Applications

Application Instructions

New Child and Adult Care Food Program Applicants

To begin this process print and complete each applicable form related to your organization – child care center, adult day care center, emergency shelter, At-Risk afterschool Care Center or outside school hours care center. Mail all necessary application forms from the list below to the Minnesota Department of Education (MDE) Food and Nutrition Service (FNS) attention applications team. The organization will be contacted during the application process to request additional information if necessary, and to schedule an on-site pre-approval visit. The Child and Adult Care Food Program (CACFP) application will not be approved until all documents have been processed and a pre-approval visit has been conducted. Meals may not be claimed prior to the visit and the approval of the CACFP application.

IMPORTANT INFORMATION

Household Income Statement (HIS) form is used by all participants of CACFP to collect information from families and is provided at this time to distribute the HIS and letter to households. Organizations collect, approve and maintain the completed HIS on-site. Do not send these forms to FNS.

View Child Care Household Income form (HIS).

View Adult Care Household Income form (HIS)

Data Universal Numbering System (DUNS) number: This nine-digit number is required of all recipients of federal funds. Provide the organization’s DUNS number to FNS along with the application documents. View the Grants.gov website to verify whether or not the organization has a DUNS number. View the Dun & Bradstreet website to register for a DUNS number.

Vendor Number Every applicant needs a vendor number to receive Child Nutrition Program payments through the Minnesota Department of Management and Budget (MMB). Once you obtain vendor number (or if you already have a vendor number) provide the number to the applications staff member at MDE as part of your application packet.

Visit MMB website (http://www.mmb.state.mn.us/vendor-ids/new-vendors).

APPLICATION INFORMATION

Child and Adult Care Food Program Agreement – This is the agreement between the organization and the MDE to participate in the USDA Federal Child Nutrition Program. The agreement outlines the main responsibilities of a CACFP sponsoring organization. Complete all requested information and obtain an original signature of an authorized representative.

View Child and Adult Care Food Program Agreement.

CACFP Policy Statement for free and reduced priced meals – This form must be completed by all applicants and identifies if the organization charges additional fees for meals.

View Policy Statement.

Child and Adult Care Food Program Center Application – This application is required to provide information about the organization and physical locations where meals are served. Complete one sponsor application and multiple site applications, as needed, for each location where meals are served.

View Child and Adult Care Food Program Center Application.

Estimated Reimbursement Worksheet. This worksheet can be used by sponsors to project annual revenue for their CACFP budget and it can be used to estimate monthly reimbursement.

View the Estimated Reimbursement Worksheet.

The budget is an annual estimate of the costs an organization will incur while operating and administering the child and adult care food program. The budget must include all CACFP costs, even those that exceed program reimbursements. All applicants must complete and provide the budget detail worksheet to demonstrate how the figures entered in the budget were established. Note to multi-site organizations, this budget is to include the costs for all sites.

View CACFP Detail Budget Worksheet.

Public Notice/News Release – A public notice must be submitted to local news media announcing intent to offer the CACFP to enrolled center participants. Enclose a copy of the public notice specific to the organization the public release must be dated and state the name of the media outlet(s) to which it was sent.

View Public Notice/News Release

Child Care License - Submit a copy of the center’s license issued from either the Department of Human Services or Tribal Authority. Proof of current licensure is required unless the facility is exempt from licensure.

Attachment for Non-Licensed Sites – A site may be exempt from licensing for example, those operating within a public school, emergency shelters, outside school hours care facility like boys and girls clubs. If alternate approval is appropriate complete and provide this document.

View Attachment for Non-Licensed Sites.

Disclosure of Birthdates for Executive Director and Chairman of the Board – This form is required to collect information about the responsible principals of the organization.

View Disclosure of Birthdates for Executive Director and Chairman of the Board.

Child Enrollment Form –Customize this form for the organization and included a copy with the application packet. This form is used to collect information from families. Exempt from completion of this form are Adult Care, Emergency/Homeless Shelters or At-Risk Afterschool care centers.

View Child Enrollment Form.

Site ID Request – This form is required and is used to identify the physical location where food service is provided. Complete a form for each site where meals are served.

View Site ID Request.

User ID and Password Request (add/delete) – This form is a requirement used to add or delete members of the organization to request access to the FNS Cyber-Linked Interactive Child Nutrition System (CLiCS) to submit claims and access the on line application.

View CLiCS User ID/Password Request.

Listserv Subscribe/Unsubscribe Form – This form is a requirement used to add or delete members of the organization to an e-mail list used by FNS to communicate specific program information. View Food and Nutrition Service (FNS) Listserv .

ADDITIONAL FORMS, as applicable

Vended Meals Contract - This contract is required if meals will be purchased from a vendor. Use the template provided by MDE. Submit a signed and complete copy of the CACFP Contract for Vended Meals. View Catering Contract template.

Sponsor Management Plan – This document must be completed by organizations with multiple sites applying for CACFP. The management plan outlines the sponsor’s oversight of the CACFP and provides the related policies, procedures and supporting budget documents.

View Sponsor Management Plan.

IRS Form 501(C)(3) - This is a requirement for all non-profit organizations. Submit a copy of the notice issued by the IRS granting tax-exempt status to private, non-profit organizations.

For-Profit Eligibility form – This is a requirement for all for-profit organizations and may take some time to complete. Submit a complete form including the required attachments listed on the form to verify that each site meets the eligibility requirements to participate in the CACFP.

View For-Profit Eligibility Form.

SUMMARY

The organization will be contacted during the application process to request additional information if necessary, and to schedule an on-site pre-approval visit. The CACFP application will not be approved until all documents have been processed and a pre-approval visit has been conducted. Meals may not be claimed for reimbursement prior to the pre-approval visit and the approval of the CACFP application. Contact the FNS Applications Team with any questions you have at 651-582-8526, 1-800-366-8922 (MN Toll-free) or by e-mail mde.fns@state.mn.us.

Send application materials as a packet to:

Minnesota Department of Education / Food and Nutrition Service / Applications Team

1500 Highway 36 West / Roseville, MN 55113