.3 Early Head Start Program 11160 Parental Notification Flyers in English and Spanish – Building for the Future 11160 Texas Department of Family and Protective Services – Sample print screen 11170 Verification of Provider’s Income 11170.1 Via IRS Form 1040 11170.2 Without IRS Form 1040 – Sample Worksheet

Texas Department of Agriculture – January 2015 Resources – 1 Child and Adult Care Food Program – Day Care Homes Handbook 11200 Training 11210 Training Registration 11220 Sample Training Registration and Activity Report for Contracting Entity Staff 11230 USDA Team Nutrition Materials 11240 National Food Service Management Institute (NFSMI) Resources and Training

11300 Other Resources & Additional Information 11310 Other Child Nutrition Publications 11320 Imported Plasticware Safety

11400 Menu Planning 11410 Meal Planning 11410.1 USDA, ARS National Nutrient Database for Standard Reference 11410.2 Manual Conversion for Nutrients per Portion of a Ready-to- Eat Breakfast Cereal 11410.3 Manual Conversion for Nutrients per Portion of a Ready-to- Cook Breakfast Cereal 11420 Child Care Recipes 11430 Calculating Percentage of Calories from Fat 11440 Meat versus Protein Fact Sheet

11500 USDA CN Labels 11510 Unapproved CN Labels 11520 Approved CN Labels

Resources – 2 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11600 Sample Provider Serious Deficiency Letters 11610 Notice of Serious Deficiency 11620 Notice of Proposed Termination and Proposed Disqualification 11630 Notice of Termination and Disqualification 11631 Provider Fails to Appeal 11632 Sponsor Wins Appeal 11640 Notice of Temporary Deferral 11641 Provider Wins Appeal 11642 Notice of Successful Corrective Action 11650 Imminent Threat to Health or Safety 11651 Notice of Serious Deficiency, Suspension, Proposed Termination and Proposed Disqualification 11652 Notice of Termination and Disqualification – Sponsor Wins Appeal 11653 Notice of Termination and Disqualification – Provider Fails to Appeal 11654 Notice of Temporary Deferral – Provider Wins Appeal

Texas Department of Agriculture – January 2015 Resources – 3 Child and Adult Care Food Program – Day Care Homes Handbook 11000 Resources

11100 Administration

11110 County Codes by Community Operations Field Office

El Paso Andrews 002 Gaines 083 Motley 173 Armstrong 006 Garza 085 Nolan 177 Bailey 009 Glasscock 087 Ochiltree 179 Borden 017 Gray 090 Oldham 180 Brewster 022 Hale 095 Parmer 185 Briscoe 023 Hall 096 Pecos 186 Brown 025 Hansford 098 Potter 188 Callahan 030 Hartley 103 Presidio 189 Carson 033 Haskell 104 Randall 191 Castro 035 Hemphill 106 Reeves 195 Childress 038 Hockley 110 Roberts 197 Cochran 040 Howard 114 Runnels 200 Coleman 042 Hudspeth 115 Scurry 208 Collingsworth 044 Hutchinson 117 Shackelford 209 Comanche 047 Jeff Davis 122 Sherman 211 Crane 052 Jones 127 Stephens 215 Crosby 054 Kent 132 Stonewall 217 Culberson 055 King 135 Swisher 219 Dallam 056 Knox 138 Taylor 221 Dawson 058 Lamb 141 Terrell 222 Deaf Smith 059 Lipscomb 148 Terry 223 Dickens 063 Loving 151 Throckmorton 224 Donley 065 Lubbock 152 Upton 231 Eastland 067 Lynn 153 Ward 238 Ector 068 Martin 156 Wheeler 242 El Paso 071 Midland 165 Winkler 248 Fisher 076 Mitchell 168 Yoakum 251 Floyd 077 Moore 171

Resources – 4 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook Dallas/Fort Worth Metroplex Anderson 001 Franklin 080 Montague 169 Archer 005 Freestone 081 Morris 172 Baylor 012 Grayson 091 Navarro 175 Bell 014 Gregg 092 Palo Pinto 182 Bosque 018 Hamilton 097 Panola 183 Bowie 019 Hardeman 099 Parker 184 Camp 032 Harrison 102 Rains 190 Cass 034 Henderson 107 Red River 194 Cherokee 037 Hill 109 Rockwall 199 Clay 039 Hood 111 Rusk 201 Collin 043 Hopkins 112 San Saba 206 Cooke 049 Hunt 116 Smith 212 Coryell 050 Jack 119 Somervell 213 Cottle 051 Johnson 126 Tarrant 220 Dallas 057 Kaufman 129 Titus 225 Delta 060 Lamar 140 Upshur 230 Denton 061 Lampasas 142 Van Zandt 234 Ellis 070 Limestone 147 Wichita 243 Erath 072 Marion 155 Wilbarger 244 Falls 073 McLennan 161 Wise 249 Fannin 074 Milam 166 Wood 250 Foard 078 Mills 167 Young 252

Houston Angelina 003 Hardin 100 Orange 181 Austin 008 Harris 101 Polk 187 Brazoria 020 Houston 113 Robertson 198 Brazos 021 Jackson 120 Sabine 202 Burleson 026 Jasper 121 San Augustine 203 Calhoun 029 Jefferson 123 San Jacinto 204 Chambers 036 Lavaca 143 Shelby 210 Colorado 045 Leon 145 Trinity 228 DeWitt 062 Liberty 146 Tyler 229 Fort Bend 079 Madison 154 Victoria 235 Galveston 084 Matagorda 158 Walker 236 Goliad 088 Montgomery 170 Waller 237 Gonzales 089 Nacogdoches 174 Washington 239 Grimes 093 Newton 176 Wharton 241

Texas Department of Agriculture – January 2015 Resources – 5 Child and Adult Care Food Program – Day Care Homes Handbook San Antonio County Code County Code County Code Atascosa 007 Gillespie 086 Medina 163 Bandera 010 Guadalupe 094 Menard 164 Bastrop 011 Hays 105 Reagan 192 Bexar 015 Irion 118 Real 193 Blanco 016 Karnes 128 Schleicher 207 Burnet 027 Kendall 130 Sterling 216 Caldwell 028 Kerr 133 Sutton 218 Coke 041 Kimble 134 Tom Green 226 Comal 046 Kinney 136 Travis 227 Concho 048 La Salle 139 Uvalde 232 Crockett 053 Lee 144 Val Verde 233 Dimmitt 064 Llano 150 Williamson 246 Edwards 069 Mason 157 Wilson 247 Fayette 075 Maverick 159 Zavala 254 Frio 082 McCullough 160

San Juan Aransas 004 Jim Wells 125 San Patricio 205 Bee 013 Kenedy 131 Starr 214 Brooks 024 Kleberg 137 Webb 240 Cameron 031 Live Oak 149 Willacy 245 Duval 066 McMullen 162 Zapata 253 Hidalgo 108 Nueces 178 Jim Hogg 124 Refugio 196

Resources – 6 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11120 Food and Nutrition Community Operations Field Offices

Austin Field Office (Region 4 Satellite Office) Dallas/Fort Worth Metroplex Field Office (Region 2) Texas Department of Agriculture Texas Department of Agriculture Food and Nutrition Food and Nutrition 1700 North Congress Avenue 1501 Circle Drive, Suite 155 Austin, TX 78701 Fort Worth, TX 76119 P.O. Box 12847 Telephone: (817) 321-8101 Austin, Texas 78711-2847 Fax: (888) 223-9037 Telephone: (877) 839-6325 Fax: (888) 237-5148

El Paso Field Office (Region 1) Houston Field Office (Region 3) Texas Department of Agriculture Texas Department of Agriculture Food and Nutrition Food and Nutrition 401 E. Franklin, Suite 410 Elias Ramirez State Office Building El Paso, TX 79901 5425 Polk Street, Suite G-40 Telephone: (915) 834-7506 Houston, TX 77023 Fax: (888) 244-9816 Telephone: (713) 921-8201 Fax: (888) 244-9764

Lubbock Field Office (Region 1 Satellite Office) Lufkin Field Office (Region 3 Satellite) Texas Department of Agriculture Texas Department of Agriculture Food and Nutrition Food and Nutrition West Texas Regional Office 3009 S. John Redditt Dr., Ste. E, No.323 4502 Englewood Ave. Lufkin, TX 75904-5669 Lubbock, TX 79414 Telephone: (936) 499-7837 or (936) 648-6879 Telephone: (806) 799-8555 Fax: (936) 639-3125 Fax: (888) 244-9816

San Antonio Field Office (Region 4) San Juan Field Office (Region 5) Texas Department of Agriculture Texas Department of Agriculture Food and Nutrition Food and Nutrition 8918 Tesoro Drive, Suite 120 Valley Regional Office San Antonio, TX 78217 900-B E. Expressway 83 Telephone: (210) 820-0288 San Juan, TX 78589 Fax: (888) 244-9763 Telephone: (956) 787-8866 Fax: (888) 250-4627

Texas Department of Agriculture – January 2015 Resources – 7 Child and Adult Care Food Program – Day Care Homes Handbook 11130 Education Service Center Offices

Region 1 Region 2 Edinburg Corpus Christi FAX (956) 984-7637 FAX (361) 561-8689 (956) 984-6000 (361) 561-8400 1900 West Schunior 209 N Water Street Edinburg, Texas 78541 Corpus Christi, Texas 78401

Region 3 Region 4 Victoria Houston FAX (361) 576-4804 FAX (713) 744-4419 (361) 573-0731 (713) 462-7708 1905 Leary Lane 7145 West Tidwell Victoria, Texas 77901 Houston, Texas 77092

Region 5 Region 6 Beaumont Huntsville FAX (409) 833-9755 FAX (936) 295-1447 (409) 951-1700 (936) 435-8400 350 Pine Street, Suite 500 3332 Montgomery Road Beaumont, Texas 77701 Huntsville, Texas 77340

Region 7 Region 8 Kilgore Mt. Pleasant FAX (903) 988-6860 FAX (903) 575-2610 (903) 988-6700 (903) 572-8551 1909 North Longview Street Mailing: P.O. Box 1894 Kilgore, Texas 75662 Mt. Pleasant, Texas 75456 Physical: 4845 US Highway 271 North, Pittsburg, Texas 75686

Region 9 Region 10 Wichita Falls Richardson FAX (940) 767-3836 FAX (972) 348-1387 (940) 322-6928 (972) 348-1700 301 Loop 11 400 E. Spring Valley Road Wichita Falls, Texas 76306 Richardson, Texas 75081

Region 11 Region12 Ft Worth Waco FAX (817) 740-3601 FAX (254) 666-0696 (817) 740-3600 (254) 297-1212 3001 North Freeway Mailing: P.O. Box 23409 Ft Worth, Texas 76106 Waco Texas 76712 Physical: 2101 W Loop 340 Waco, Texas 76712

Resources – 8 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook Region 13 Region 14 Austin Abilene FAX (512) 919-5430 FAX (325) 675-8659 (512) 919-5228 (325) 675-8600 5701 Springdale Road 1850 State Highway 351 Austin Texas 78723 Abilene Texas 79601

Region 15 Region 16 San Angelo Amarillo FAX (325) 655-4823 FAX (806) 677-5001 (325) 658-6571 (806) 677-5000 Mailing: P.O. Box 5199 5800 Bell Street San Angelo Texas 76902 Amarillo Texas 79109 Physical: 612 South Irene Street, San Angelo 76903

Region 17 Region 18 Lubbock Midland FAX (806) 799-8630 FAX (432) 567-3290 (806) 972-4000 (432) 563-2380 1111 W. Loop 289 Mailing: P.O. Box 60580 Lubbock Texas 79416 Midland Texas 79711 Physical: 2811 LaForce Blvd.

Region 19 Region 20 El Paso San Antonio FAX (915) 780-5325 FAX (210) 370-5754 (915) 780-1919 (210) 370-5200 6611 Boeing Drive 1314 Hines Avenue El Paso, Texas 79925 San Antonio Texas 78208

Texas Department of Agriculture – January 2015 Resources – 9 Child and Adult Care Food Program – Day Care Homes Handbook 11140 Sample Forms

11141 Time Distribution Report

Employee Name Position Normal Work Hours Month/Year

WORK FOOD SERVICE FOOD SERVICE OPERATIONS TASKS HOURS ADMINISTRATION TASKS A. B. C. D. E. F. G. H. I. J. Day Start End Managing Planning Organizing Menu Meal Meal Supervise Meal Non Total Planning Prep/Serve Clean- Meal Records Food Hours Up Service 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Monthly Totals

Resources – 10 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook Total Food Service Hours______+ Total Non-Food Service Hours ______= Total Hours Worked ______□ Alternate Certification Statement: I certify that I am on a fixed work schedule. My work days are______through______. My work hours are______a.m. to______p.m. I did not work outside the hours of my fixed schedule, and all my work hours were spent performing Food Service duties.

I certify that all information is true and correct.

______Signature – Employee Date Approval: ______Signature – Supervisor Date

Form Revised November 2011

Texas Department of Agriculture – January 2015 Resources – 11 Child and Adult Care Food Program – Day Care Homes Handbook 11141.1Instructions – Time Distribution Report

PURPOSE Work Hours – The employee enters the start and end time To document the amount of time spent performing for each workday. More than one time may be entered if Food Service and Non-Food Services tasks for each the employee has a break in work hours other than normal day of the month. This information is used to lunch and break times. establish the portion of costs that may be claimed as Food Service labor. Food Service Administration Tasks and Food Service Operations Tasks – The employee enters the amount of PROCEDURE time spent performing Food Service tasks in the column that best describes the nature of the activity. Time must When to Prepare be reported in 15 minute intervals. Employees should round up or down to the nearest half-hour. This should All full-time and part-time employees whose reflect an after-the-fact determination of the actual time compensation in whole or in part is paid with Food spent in each activity. Service funds must complete this report. The Information must account fort the total activity for Non Food Service – The employee enters the amount of which each employee is compensated. The reports time spent performing tasks that ARE NOT related to the must reflect an after-the-fact determination of the administration or operation of the Food Service. Time actual activity of each employee. A separate report must be reported in 15 minute intervals. Time should be is required for each employee. rounded up or down to the nearest half-hour. This should reflect an after-the-fact determination of the actual time Number of Copies spent in each activity.

Complete one original for each employee for each Total Hours – The employee enters the total number of month. hours worked that day. It should agree with the total of the hours entered under the task columns. Transmittal Monthly Total – Enter the total time spent performing the Keep the completed and signed form in your files. task identified in each column.

Form Retention Total Food Service Hours – Enter the total of columns A, B, C, D, E, F, G, and H. Keep the Time Distribution Report for three years from the end of the contract period. Exception: If Total Non-Food Service – Enter the total time noted in audit findings, claims, or litigation have not been column I. resolved by the end of the retention period, all forms and records must be retained until all issues are Total Hours Worked – Enter the total hours worked resolved. during the month. This entry should agree with the total of column J.

DETAILED INSTRUCTIONS Alternate Certification Statement – This certification statement may be completed in lieu of the detailed daily Employee Name – Enter the name of the employee time distribution entries if the employee did not work whose time distribution is being recorded. outside of the fixed schedule and all hours were spent performing Food Service duties. Position – Enter the title of the position for this employee. Signature and Date – Employee – The employee must sign and date the document to certify that all information Normal Work Hours – Enter the normal start and is true and correct. end time for this employee. Signature and Date – Supervisor – The employee's Month/Year – Enter the month and the year covered supervisor must sign and date the document to show by this time distribution report. approval of the form.

Day – No entry is required. This column indicates that day of the month.

Resources – 12 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11142 Household Contact Form

Child and Adult Care Food Program HOUSEHOLD CONTACT FORM

Provider Name: Name of Staff Member Conducting the Household Contact: Child/Children Names: Name Of Person Interviewed:

Reason for Initiating Household Contact:

Attempt #1 Attempt #2 Attempt #3 Date: ______Date: ______Date: ______Type of Contact: ______Type of Contact: ______Type of Contact: ______Contact: Yes No Contact: Yes No Contact: Yes No Initiate Secondary Contact: State circumstances for no contact: State circumstances for no contact: Yes No ______State circumstances for no ______contact and initiation of secondary contact: ______

Information Obtained from Household Contact:

Action Taken:

Texas Department of Agriculture – January 2015 Resources – 13 Child and Adult Care Food Program – Day Care Homes Handbook 11143 Daily Infant Food Record

The form on the next page is a TDA developed alternate form that may be used as an alternate to Form H1530-A, Daily Meal Production Record for Infants. The use of this form requires no further approval from F&N.

Resources – 14 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook Texas Department of Agriculture November 2011 Daily Infant Food Record Name of Contracting Entity: CE ID: Name of Site: Date:

AGE GROUP MENU NAME OF INFANT Date of Birth BREAKFAST A.M. LUNCH P.M. SUPPER EVENING Formula/Breast Milk SNACK SNACK SNACK Iron Fortified Infant Formula (IFIF) and/or IFIF and/or IFIF and/or BM IFIF and/or BM IFIF and/or BM IFIF and/or BM BIRTH THROUGH 3 MONTHS Breast Milk (BM) BM Name: DOB: IFIF /BM: Name: DOB: IFIF/BM: Name: DOB: IFIF /BM: Name: DOB: IFIF /BM: Planned participation:

Quantity Used:

Formula 4 THROUGH 7 MONTHS IFIF and/or Other Foods IFIF and/or IFIF and/or Other Foods IFIF and/or BM and/or Other Foods IFIF and/or BM BM BM BM Breast Milk Name: DOB: IFIF /BM: Name: DOB: IFIF /BM: Name: DOB: IFIF /BM: Name: DOB: IFIF /BM: Planned participation:

Quantity Used:

Fruit IFIF/BM/Fruit Fruit IFIF/BM/Fruit Fruit IFIF/BM/Fruit Juice 8 THROUGH 11 MONTHS IFIF and/or IFIC and/or Veg Juice and IFIF and/or and/or Veg IFIC and/or Juice and Other IFIF and/or and/or Veg IFIC and/or and Other Foods BM Other Foods BM Meat/Alt Foods BM Meat/Alt Name: DOB: IFIF /BM: Name: DOB: IFIF /BM: Name: DOB: IFIF /BM: Name: DOB: IFIF /BM: Planned participation:

Quantity Used:

Meals Claimed Breakfast: ______A.M. Snack: ______Lunch: ______P.M. Snack: ______Supper: ______Evening Snack: ______

Resources – 15 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook Instructions

Daily Infant Food Record

11-2011

PURPOSE

To document that infant meals served daily at child care centers, emergency shelters and day care homes are eligible for program reimbursement.

PROCEDURE

When to Prepare

The menu may be planned in advance; however, complete the entire form daily at the time of meal service.

Number of Copies

Day care home providers and child care sites complete one original and one copy. Independent centers and emergency shelters complete one original.

Transmittal

Day care home providers and sponsored child care sites retain the copy for their files and submit the original to their sponsor. Sponsors keep the original in their files. Independent CEs keep the original in their files.

How to Obtain Copies

Make additional copies as needed. This form is located in Section 11000 of the Child Care Center and Day Care Home handbooks.

Form Retention

Keep the Daily Infant Meal Record for three years from the end of the program year. Exception: If audit findings, claims or litigation have not been resolved by the end of the retention period, all forms and records must be retained until all issues are resolved.

Resources – 16 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook DETAILED INSTRUCTIONS

Name of Contracting Entity – Enter the name of the contracting organization.

Name of Site – Enter the name of the child care center or day care home provider or emergency shelter at which meals are prepared.

CE ID – Enter the contracting organization’s CE ID assigned by TX-UNPS.

Date – Enter the date the meals were prepared.

Age Group – Enter the name, date of birth (DOB) and brand of Iron-Fortified Infant Formula (IFIF) and/or breast milk (BM).

Menu – Enter the menu to be prepared at each meal type on the date of service.

Planned Participation – Enter the number of infants, by age group, for whom meals are prepared at each meal type.

Quantity Used – Enter the amount of each food item served. This entry is optional for day care homes.

Note: Refer to the handbook for meal pattern requirements to ensure the correct required food components are served.

Meals Claimed – Enter the number of meals claimed for each meal type.

Texas Department of Agriculture – January 2015 Resources – 17 Child and Adult Care Food Program – Day Care Homes Handbook 11144 CACFP Infant Feeding Preference

CACFP INFANT FEEDING PREFERENCE

Dear Parent/Guardian,

This child care provider participates in the Child and Adult Care Food Program (CACFP) and receives USDA reimbursement for serving nutritious meals to infants according to program requirements. Participation in this program requires child care providers to follow specific meal patterns according to the age of the infant.

If your child is exclusively breastfed, child care providers participating in the CACFP can feed your infant the breast milk you supply and meet the meal pattern requirements. Breastfeeding is widely recognized as the best source of nutrition for infants.

The Institute of Medicine and the American Academy of Pediatrics recommend that adults/caregivers, who work with infants and their families, promote and support exclusive breastfeeding for the first six months and continuation of breastfeeding in conjunction with complementary foods for 1 year or more.

Child care providers participating in the CACFP are required to offer at least one infant formula for infants who are enrolled for child care. You may decline the infant formula offered, and supply breast milk and/or your own preferred infant formula.

Additionally, when you determine in consultation with your physician that your child is developmentally ready, the child care provider will also be required to offer infant cereal and other foods. As with infant formula, you can decline the infant cereal and other foods offered and provide those items to your child care provider.

This child care provider offers the following infant formula(s): ______

It is very important that you indicate your preferences on the form that follows so we can honor the nutrition choices you have made for your family. Please complete the information on the next page to designate your preference for infant formula, infant cereal and other foods.

Resources – 18 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook Infant’s Name Infant’s Date of Birth

Breast milk and/or Formula preference

Today’s Date Today’s Date Today’s Date Please mark your preference (choose all that apply) Birth – 3 4 – 7 months 8 – 11 months months I will bring expressed breast milk for my infant. I want the child care provider to provide the infant formula it offers for my infant. I will bring the infant formula for my infant. Please list the kind of infant formula you will bring:

Preference regarding infant cereal and other foods

Today’s Date Today’s Date Please mark your preference 4 – 7 months 8 – 11 months My child is developmentally ready for solid foods. I want the child care provider to provide the infant cereal and other foods for my infant. My child is developmentally ready for solids. I will bring the infant cereal and/or other foods for my infant. My child is NOT developmentally ready for solid foods. I will inform the provider when and designate the solid food(s) to be introduced to my infant at that time.

Parents (or guardians) Signature ______Date of Signature

1. This form must be kept on file for each infant enrolled for child care. 2. This form must be kept current and accurate for each infant enrolled for child care until the infant reaches one year of age. 3. If the parent (or guardian) provides expressed breast milk and the child care provider feeds it to the child, the meal may be claimed for reimbursement. 4. If the parent (or guardian) declines the formula and the child care provider provides meal and/or snack components, the meal may be claimed for reimbursement. 5. If the parent (or guardian) declines infant meals/snack, meals and snacks may NOT be claimed for reimbursement.

Texas Department of Agriculture – January 2015 Resources – 19 Child and Adult Care Food Program – Day Care Homes Handbook 11145 Shared Income Eligibility Documentation – Form and Instructions

Texas Department of January 2009 Agriculture

SHARED INCOME ELIGIBILITY DOCUMENTATION (CACFP and SFSP) PART I: School Food Authority (SFA) Information Name of SFA:

Address of SFA:

Telephone Number of SFA: Date:

Name of SFA Representative:

PART II: Student and Eligibility Information Name of Student (Last, First): Date of Birth – month/day/year (if applicable):

SNAP Number: TANF Number:

Total Number of Household Members:

Total Household Monthly Income:

The above student’s eligibility category is:

Free Reduced-Price Paid PART III: Disclosure The above income eligibility information is being disclosed for use in the following USDA Child Nutrition Program:

CACFP SFSP

Disclosure of Information: The above income information may be disclosed for the purpose of determining eligi bility in the Child and Adult Care Food Program (CACFP) or the Summer Food Service Program (SFSP). I underst and that the privacy and confidentiality of personal data must be protected and we will take the decision to obtai n eligibility information seriously. This eligibility information will be securely stored and will not be shared wit h any other entity.

Signature of CACFP/SFSP Representative Date

Name of CACFP/SFSP Representative Title of CACFP/SFSP Representative

Resources – 20 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook SHARED INCOME ELIGIBILITY DOCUMENTATION (CACFP and SFSP)

Instructions

01-2009

PURPOSE

To obtain eligibility information from school food authorities (SFAs) so that Child and Adult Care Food Program (CACFP) CEs and sites and Summer Food Service Program (SFSP) sponsors can determine individual child eligibility and/or site eligibility.

When to Prepare

SFAs have the option to disclose eligibility information to CACFP contracting entities and sites and SFSP sponsors.

Number of Copies

Keep the original on file.

Transmittal

There are two options to obtain eligibility information from the SFA:

1) The Shared Income Eligibility Documentation form can be provided to the SFA to complete and return. 2) The information can be obtained verbally and documented on the form.

How to Obtain Copies

Make additional copies as needed.

Form Retention

Keep the Shared Income Eligibility Documentation form for three years from the end of the program year. Exception: If audit findings, claims or litigation have not been resolved by the end of the retention period, you must retain all forms and records until all the issues are resolved.

Texas Department of Agriculture – January 2015 Resources – 21 Child and Adult Care Food Program – Day Care Homes Handbook DETAILED INSTRUCTIONS

Part I: School Food Authority (SFA) Information

Name of SFA — Enter the name of the SFA in which the student is enrolled.

Address of SFA — Enter the address of the SFA in which the student is enrolled.

Telephone Number of the SFA— Enter the telephone number of the SFA in which the student is enrolled.

Date — Enter the date the information was obtained.

Name of the SFA Representative — Enter the name of the representative of the SFA who provided the eligibility information.

Part II: Student and Eligibility Information

Name of Student — Enter the name of the student for whom the information is being obtained.

Date of Birth — Enter the date of birth for the student for whom the information is being obtained. The date of birth should only be entered if more than one child with the same name is enrolled at the SFA.

SNAP Number — Enter the SNAP number, if applicable.

TANF Number — Enter the TANF number, if applicable.

Total Number of Household Members — Enter the total number of members in the student’s household.

Total Household Monthly Income — Enter the total household monthly income..

The above student’s eligibility… — Mark the box indicating the eligibility category of the student for whom the information is being obtained.

Part III: Disclosure

Self-explanatory

Resources – 22 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11150 Statement of Child’s Enrollment Examples

11150.1Even Start Family Literacy Program

Example:

Statement of Child's Enrollment in the Even Start Family Literacy Program

This is to verify that ______is currently (name of child) enrolled as a participant in the Even Start Family Literacy Program and that the child has not yet entered kindergarten.

______

Name of Even Start Program

______Signature of Even Start Program Director or Official Date

Texas Department of Agriculture – January 2015 Resources – 23 Child and Adult Care Food Program – Day Care Homes Handbook 11150.2Head Start Program

Example:

Statement of Child's Enrollment in the Head Start Program

This is to verify that ______is currently (name of child) enrolled as a participant in the Head Start Program provided by

______. (Name of Head Start Program)

______Signature of Head Start Program Director or Official Date

Resources – 24 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11150.3Early Head Start Program

Example:

Statement of Child's Enrollment in the Early Head Start Program

This is to verify that ______is currently (name of child) enrolled as a participant in the Early Head Start Program provided by

______. (Name of Early Head Start Program)

______Signature of Early Head Start Program Director or Official Date

Texas Department of Agriculture – January 2015 Resources – 25 Child and Adult Care Food Program – Day Care Homes Handbook 11160 Parental Notification Flyers In English and Spanish (Building for the Future)

See next pages for Parental Notification Flyers in English and Spanish

Resources – 26 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook December 2014 Building for the Future

This child care center receives Federal cash assistance to serve healthy meals to your children. Good Nutrition today means a stronger tomorrow!

Meals served here must meet nutrition requirements established by USDA’s Child and Adult Care Food Program

Questions? Concerns? Call USDA at 1-866-873-2263

Food and Nutrition at 1-800-TELL-TDA (835-5832) or

Your child care center at

USDA is an equal opportunity provider and employer.

Texas Department of Agriculture – January 2015 Resources – 27 Child and Adult Care Food Program – Day Care Homes Handbook December 2014 Construyendo Para El Futuro

Este guardería infantile recibe asistencia monetaria del gobierno federal para server comidas nutritivas a sus niños. ¡Buena nutrición hoy significa un mañana más saludable!

Comidas servidas aquí deben de seguir los requisites nutricionales establecidos por el programa “Child and Adult Care Food Program” del Departamento de Agricultura de los Estados Unidos (USDA por sus siglas en inglés).

¿Preguntas? ¿Inquietudes? Llame gratuitamente a USDA al 1-866-873-2263

Alimentación y Nutrición al 1-800-TELL-TDA (835-5832) o

Centro de cuidado de niños de su hijo al

USDA es un proveedor y empleador que ofrece oportunidad igual para todos.

Resources – 28 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11160 Texas Department of Family and Protective Services – Sample print screen

Texas Department of Agriculture – January 2015 Resources – 29 Child and Adult Care Food Program – Day Care Homes Handbook Resources – 30 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11170 Verifying Provider’s Income

11170.1Via IRS Form 1040

In the CACFP for Day Care Homes, all providers' households will include at least one self- employed person - the provider. Because of difficulties that may exist in verifying income for self-employed persons, Internal Revenue Service (IRS) Form 1040 may be a good source for verifying a provider's household income.

When Is It Appropriate/Not Appropriate To Use IRS Form 1040? — IRS Form 1040 is an excellent tool for sponsors to use in verifying the income of any of the provider's household members who are self-employed. Because they are self-employed, these individuals will lack the normal documentation of earnings (such as wage stubs or other records of pay) that are readily available to most wage earners. Although the use of the prior year's tax form to verify self-employment income does not provide information which is quite as current as a biweekly pay stub for a wage earner, it often represents a reasonable estimate of a day care provider's current income.

In some cases, however, a provider's household income may have changed significantly between the end of a tax year and the time when the provider applies for Tier I status on the basis of their household income. In such circumstances, it may be necessary for a sponsor to utilize sources other than, or in addition to, Form 1040 to verify current household income.

If, for example, there were two income earners in a household, Form 1040 would not be useful as the sole source for verification if either person's income had changed substantially. Other examples of such circumstances could include:

Change in Household Composition - The household's composition has changed since the end of the prior tax year, due to a spouse's death or a change in marital status. In this case, Form 1040 might still be an accurate representation of the remaining spouse's income, but the other spouse's income from the prior tax year would have to be excluded. In calculating and verifying current household income in such instances, please remember that the loss of some type of income may be at least partially replaced by other sources of income (e.g., separation or death will cause the loss of spousal income, but may be at least partially offset by other sources of income, such as child support, alimony, or survivor's benefits).

Change in Household Income - Household income has changed markedly due to one member's loss or gain of regular employment. (Here, too, it is important to remember that Form 1040 may still serve as verification of income for another household member whose circumstances may not have changed, and that at least some portion of lost income may be offset by welfare benefits, unemployment compensation, or the like.)

Texas Department of Agriculture – January 2015 Resources – 31 Child and Adult Care Food Program – Day Care Homes Handbook Change in Provider’s Income - The provider's own income has changed as a result of gaining or losing children in day care. In this situation (where the sponsor should already be aware of this change as a result of changes to the provider's enrollment and meal claims), a reasonable attempt should be made to use Form 1040 (and attached forms showing business expenses) as a basis for calculating the provider's new income for verification purposes.

Change in Provider’s Income, cont. - For example, the current income of a provider whose prior year earnings were based on providing care for two children for the entire year might reasonably be estimated to have doubled if the provider added two day care children on January 1st. However, sponsoring organizations are not expected to sort through boxes of receipts or to retain the services of tax consultants for the purpose of determining the provider's current household income. In some cases, such as when the provider has added several day care children with variable hours of care, it may be advisable for the sponsor to require the provider to fill out an estimate of his/her current year income and expenses on Schedule C of Form 1040 ("Profit or Loss from Business") or some similar statement of earnings and expenses.

Unemployment - A new day care home provider who was either unemployed or employed in different pursuits in the prior year. In this case, IRS Form 1040 would not serve as a useful tool for verifying provider income (though it might, in some circumstances, suffice to verify other household members' income).

Finally, when using Form 1040 for verification purposes, sponsoring organizations should take care to ensure that the entire household's income is reflected on the prior year's Form 1040. If, for example, the provider has used filing status "3" (Married, filing Separately), the sponsor would also have to review Form 1040s for other income holders in the household.

How to Use IRS Form 1040 to Verify a Provider's Household Income

The IRS and the CACFP define income differently; therefore, there is not a single line on Form 1040 that adequately captures "household income" for CACFP purposes. Although losses from self-employment, farming, other businesses, etc, and deductions from IRAs, pensions, and Social Security distributions are allowed for IRS purposes, they are not allowed for the CACFP. Business losses cannot be deducted when determining household income. For CACFP purposes, the income of a household member reporting a loss must be treated as "zero income." Example: A provider's spouse reports earnings of $30,000 and the self-employed provider reports a business loss of $5,000 (-$5,000) on Form 1040. Although IRS would allow the provider's business loss to be deducted from the spouses’ income to determine their total income ($30,000 - $5,000 = $25,000 total income), the CACFP does not allow the provider's business loss to be deducted from the spouses’ income. The CACFP considers the provider's income to be "0" not "-$5,000" therefore, the household income for CACFP purposes is $30,000, not $25,000.

Resources – 32 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook If you use Form 1040 to verify a provider's household income, you must always look at lines 7- 22 of Form 1040 and:

 Treat all negative numbers reported on lines 12, 13, 14, and 18 as "zero income," NOT as losses.  Use the income reported on lines 15a, 16a, and 20a, NOT the adjusted income reported on lines 15b, 16b, and 20b.  Calculate the total household income, by adding lines 7-11, 17, 19, and 21, any positive numbers (gains) reported on lines 12, 13, 14, and 18, and the distributions reported on lines 15a, 16a, and 20a.

Record Retention

You must retain copies of IRS forms and any other information you use to verify a provider's household income for 3 years from the end of the program year.

Texas Department of Agriculture – January 2015 Resources – 33 Child and Adult Care Food Program – Day Care Homes Handbook 11170.2 Without IRS Form 1040 – Sample Worksheet

WORKSHEET TO DETERMINE CURRENT MONTHLY INCOME (without a tax return) Last Month’s Gross Income of a Provider Parent fees (provide copy of payment records) $ Other Child Care income (i.e., funded day care) $ Other income (if applicable) Salary received from outside employment $ Child Support (provide copy of court decree) $ Other $ CHILD AND ADULT CARE FOOD PROGRAM $ The amount of reimbursement from last month (if applicable) GRAND TOTAL OF PROVIDER INCOME $

Last Month’s Business Expenses of Provider (You must attach itemized receipts for any expense you wish deducted) Day Care Home food & food-related supplies $ Day Care business-related expenses $ Advertising $ Toys/Books/Art supplies $ Bank/Legal Fees $ Utilities (% Time & Space % age) $ Child Care Supplies (diapers, clean-up supplies) $ Mileage (miles from log x state rate) $ Other $ GRAND TOTAL OF ALL BUSINESS EXPENSES $

- = GROSS INCOME BUSINESS EXPENSES CURRENT NET INCOME “provider only”

Resources – 34 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11200 Training

Training is an organized, instructional activity designed to develop the skills and knowledge necessary for CEs to understand and comply with Program requirements and to improve the nutrition of the children and adults participating in the USDA nutrition programs they offer. The F&N Training Unit conducts both nutrition and Program training.

11210 Training Registration

Information on training sessions, for both general nutrition education and program-specific courses, is available at the TDA web site at http://www.squaremeals.org and click on “F&N Resources” and then select training.

The F&N Training Unit uses a web-based Learning Management System (LMS) located on the Training web site. The LMS is used to locate upcoming classes and register or cancel seats at upcoming training events. Class details show the cities, dates, times and locations of the classes. The web site also includes links to maps showing the location of the training site. You must have an active Personal User Code (PUC) to self-register for training. To request a PUC download the F&N Training Request Form and fax it to the F&N Training Unit at 1-888-237- 5030.

Non-mandatory nutrition training events are scheduled throughout the state each year. Although TDA and USDA have not established an annual nutrition training requirement, TDA may implement such requirements in the future.

Mandatory and optional Program training events are presented each program year. The F&N Training Unit establishes a schedule for these events and develops curricula in conjunction with other F&N sections. The curricula are based on needs assessments, suggestions, and USDA requirements.

The F&N Training Unit adheres to the following standard procedures to ensure success at our training events:

 Sign-in begins 30 minutes before each training event.

 Classes start promptly at the scheduled start time.

 Late arrivals are only accepted during the first 30 minutes of each class. Participants arriving later than 30 minutes after the class has started will need to reschedule for another event and will not be allowed to remain in the class.

Texas Department of Agriculture – January 2015 Resources – 35 Child and Adult Care Food Program – Day Care Homes Handbook  Register early for Training events. The on-line self-registration/cancellation cut-off is three (3) days before a class. Since seating limitations occur at most sites, it is important to guarantee your seat as soon as possible.

If you choose to register within 3 days of an event, you must download a “F&N Training Request Form”, enter the requested information and fax the form to the Training Unit at 1-888-237-5030.

 Current contracting entities are expected to self-register for training to guarantee pre- registration seating. Current contracting entities receive one complimentary enrollment when they submit a “F&N Training Request Form” with their request for an active Personal User Code and account in the F&N Learning Center. Potential contracting entities are not granted self-registration rights and must submit a “F&N Training Request Form” to the F&N Training Unit for each training event until a contract is awarded.

 Substitutions will be accepted if they are attending in place of a pre-registered employee. (See additional policy related to Substitutions below.) Please notify the F&N Training Unit, at [email protected] immediately in the event there is an emergency or unforeseen circumstance that requires a change in personnel attending a training event.

 Walk-ins are only accepted on a space-available basis. (See additional policy related to Walk-Ins below.)

There is no guarantee that adequate seating and/or training materials will be available for non-registered participants. The best way to ensure accommodations is to register early.

 Both Substitutions and Walk-ins . Are subject to the same late arrival guidelines and must arrive before class or not later than the first 30 minutes of each class.

. Must complete a “Walk-In” Form.

. Must meet the eligibility and/or pre-requisite criteria for the course to receive completion credit.

. Receive certification following the training event. A copy of training certificates will be emailed from the F&N Training Unit. Current CEs will receive training certificates in class if they pre-registered, walk- ins may print a copy of their training transcript (certification) for the event from the F&N Learning Center.

Resources – 36 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook Before awarding credit for completing the class, the F&N Training Unit must obtain the trainer’s documentation, ensure course eligibility and/or pre- requisite criteria are met, and validate Walk-In/Substitution status in the learning database. Providing accurate information on the Walk-In Form will help expedite the process to receive credit.

 We do not provide childcare services and children are not allowed to attend training events. Please arrange for childcare when you schedule your training event(s).

 During our classes we ask that cell phones and pagers be turned off or placed on “silent mode”. If you must take a call, we ask that you do so outside the classroom to avoid disrupting both the trainer and other participants.

 Training cancellations do occur. The F&N Training Unit reserves the right to cancel optional (non-mandatory) events due to low enrollment. If this should occur to a class for which you are enrolled, you will be notified (by telephone, e- mail, postal mail, or fax) and offered an optional date/location, if available.

CEs are encouraged to enroll in nutrition classes of interest once they become available on our Website.

Texas Department of Agriculture – January 2015 Resources – 37 Child and Adult Care Food Program – Day Care Homes Handbook 11220 Sample Training Registration and Activity Report for Contracting Entity Staff

This is a sample of a form the F&N Training Unit uses to sign in attendees at a training event, to confirm that a registered participant attended and completed the training.

Child and Adult Care Food Program Training Registration and Activity Report For Contracting Entity Staff

Contracting Entity Name: CE ID: Date:

Location of Training: Instructor(s):

Training Topic(s):

Name of Participant Position Signature (Please print name clearly)

Resources – 38 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11230 USDA Team Nutrition Materials

TDA wants to ensure that all CEs and day care homes participating in the CACFP have copies of all the Team Nutrition technical assistance and support materials available to them. These items include:

Team Nutrition Technical Assistance and Support Materials  The Food Buying Guide for Child Nutrition Programs, which provides important yield information necessary to ensure CEs and sites are meeting the meal pattern requirements for compliance with the CACFP. To view and/or print a copy of the Food Buying Guide for Child Nutrition Programs, go to the TDA website at http://www.squaremeals.org click on “F&N Resources” and then select tools and links.  Fruits and Vegetables Galore: Helping Kids Eat More, which contains marketing and nutrition education tips CEs and sites can use to encourage children to increase their intake of fruits and vegetables.

Team Nutrition Posters

The following posters, as well as others, can be ordered from Team Nutrition:  Food for a Day  How Much Do You Eat  MyPyramid for Kids Poster (English and Spanish)  Read It before you Eat It! Poster

To order Team Nutrition materials, visit the Team Nutrition website at: http://teamnutrition.usda.gov/

11240 National Food Service Management Institute (NFSMI) Resources and Training

The National Food Service Management Institute (NFSMI) provides online CACFP resources and training. Visit their website at: http://www.nfsmi.org/.

Texas Department of Agriculture – January 2015 Resources – 39 Child and Adult Care Food Program – Day Care Homes Handbook 11300 Other Resources & Additional Information

11310 Other Child Nutrition Publications

The TDA website at http://www.squaremeals.org offers a large number of posters, publications, menu planners, videos, and contests for kids, information for parents, educational materials for child nutrition professionals and links to other nutrition-oriented sites. All publications are available for free download, or can be ordered through the site at no charge, while supplies last.

11320 Imported Plasticware Safety

Any supplier with an office or address in the United States must abide by Food and Drug Administration (FDA) regulations. While many manufacturers use labor and products from all over the world, they still have to follow FDA rules regarding the chemical composition of the final product.

The FDA also states that imported plasticware that does not contain bright colors or is overly soft or flexible provides little risk of migration of chemicals into food. They further noted that food should not be heated or microwaved in imported plasticware unless the plasticware is specifically made for microwave use.

11400 Menu Planning

11410 Meal Planning

Below are resources to assist CEs and day care homes plan healthy snacks and incorporating fruits and vegetables into their menus. http://teamnutrition.usda.gov/ http://www.health.gov/dietaryguidelines/ http://www.whatscooking.fns.usda.gov/

Texas Department of Agriculture – January 2015 Resources – 34 Child and Adult Care Food Program – Day Care Homes Handbook 11410.1 USDA, ARS National Nutrient Database for Standard Reference

Using the online USDA, ARS National Nutrient Database for Standard Reference to convert Nutrient Values per Portion Size of Breakfast Cereals

1. Go online to the ARS National Nutrient Database for Standard Reference at: http://www.nal.usda.gov/fnic/foodcomp/search/

2. Using the search function, type in the key word “cereals” to pull up all of the cereal selections or enter in a specific cereal you are looking for then click “submit”.

3. Choose one cereal by clicking on the button to the left of the product you wish to select (the button will be filled in to show that you have made a selection). Only one selection is permitted. If you want data for a ready-to-cook cereal, make sure you select the cereal option described as dry, e.g.; cereals, oats, dry. Click on “submit” which is located at the bottom of the product list.

4. Select the quantities and units you want data for and click submit (one or more selections are permitted): a. Ready-to-eat cereals

You will need to select both 1 oz and ¾ cup measures to determine which serving size weighs less. (if volume data is not available, use the manual conversion method shown in attachments B and C.)

i. Review nutrient data for one ounce (28.35 grams) of cereal: Select 100 grams as the description, Change 1.00 (100 grams) to 0.2835 (100 grams), and

ii. Review the nutrient data for ¾ cup (0.75 cup) of cereal: Select the description measured in cups, The volume unit may be different depending on the cereal, If the unit is 1.00 (.75 cup), keep as 1.00 (.75 cup), If the unit is 1.00 (1 cup), change to 0.75 (1 cup), If the unit is 1.00 (.5 cup), change to 1.5 (.5 cup) If the unit is 1.00 (? cup), you will need to determine what number or fraction ¾ cup is of the unit provided in parentheses and change 1.00 to the number or fraction required to obtain ¾ cup

iii. Click “submit”

Resources – 35 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook b. Ready-to-cook cereals, dry

i. Review the nutrient data for 25 grams of dry cereal: Select 100 grams as the description, Change 1.00 (100 grams) to 0.25 (100 grams), Make sure this option is selected. ii. Click “submit”

5. Compare the nutrient profile provided for the cereal to the FNS Nutrient Criteria for Breakfast Cereals.

a. Ready-to-eat cereals:

The nutrient profile will show the amounts for 28.35 grams (1 ounce) and for ¾ cup. The gram weight for ¾ cup will appear in the heading. Since cereals are credited 1 ounce or ¾ cup whichever amount weighs less, choose the column having the lowest gram weight and use that column of nutrients to compare to the FNS Nutrient Criteria for Breakfast Cereals. To be creditable, the cereal must meet or exceed the minimum criteria for all five of the required nutrients.

b. Ready-to-Cook cereals, dry:

Since the portion size for ready-to-cook cereals is 25 grams dry, all cooked cereals will be based on 25 grams dry, regardless of the amount of cooked cereal served in the meal or how much liquid is added to cook the cereal. Compare the nutrient values to the FNS Nutrient Criteria for Breakfast Cereals. To be creditable, the cereal must meet or exceed the minimum criteria for all five of the required nutrients.

6. Print the documentation and keep on file.

Texas Department of Agriculture – January 2015 Resources – 36 Child and Adult Care Food Program – Day Care Homes Handbook 11410.2 Manual Conversion for Nutrients per Portion of a Ready-to-Eat Breakfast Cereal

Manual Conversion for Nutrients per Portion of a Ready-to-Eat Breakfast Cereal

Ready-to-Eat Cereals: Cereal portion size from the FNS Nutrient Criteria for Breakfast Cereals = 1.0 ounce (28.35 grams) or the weight of ¾ cup – whichever amount weighs less;

Brand Name ______Cereal Name ______

1. The portion size of the ready-to-eat cereal on Nutrition Facts Label = ______cup(s) ______grams

2. Determine the weight of ¾ cup of the cereal:

0.75 cup divided by ______cup(s) of cereal from Nutrition Facts Label = ______factor ______factor multiplied by ______grams/portion from Nutrition Facts Label = ______grams per ¾ cup cereal

3. Which weighs less, One Ounce (28.35 grams) or ______grams per ¾ cup cereal?

The amount that weighs less = ______grams; the nutrients in this amount of cereal will be used to compare to the FNS Criteria for Breakfast Cereals.

4. Determine the conversion factor based on the amount of ready-to-eat cereal that weighs less (Do not round up): ______grams (amount that weighs less) divided by ______grams (from Nutrition Facts Label) = ______conversion factor for nutrients

5. Calculate the nutrients from the Nutrition Facts Label to the nutrients in the amount that weighs less by multiplying by the conversion factor for nutrients:

A. B. x C. = D. E. F. Nutrient % DV from Conversion Nutrients per FNS Is the Amount Nutrition Factor for Amount that Nutrient in Column D Facts Label Nutrients Weighs less Criteria Equal to or For Greater than the Breakfast Amount in Cereals Column E? Yes or No Thiamin (B1) x = 6.7% Riboflavin (B2) x = 3.5% Niacin (B3) x = 4.2%

Resources – 37 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook Folic Acid (B9) x = 5.0% Iron x = 3.9%

6. ______All of the answers in Column F are “yes,” the cereal is creditable using this option

______One or more of the answers in Column F are “no,” the cereal is not creditable using this option

(Keep in mind that cereals meeting the requirements are allowed in the Grains/Breads Instruction or FBG flowchart are creditable even if they do not meet the FNS Nutrient Criteria for Breakfast Cereals.)

Manual Conversion for Nutrients per Portion of a Ready-to-Eat Breakfast Cereal - EXAMPLE

Ready-to-Eat Cereals: Cereal portion size from the FNS Nutrient Criteria for Breakfast Cereals = 1.0 ounce (28.35 grams) or the weight of ¾ cup – whichever amount weighs less;

Brand Name General Mills Cereal Name Wheaties

1. The portion size of the ready-to-eat cereal on Nutrition Facts Label = 1 cup(s) 30 grams

2. Determine the weight of ¾ cup of the cereal:

0.75 cup divided by 1 cup(s) of cereal from Nutrition Facts Label = 0.75 factor 0.75 factor multiplied by 30 grams/portion from Nutrition Facts Label = 22.5 grams per ¾ cup cereal

3. Which weighs less, One Ounce (28.35 grams) or 22.5 grams per ¾ cup cereal?

The amount that weighs less = 22.5 grams; the nutrients in this amount of cereal will be used to compare to the FNS Criteria for Breakfast Cereals.

4. Determine the conversion factor based on the amount of ready-to-eat cereal that weighs less (Do not round up): 22.5 grams (amount that weighs less) divided by 30 grams (from Nutrition Facts Label) = 0.75 conversion factor for nutrients

Texas Department of Agriculture – January 2015 Resources – 38 Child and Adult Care Food Program – Day Care Homes Handbook 5. Calculate the nutrients from the Nutrition Facts Label to the nutrients in the amount that weighs less by multiplying by the conversion factor for nutrients:

A. B. x C. = D. E. F. Nutrient % DV from Conversion Nutrients per FNS Is the Amount Nutrition Factor for Amount that Nutrient in Column D Facts Label Nutrients Weighs less Criteria Equal to or For Greater than the Breakfast Amount in Cereals Column E? Yes or No Thiamin (B1) 50% x 0.75 = 37.5% 6.7% Yes Riboflavin (B2) 50% x 0.75 = 37.5% 3.5% Yes Niacin (B3) 50% x 0.75 = 37.5% 4.2% Yes Folic Acid (B9) 50% x 0.75 = 37.5% 5.0% Yes Iron 45% x 0.75 = 33.7% 3.9% Yes

6. All of the answers in Column F are “yes,” the cereal is creditable using this option

______One or more of the answers in Column F are “no,” the cereal is not creditable using this option

Resources – 39 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11410.3 Manual Conversion for Nutrients per Portion of a Ready-to-Cook Breakfast Cereal

Manual Conversion for Nutrients per Portion of a Ready-to-Cook Breakfast Cereal

Ready-to-Cook Cereals: Cereal portion size from the FNS Nutrient Criteria for Breakfast Cereals = 25.0 grams ready-to-cook dry cereal

Brand Name ______Cereal Name ______

1. The portion size of the ready-to-cook dry cereal on Nutrition Facts Label = ______cup(s) ______grams

2. Determine the conversion factor for nutrients (Do not round up): 25 grams divided by ______grams (from Nutrition Facts Label) = ______conversion factor for nutrients

3. Calculate the nutrients from the Nutrition Facts Label to the nutrients in 25 grams of ready- to-cook dry cereal multiplying by the conversion factor for nutrients:

A. B. x C. = D. E. F. Nutrient % DV from Conversion Nutrients per FNS Is the Amount Nutrition Factor for 25 grams Nutrient in Column D Facts Label Nutrients Ready-to- Criteria Equal to or Cook Dry For Greater than the Cereal Breakfast Amount in Cereals Column E? Yes or No Thiamin (B1) x = 6.7% Riboflavin (B2) x = 3.5% Niacin (B3) x = 4.2% Folic Acid (B9) x = 5.0% Iron x = 3.9%

4. ______All of the answers in Column F are “yes,” the cereal is creditable using this option

______One or more of the answers in Column F are “no,” the cereal is not creditable using this option

Texas Department of Agriculture – January 2015 Resources – 40 Child and Adult Care Food Program – Day Care Homes Handbook Manual Conversion for Nutrients per Portion of a Ready-to-Cook Breakfast Cereal - Example

Ready-to-Cook Cereals: Cereal portion size from the FNS Nutrient Criteria for Breakfast Cereals = 25.0 grams ready-to-cook dry cereal

Brand Name Quaker Cereal Name Instant Grits, Real Cheddar Cheese Flavor

1. The portion size of the ready-to-cook dry cereal on Nutrition Facts Label = 1 packet cup(s) 28 grams

2. Determine the conversion factor for nutrients (Do not round up): 25 grams divided by 28 grams (from Nutrition Facts Label) = 0.89 conversion factor for nutrients

3. Calculate the nutrients from the Nutrition Facts Label to the nutrients in 25 grams of ready- to-cook dry cereal multiplying by the conversion factor for nutrients:

A. B. x C. = D. E. F. Nutrient % DV from Conversion Nutrients per FNS Is the Amount Nutrition Factor for 25 grams Nutrient in Column D Facts Label Nutrients Ready-to- Criteria Equal to or Cook Dry For Greater than the Cereal Breakfast Amount in Cereals Column E? Yes or No Thiamin (B1) 10% x 0.89 = 8.9% 6.7% Yes Riboflavin (B2) 10% x 0.89 = 8.9% 3.5% Yes Niacin (B3) 10% x 0.89 = 8.9% 4.2% Yes Folic Acid (B9) 10% x 0.89 = 8.9% 5.0% Yes Iron 45% x 0.89 = 40% 3.9% Yes

4. All of the answers in Column F are “yes,” the cereal is creditable using this option

______One or more of the answers in Column F are “no,” the cereal is not creditable using this option

Resources – 41 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11420 Child Care Recipes

The USDA website provides child care recipes that meet program requirements for CACFP meal patterns when prepared and served as indicated. These recipes can be a useful resource when planning healthy and nutritious meals for the children you serve, while offering a variety of foods to keep children interested. CEs and sites should always ensure they are using the most updated recipes provided by USDA.

The recipes can be accessed on the National Food Service Management Institute website at: http://www.nfsmi.org

Select Child and Adult Care Food Program, and then select Recipes – USDA Recipes for Child Care

11430 Calculating Percentage of Calories from Fat

Example 1: 1 cup frozen cut green beans plus 1 pat butter contains 4 grams of fat. Total calories: 75

To calculate the percent of calories from fat in this food:

# grams of fat (4) X Calories/gram of fat (9) = 48 percent calories from fat Total Calories (75)

Example 2: 1 cup low fat (2 percent) cottage cheese contains 4 grams of fat. Total calories: 205

4 X 9 = 18 percent calories from fat 205

Example 3: 1 cupcake contains 4 grams of fat. Total calories: 120

4 X 9 = 30 percent calories from fat 120

From this analysis, it would seem that Example 3 (a cupcake) would be a better choice than Example 1 (green beans). This is due to the low calorie content of the green beans and the higher calorie content of the cupcake. All three foods contribute the same amount of fat (4 grams) to a meal. They differ only in the amount of protein and carbohydrate and, therefore, in the calories contained.

Texas Department of Agriculture – January 2015 Resources – 42 Child and Adult Care Food Program – Day Care Homes Handbook 11440 Meat versus Protein Fact Sheet

What is Meat and what is Protein?

Meat is a general term used to cover the flesh of beef, sheep and pigs. Although the different components of meat will vary depending on species of the animal and the cut of the meat, among other factors, an average picture of the composition of meat can be made.

Meat is composed of water, protein, fat and various amounts of minerals and vitamins. The protein in meat is found in the muscle tissue. The protein content of meat ranges from 15% to 20% of the piece of meat. Fat content is more variable, generally from 5% to 40%, depending on several factors including the type of animal and its diet, the cut of meat and the extent of trimming of the fat. Water content also varies from 55% to 70%.

Are Meat and Protein the Same Things?

No. Often the term protein is used interchangeable for the term meat. Protein, however, is only one component of meat. Although meat is a protein rich source, protein still only makes up about 18% of the meat. The terms should not be interchanged as they are not equivalent.

What do the Meal Pattern Requirements Specify?

The meal pattern requirements specify meat/meat alternate. The requirements do not mention protein. A request for a product to supply a specific amount of protein (such as 2 oz) has no meaning and does not meet the requirements of the meal pattern.

11500 USDA CN Labels

The USDA, Child Nutrition (CN) Labeling Program provides food manufacturers the option to include a standardized food crediting statement on their product label. Labels must be authorized by USDA, FNS prior to use and manufacturers must have quality control procedures and inspection oversight that meet the FNS requirements.

11510 Unapproved CN Labels

The following CN Labels have not been approved by USDA FNS and therefore cannot be counted towards a reimbursable meal in the CACFP. If you wish to use any of the products listed below to be counted towards a reimbursable meal in the CACFP, you must obtain a product analysis/product formulation or manufacturer’s specification from the manufacturer as outlined in Section 4000 of this handbook.

Resources – 43 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook Bernardi Italian Foods

Bernardi Italian Foods, establishment 8545, East Side Entrees, 3.5 oz. Cheese Roll-up, CN ID number 062444.

Profera, Inc.

Profera Inc., establishment 4007, Pepperoni Cheese Pizza with Whole Grain, CN ID number 006074.

RCG Foods of Texas, Inc.

RCG Foods of Texas, Inc., establishment No. 1353:

CN Number Product Name and Code 068783 East Side Entrees Cheese Quesadilla 25101 067457 Beef Enchilada 3501 067456 Beef and Bean Burrito 3500 065419 Cheese Quesadilla 25101B119 064668 East Side Entrees Cheese Quesadilla 25101 062942 Beef and Bean Burrito 3500 045034 Pork Egg Roll 3 oz 035119 Pork Egg Roll 69340 035118 Pork Egg Roll 69300

Townsends, Inc.

Townsends, Inc., Establishment No. P4693, Located in Mount Bethel, Pennsylvania, Chick-N- Fries, CN Code 7651, CN Number 070310.

Advance Food Company

Advance Food Company, No. 1932, Garland, Texas, CN Number 064321, Breaded Chicken Fried Beef Pattie, CN04080-761. FMB 45178.

Best Express Foods, Inc.

Best Express Foods, Inc., No 20735/P20735, Williamston, Michigan, CN Number: any products less than 078000, closed-face sandwich-type products.

Texas Department of Agriculture – January 2015 Resources – 44 Child and Adult Care Food Program – Day Care Homes Handbook 11520 Approved CN Labels

The United States Department of Agriculture (USDA) has made lists available of authorized CN labels issued to manufacturers since January 2005, on the FNS CN Labeling Program website.

The web address for the FNS CN Labeling Program is: http://www.fns.usda.gov/cnd/cnlabeling/authorized.htm

The website provides links to manufacturers and products that have met the Quality Control Program requirements for the CN Labeling Program, which includes the United States Department of Commerce’s (USDC) seafood inspection program and the Food Safety and Inspection Service inspection directory for meat, poultry and eggs. The lists are updated monthly.

For additional information on the CN Labeling Program and how it can be used in meeting meal pattern requirements, see Appendix C of your Food Buying Guide, also available online at http://www.fns.usda.gov/tn/Resources/FBG_AppendixC.pdf

Resources – 45 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11600 Sample Provider Serious Deficiency Letters

11610 Notice of Serious Deficiency

Prototype Letter: Notice of Serious Deficiency [Note: this letter must be sent by certified mail/return receipt and by regular mail.]

Dear [Provider]:

This letter concerns the [brief description of the basis for the serious deficiency determination – review, audit, etc. and date] of your operation of the Child and Adult Care Food Program (CACFP).

SERIOUS DEFICIENCY DETERMINATION

Based on the [review/audit/etc.], we have determined that you are seriously deficient in your operation of the CACFP. If you do not fully and permanently correct all of the serious deficiencies and submit documentation of the corrective action by the due date, we will:

 Propose to terminate your agreement to participate in the CACFP for cause, and

 Propose to disqualify you from future CACFP participation.

If you voluntarily terminate your agreement after receiving this letter, we will formally terminate your agreement, disqualify you and place your name on the National Disqualified List (NDL) without further opportunity for corrective action.

However, if any debt relating to the serious deficiencies has not been repaid, you will remain on the NDL until the debt has been repaid.

SERIOUS DEFICIENCIES AND REQUIRED CORRECTIVE ACTION

The following paragraph(s) detail each serious deficiency and the corrective action required.

[Insert discussion of serious deficiencies and required corrective action, including disallowances/repayment of funds if applicable.]

Texas Department of Agriculture – January 2015 Resources – 46 Child and Adult Care Food Program – Day Care Homes Handbook You must provide documentation of the required corrective action for each of the serious deficiencies cited in this letter. The documentation must be received (not just postmarked) by [corrective action deadline; may establish different deadlines for different serious deficiencies, but no more than 30 days].

If we do not receive the documentation of your corrective action by the due date, or if we determine that the actions taken do not fully and permanently correct all of the serious deficiencies, we will propose to terminate your CACFP agreement for cause and will propose to disqualify you. However if we receive your documentation timely and it demonstrates full and permanent corrective action we will temporarily defer the serious deficiency determination and not terminate your agreement of disqualify you from participation in the CACFP.

You may not appeal the serious deficiency determination [If there are disallowances, the provider may appeal those and you must provide appeal rights for that; however the provider may not appeal the serious deficiency determination.]. However, if we propose to terminate your agreement for cause or propose to disqualify you, you will be able to appeal those actions and you will be advised of your appeal rights and the appeal procedures at that time.

If you have any questions please contact {enter contact information here}.

Sincerely, Sponsor Employee Name & Title cc: F&N Community Operations Field office

Resources – 47 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11620 Notice of Proposed Termination and Proposed Disqualification

Prototype Letter: Notice of Proposed Termination and Proposed Disqualification [NOTE: this letter must be sent by certified mail/return receipt and regular mail.]

Dear [Provider]:

On [date of Serious Deficiency Notice] you were notified that you were determined to be seriously deficient in your operation of the Child and Adult Care Food Program (CACFP) and of the required corrective actions and due date for the corrective actions.

We received the documentation detailing the actions you have taken to correct these serious deficiencies on [date]. [Insert if applicable: “We conducted a follow-up review on [date] to verify the adequacy of the corrective actions.”, or “We did not receive the documentation required to demonstrate that the serious deficiencies were corrected.”]

Based on our review of the documentation [insert if applicable: “and the follow-up review”], we have determined that you have not fully and permanently corrected the serious deficiencies that were cited in the Serious Deficiency Notice. {Do not include this paragraph and the paragraph below if the Provider failed to provide any corrective action.}

The following paragraphs detail each serious deficiency and its status based on our review of the corrective action documentation [insert if applicable: “and the [date] follow-up review”]. [Insert discussion of each serious deficiency and the reasons why corrective action was inadequate (the corrective action may be adequate for some items and not for others; make sure you specify the status of the corrective action for each serious deficiency).

PROPOSED TERMINATION AND PROPOSED DISQUALIFICATION

As a result, we are proposing to:

 Terminate your agreement to participate in the CACFP for cause effective [date], and

 Disqualify you from future CACFP participation effective [date].

[The effective date for the termination/disqualification must be no earlier than 30 days from the date of this letter.]

You may continue to participate in the CACFP until [termination/disqualification effective date] or, if you appeal the proposed actions, until the hearing official issues a decision on the appeal. We will pay any valid claims for reimbursement submitted by you for this period. You must submit the claims by the normal deadline.

Texas Department of Agriculture – January 2015 Resources – 48 Child and Adult Care Food Program – Day Care Homes Handbook If you voluntarily terminate your agreement after receiving this letter, we will formally terminate your participation and disqualify you and place your name on the National Disqualified List (NDL) without opportunity for appeal.

While on the NDL, you will not be able to participate in the CACFP as a day care home provider. In addition, you will not be able to serve as a principal in, or perform any key CACFP functions for, any CACFP institution or site. You will remain on the NDL until such time as the Texas Department of Agriculture Food and Nutrition determines that the serious deficiencies have been corrected or until 7 years after your disqualification. However, if any debt relating to the serious deficiencies has not been repaid, you will remain on the list until the debt has been repaid. [Insert if applicable: You owe a debt in the amount of {enter dollar amount}.]

APPEAL OF PROPOSED TERMINATION AND PROPOSED DISQUALIFICATIONS

You may appeal the proposed termination proposed disqualification. A copy of the appeal procedures is enclosed. (Or you can include the appeal procedures here in the letter)

If you submit a timely request for appeal the proposed actions will not take effect until the hearing official issues a decision. If you do not make a timely request for an appeal, your agreement will be terminated and you will be disqualified effective [date].

Sincerely, Sponsor Employee Name & Title

Enclosure Appeal Procedures cc: F&N Community Operations Field office

Resources – 49 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11630 Notice of Termination and Disqualification

11631 Provider Fails to Appeal

Prototype Letter: Notice of Termination and Disqualification (following failure to appeal) [NOTE: this letter must be sent by certified mail/return receipt and regular mail.]

Dear [Provider]:

On [date of Notice of Proposed Termination & Proposed Disqualification] you were sent a Notice of Proposed Termination & Proposed Disqualification, which proposed to terminate your agreement to participate in the Child and Adult Care Food Program (CACFP) for cause and proposed to disqualify you from further CACFP participation. These actions were based on the determination in our [date of Serious Deficiency Notice] Notice of Serious Deficiency that you are seriously deficient in your operation of the CACFP.

You received the Notice of Proposed Termination & Proposed Disqualification on [date received]. You had until [insert deadline for requesting appeal] to submit any requests for appeals of the proposed actions. No requests for appeals were submitted by that deadline.

TERMINATION AND DISQUALIFICATION

As a result, we are:  Terminating your agreement to participate in the CACFP for cause effective [date], and

 Disqualifying you from future CACFP participation effective [date].

[The effective date for the agreement termination and disqualification must match the date given in the Notice of Proposed Termination & Proposed Disqualification.]

Upon disqualification, you will be placed on the National Disqualified List (NDL). While on the NDL, you will not be able to participate in the CACFP as a day care home provider. In addition, you will not be able to serve as a principal in, or perform any key CACFP functions for, any CACFP institution or site. You will remain on the NDL until such time as the Texas Department of Agriculture Food and Nutrition determines that the serious deficiencies have been corrected or until 7 years after your disqualification.

Texas Department of Agriculture – January 2015 Resources – 50 Child and Adult Care Food Program – Day Care Homes Handbook However, if any debt relating to the serious deficiencies has not been repaid, you will remain on the list until the debt has been repaid. [Insert if applicable: You owe a debt in the amount of {enter dollar amount}.]

You may not appeal the termination of the agreement for cause or the disqualification.

Sincerely, Sponsor Employee Name & Title cc: F&N Community Operations Field office

Resources – 51 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11632 Sponsors Wins Appeal

Prototype Letter: Notice of Termination and Disqualification (after sponsor wins appeal) [NOTE: this letter must be sent by certified mail/return receipt and regular mail.]

Dear [Provider]:

You filed a timely appeal of the proposed termination and proposed disqualification. On [date of hearing official’s decision], the hearing official upheld our proposed actions.

TERMINATION AND DISQUALIFICATION

As a result, we are:  Terminating your agreement to participate in the CACFP for cause effective [date], and

 Disqualifying you from future CACFP participation effective [date].

[The effective date for the termination and disqualification must be the date of the hearing official’s decision.]

You may not appeal the termination of the agreement for cause or the disqualification.

Sincerely, Sponsor Employee Name & Title cc: F&N Community Operations Field office

Texas Department of Agriculture – January 2015 Resources – 52 Child and Adult Care Food Program – Day Care Homes Handbook 11640 Notice of Temporary Deferral

11641 Provider Wins Appeal

Prototype Letter: Notice of Temporary Deferral of Serious Deficiency, Proposed Termination and Proposed Disqualification (after provider wins appeal) [NOTE: this letter must be sent by certified mail/return receipt and regular mail.]

Dear [Provider]:

You filed a timely appeal of the proposed termination and proposed disqualification. On [date of hearing official’s decision], the hearing overturned our proposed actions.

SERIOUS DEFICIENCY DETERMINATION TEMPORARILY DEFERRED

As a result, we have temporarily deferred our serious deficiency determination and will not terminate your agreement or disqualify you from participation in the CACFP. However, if at any time it is determined that you have not fully and permanently corrected the serious deficiencies we will immediately propose to terminate your agreement and disqualify you from participation in the CACFP without further opportunity for corrective action.

Sincerely,

Sponsor Employee Name & Title cc: F&N Community Operations Field office

Resources – 53 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11642 Notice of Successful Corrective Action

Prototype Letter: Notice of Successful Corrective Action, Temporary Deferral of Serious Deficiency [NOTE: this letter must be sent by certified mail/return receipt and regular mail]

Dear [Provider]:

We received the documentation detailing the actions you have taken to correct these serious deficiencies on [date. [Insert if applicable: “We conducted a follow-up review on [date] to verify the adequacy of the corrective actions.”]

SERIOUS DEFICIENCY DETERMINATION TEMPORARILY DEFERRED

Based on our review of the documentation [insert if applicable: “and the [date] follow-up review”], we have determined that you have fully and permanently corrected the serious deficiencies. As a result, we have temporarily deferred our serious deficiency determination and will not terminate your agreement or disqualify you from participation in the CACFP.

However, if at any time it is determined that you have not fully and permanently corrected the serious deficiencies we will immediately propose to terminate your agreement and disqualify you from participation in the CACFP without further opportunity for corrective action.

Sincerely,

Sponsor Employee Name & Title cc: F&N Community Operations Field office

Texas Department of Agriculture – January 2015 Resources – 54 Child and Adult Care Food Program – Day Care Homes Handbook 11650 Imminent Threat to Health or Safety

11651 Notice of Serious Deficiency, Suspension, Proposed Termination and Proposed Disqualification

Prototype Letter: Notice of Serious Deficiency, Suspension, Proposed Termination and Proposed Disqualification; Imminent Threat to Health or Safety [NOTE: this letter must be sent by certified mail/return receipt and regular mail.]

Dear [Provider]:

We have received correspondence from the Texas Department of Family and Protective Services dated {enter date of correspondence} which indicates you have been cited for serious health or safety violations which constitute an imminent threat to the health or safety of participants and the public. See the attached correspondence for the specific violations.

As a result we have determined you are seriously deficient in the operation of the CACFP and your participation in the CACFP, including all payments, has been suspended as of the date of this letter.

In addition, we are also proposing to:  Terminate your home’s agreement to participate in the CACFP for cause effective [date], and  Disqualify you from future CACFP participation effective [date].

[The effective date for the termination/disqualification must be no earlier than 30 days from the date of this letter.]

The suspension will remain in effect during the period of any appeal. If you appeal the proposed termination and the proposed disqualification, the proposed actions will not take effect until the hearing official issues a decision on the appeals. If you do not make a timely request for an appeal, your agreement will be terminated and you will be disqualified from future CACFP participation and placed on the National Disqualified List.

If you voluntarily terminate your agreement after receiving this letter, we will formally terminate your agreement and disqualify you from future CACFP participation and place your name on the National Disqualified List (NDL). While on the NDL, you will not be able to participate in the CACFP as a day care home provider. In addition, you will not be able to serve as a principal in any CACFP institution or facility.

Resources – 55 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook You will remain on the NDL until such time as the Texas Department of Agriculture Food and Nutrition determines that the serious deficiencies have been corrected or until 7 years after your disqualification. However, if any debt relating to the serious deficiencies has not been repaid, you will remain on the NDL until the debt has been repaid. [Insert if applicable: You owe a debt in the amount of {enter dollar amount}.]

APPEAL OF PROPOSED TERMINATION AND PROPOSED DISQUALIFICATION

You may appeal the proposed termination of your agreement for cause and your proposed disqualification. A copy of the appeal procedures is enclosed. (Or you can include the appeal procedures here in the letter)

If you need assistance please contact {enter contact information}.

Sincerely,

Sponsor Employee Name & Title

Enclosure Appeal Procedures cc: F&N Community Operations Field office

Texas Department of Agriculture – January 2015 Resources – 56 Child and Adult Care Food Program – Day Care Homes Handbook 11652 Notice of Termination and Disqualification – Sponsor Wins Appeal

Prototype Letter: Notice of Termination and Disqualification (after sponsor wins appeal); Imminent Threat to Health or Safety [NOTE: this letter must be sent by certified mail/return receipt and regular mail.]

Dear [Provider]:

On [date of Notice of Suspension] you were sent a Notice of Serious Deficiency, Suspension, Proposed Termination and Proposed Disqualification; Imminent Threat to Health or Safety, which suspended your participation in the CACFP and proposed to terminate your CACFP agreement disqualify you from further CACFP participation. These actions were based on the determination that you are seriously deficient in your operation of the CACFP due to an imminent threat to the health or safety of participants or the public.

You filed a timely appeal of the proposed termination and proposed disqualification. On [date of hearing official’s decision], the hearing official upheld the proposed actions.

TERMINATION AND DISQUALIFICATION

As a result, we are:  Terminating your agreement to participate in the CACFP for cause effective [date], and  Disqualifying you from future CACFP participation effective [date].

[The effective date for the termination and disqualification must be the date of the hearing official’s decision.]

Upon disqualification, you will be placed on the National Disqualified List (NDL). While on the NDL, you will not be able to participate in the CACFP as a day care home provider. In addition, you will not be able to serve as a principal in, or perform any key CACFP functions for, any CACFP institution or facility. You will remain on the NDL until such time as the Texas Department of Agriculture Food and Nutrition determines that the serious deficiencies have been corrected or until 7 years after your disqualification.

However, if any debt relating to the serious deficiencies has not been repaid, you will remain on the list until the debt has been repaid. [Insert if applicable: You owe a debt in the amount of {enter dollar amount}.]

Sincerely,

Sponsor Employee Name & Title cc: F&N Community Operations Field office Resources – 57 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11653 Notice of Termination and Disqualification – Provider Fails to Appeal

Prototype Letter: Notice of Termination and Disqualification (following failure to appeal); Imminent Threat to Health or Safety [NOTE: this letter must be sent by certified mail/return receipt and regular mail.]

Dear [Provider]:

You received Notice of Serious Deficiency, Suspension, Proposed Termination and Proposed Disqualification; Imminent Threat to Health or Safety on [date received]. You had until [insert deadline for requesting appeal] to submit any request for an appeal of the proposed actions. No request for an appeal was submitted by that deadline.

TERMINATION AND DISQUALIFICATION

As a result, we are:  Terminating your home’s agreement to participate in the CACFP for cause effective [date], and  Disqualifying you from future CACFP participation effective [date].

[The effective date for the agreement termination and disqualification is the date stated in the Notice of Serious Deficiency, Suspension, Proposed Termination and Proposed Disqualification; Imminent Threat to Health or Safety.]

Upon disqualification, you will be placed on the National Disqualified List (NDL). While on the NDL, you will not be able to participate in the CACFP as a day care home provider. In addition, you will not be able to serve as a principal in, or perform any key CACFP functions for, any CACFP institution or facility. You will remain on the NDL until such time as the Texas Department of Agriculture Food and Nutrition determines that the serious deficiencies have been corrected or until 7 years after your disqualification.

Texas Department of Agriculture – January 2015 Resources – 58 Child and Adult Care Food Program – Day Care Homes Handbook However, if any debt relating to the serious deficiencies has not been repaid, you will remain on the list until the debt has been repaid. [Insert if applicable: You owe a debt in the amount of {enter dollar amount}.]

You may not appeal the termination of your agreement for cause or your disqualification.

Sincerely,

Sponsor Employee Name & Title cc: F&N Community Operations Field office

Resources – 59 Texas Department of Agriculture – January 2015 Child and Adult Care Food Program – Day Care Homes Handbook 11654 Notice of Temporary Deferral – Provider Wins Appeal

Prototype Letter: Notice of Rescission (Rescinding Serious Deficiency, Suspension, Proposed Termination and Proposed Disqualification (after provider wins appeal); Imminent Threat to Health or Safety [NOTE: this letter must be sent by certified mail/return receipt and regular mail.]

Dear [Provider]:

You filed a timely appeal of the proposed termination and proposed disqualification. On [date of hearing official’s decision], the hearing official overturned the proposed actions.

SERIOUS DEFICIENCY DETERMINATION, SUSPENSION, PROPOSED TERMINATION AND PROPOSED DISQUALIFICATION TEMPORARILY DEFERRED

As a result, we have temporarily deferred our serious deficiency determination and will not terminate your agreement or disqualify you from participation in the CACFP.

We will pay any valid claims for reimbursement submitted by you for the period of the suspension. You must submit these claims by [insert a date that will give the provider an appropriate length of time to submit these claims].

Sincerely,

Sponsor Employee Name & Title cc: F&N Community Operations Field office

Texas Department of Agriculture – January 2015 Resources – 60 Child and Adult Care Food Program – Day Care Homes Handbook