Day Care Homes
(All Brochures, Forms, Informational Charts, and Sample Menus are available below in PDF Format or may be requested by contacting the Child and Adult Care Food Program at our Toll Free Number: 1-800-942-3858). To view or print PDF Documents, Adobe Acrobat Reader must be installed on your computer.
Brochures
- Building For the Future (English)- Notification to parents about CACFP and its Benefits
- (English) (PDF, 128KB, 1pg.)
- (Versión en español) (PDF, 109KB 1pg.)
- (Arabic Version) (PDF, 41.9KB, 1pg.)
- (Bengali Version) (PDF, 60.8KB, 1pg.)
- (Chinese Version) (PDF, 52.6KB, 1pg.)
- (French Version) (PDF, 127KB, 1pg.)
- (Haitian Creole Version) (PDF, 139KB, 1pg.)
- (Hebrew Version) (PDF, 29.9KB, 1pg.)
- (Hmong Version) (PDF, 136KB, 1pg.)
- (Japanese Version) (PDF, 59.9KB, 1pg.)
- (Khmer Version) (PDF, 54.2KB, 1pg.)
- (Lao Version) (PDF, 45.8KB, 1pg.)
- (Portuguese Version) (PDF, 129KB, 1pg.)
- (Russian Version) (PDF, 67.5KB, 1pg.)
- (Thai Version) (PDF, 54.2KB, 1pg.)
- (Vietnamese Version) (PDF, 54.8KB, 1pg.)
- (Yiddish Version) (PDF, 53.3KB, 1pg.)
- Funding to Feed Children - County Outreach Flyer
- Homes Outreach Advertisement (Large) (PDF, 84.8KB, 1pg.)
- Homes Outreach Advertisement (Smaller Sizes) (PDF, 5.78MB, 1pg.)
Forms
-
2009 Agreement Renewal Package
Forms:
- CACFP-146 Renewal Checklist (RTF, 1.26MB, 1pg.)
- DOH-4040 FFY 2008 Budget Renewal Application for Sponsoring Organizations of Day Care Homes (PDF Fillable Form, 356KB, 13pg.)
- DOH-4040 FFY 2008 Budget Renewal Application for Sponsoring Organizations of Day Care Homes (RTF, 1.72MB, 13pg.)
- DOH-3671 - Certificate of Authority (RTF, 678 KB, 1pg.)
- CACFP-3854H - Participant Data Form (RTF, 647KB, 1pg.)
- CACFP-4217 - Listing of Board of Director Members (RTF, 641KB, 1pg.)
- CACFP-3979H - Annual Update of CACFP Manual (RTF, 47KB, 2pg.)
- Annual Update of CACFP Manual for Sponsoring Organizations of Day Care Homes (CACFP-3979H) (PDF, 50KB, 2pg.)
- Download CACFP-3979H (RTF, 47KB, 2pg)
- Breastfeeding-Friendly Day Care Home (CACFP-151) General Information and Overview (PDF, 47KB, 1pg.)
- Breastfeeding Form and Self-Assessment: Is My Day Care Home Breastfeeding Friendly? (CACFP-152) (PDF, 60KB, 2pg.)
- Download CACFP-152 (RTF, 6.01MB, 2pg.)
- Breastfeeding Information For Parents (CACFP-153) (PDF, 78KB, 2pg.)
- Download CACFP-153 (RTF, 11.4MB, 2pg.)
- Certificate of Authority Form (DOH3671) (PDF, 41KB, 1pg.)
- Download DOH3671 (RTF, 678KB, 1pg.)
- Claim Form for Day Care Homes with Instructions (DOH3709) (PDF, 235KB, 2pg.)
- Download DOH3709 (RTF, 764KB, 2pg.)
- Claim Form Attachment for Day Care Homes with Instructions (DOH3710) (PDF, 239KB, 2pg.)
- Download DOH3710 (RTF, 354KB, 2pg.)
- Continuous Application and Agreement for Day Care Home Participation (DOH-3705) (PDF, 86KB, 2pg.)
- Download DOH-3705 (RTF, 1.49MB, 2pg.)
- (Versión en español) (PDF, 95KB, 2pg.)
- Descargar versión en español (RTF, 1.00MB, 2pg.)
- Enrollment Form for Day Care Home (DOH-4419) (PDF, 34KB, 1pg.)
- Download DOH-4419 (RTF, 1.27MB, 1pg.)
- Expansion Grant Application with Instructions - Homes (DOH3805) (PDF, 103KB, 13pg.)
- Download DOH3805 (RTF, 151KB, 13pg.)
- Income Eligibility Guidelines - Provider Eligibility for Tier 1, Provider's Own, Foster Children and Participant Eligibility in Tier 2 Homes (CACFP-3977) (PDF, 33KB, 1pg.)
- Letter to Households Tier 2 Day Care Home Participant
Income Eligibility Guidelines for Tier 1
Day Care Home Participant Income Eligibility Application (DOH4160) (PDF, 82KB, 4pg.)- Download DOH4160 (RTF, 774KB, 4pg.)
Please Note: The following list of translated DOH-4160 forms still contain 2007-2008 rates. These forms will be updated shortly. - Versión en español (PDF, 268KB, 4pg.)
- Descargar versión en español (RTF, 766KB, 4pg.)
- Russian DOH-4160ru (PDF, 294KB, 4pg.)
- Download Russian DOH-4160ru (RTF, 863KB, 4pg.)
- Chinese DOH-4160zh (PDF, 167KB, 4pg.)
- Download Chinese DOH-4160zh (RTF, 902KB, 4pg.)
- Download DOH4160 (RTF, 774KB, 4pg.)
- Letter to Households Day Care Home Provider
Income Eligibility Guidelines for Tier 1
Day Care Home Provider Income Eligibility Application
(This list applies to day care home provider households
applying for Tier 1 reimbursement rates.) (DOH4161) (PDF, 77KB, 4pg.)- Download DOH4161 (RTF, 758KB, 4pg.)
Please Note: The following list of translated DOH-4161 forms still contain 2007-2008 rates. These forms will be updated shortly. - Versión en español (PDF, 260KB, 4pg.)
- Descargar versión en español (RTF, 762KB, 4pg.)
- Russian DOH-4161ru (PDF, 310KB, 4pg.)
- Download Russian DOH-4161ru (RTF, 862KB, 4pg.)
- Chinese DOH-4161zh (PDF, 171KB, 4pg.)
- Download Chinese DOH-4161zh (RTF, 897KB, 4pg.)
- Download DOH4161 (RTF, 758KB, 4pg.)
- Monitor Check List for Day Care Homes with Instructions (CACFP-4118) (PDF, 83.3KB, 2pg.)
- Download CACFP-4118 (RTF, 771KB, 2pg.)
- Order Form for CACFP Day Care Homes (CACFP-3978) (PDF, 62KB, 2pg.)
- Download CACFP-3978 (RTF, 739KB, 2pg.)
- Outside Employment Policy - Sample
- Download Outside Employment Policy (RTF, 12.7KB, 1pg.)
- Provider Transfer Form (DOH-4219) (PDF, 31KB, 1pg.)
- Download Provider Transfer Form (DOH-4219) (RTF, 640KB, 1pg.)
- Serious Deficiency Process for Providers - Handouts (English and Versión en español)
Sample letters may be downloaded and are also available on CD or diskette by request. - Suspension Handouts - Providers (English and Versión en español)
Sample letters may be downloaded and are also available on CD or diskette by request.
Informational Charts and Guides
- 2000 Census Data for New York State (PDF, 304KB, 2pg.)
- Child Meal Pattern (CACFP-102) (PDF, 64.5KB, 1pg.)
- (Versión en español) (PDF, 55.9KB, 1pg.)
- Crediting Foods in CACFP (PDF, 678KB, 29pg.)
- Infant Meal Pattern (CACFP-103) (PDF, 48.4KB, 1pg.)
- (Versión en español) (PDF, 48.4KB, 1pg.)
- Tier 1 Eligible Public Schools in Upstate NY - March 2007 (PDF, 406KB, 48pg.)
- Tier 1 Eligible Public Schools in NYC - March 2007 (PDF, 416KB, 16pg.)
Sample Menus
- Easy and Economical Snack Ideas (PDF, 125KB, 1pg.)