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.)
- (Bosnian) (PDF, 173KB, 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.)
- (Karen) (PDF, 59KB, 1pg.)
- (Khmer Version) (PDF, 54.2KB, 1pg.)
- (Lao Version) (PDF, 45.8KB, 1pg.)
- (Mai Mai) (PDF, 87KB, 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
- Funding to Feed Children - County Outreach Flyer (Spanish)
- Homes Outreach Advertisement (Large) (PDF, 84.8KB, 1pg.)
- Homes Outreach Advertisement (Smaller Sizes) (PDF, 5.78MB, 1pg.)
Forms
-
2010 Agreement Renewal Package
Forms:
- CACFP-146 Renewal Checklist (RTF, 78KB, 1pg.)
- DOH-4040 FFY 2010 Budget Renewal Application for Sponsoring Organizations of Day Care Homes (PDF Fill-in Version, 1.7MB, 13pg.)
- DOH-4040 FFY 2010 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, 131MB, 2pg.)
- Annual Update of CACFP Manual for Sponsoring Organizations of Day Care Homes (CACFP-3979H) (PDF, 123KB, 2pg.)
- Download CACFP-3979H (RTF, 131MB, 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.)
- Spanish Version of DOH-3705 (PDF, 95KB, 2pg.)
- Download Spanish Version of DOH-3705 (RTF, 1.00MB, 2pg.)
- Enrollment Form for Day Care Home (DOH-4419) (PDF, 106KB, 1pg.)
- Download DOH-4419 (RTF, 1.27MB, 1pg.)
- Russian Version of DOH-4419 (PDF, 212KB, 1pg.)
- Download Russian Version of DOH-4419 (RTF, 1.29MB, 1pg.)
- Chinese Version of DOH-4419 (PDF, 176KB, 1pg.)
- Download Chinese Version of DOH-4419 (RTF, 1.34MB, 1pg.)
- Expansion Grant Application with Instructions - Homes (DOH3805) (PDF Fill-in Version, 297KB, 13pg.)
- Download DOH3805 (RTF, 5.03MB, 13pg.)
- Income Eligibility Guidelines - Provider Eligibility for Tier 1, Provider's Own, Foster Children and Participant Eligibility in Tier 2 Homes (CACFP-3977) (PDF, 76KB, 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, 66KB, 4pg.)- Download DOH4160 (RTF, 2.57MB, 4pg.)
- Versión en español (PDF, 64KB, 4pg.)
- Descargar versión en español (RTF, 2.58MB, 4pg.)
- Russian DOH-4160ru (PDF, 171KB, 4pg.)
- Download Russian DOH-4160ru (RTF, 1.41MB, 4pg.)
- Chinese DOH-4160zh (PDF, 273KB, 4pg.)
- Download Chinese DOH-4160zh (RTF, 2.65MB, 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, 102KB, 4pg.)- Download DOH4161 (RTF, 3.82MB, 4pg.)
- Versión en español (PDF, 65KB, 4pg.)
- Descargar versión en español (RTF, 3.92MB, 4pg.)
- Russian DOH-4161ru (PDF, 164KB, 4pg.)
- Download Russian DOH-4161ru (RTF, 4.09MB, 4pg.)
- Chinese DOH-4161zh (PDF, 319KB, 4pg.)
- Download Chinese DOH-4161zh (RTF, 21.5MB, 4pg.)
- Monitor Check List for Day Care Homes with Instructions (CACFP-4118) (PDF, 222KB, 2pg.)
- Download CACFP-4118 (RTF, 1.41MB, 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.)
- (Bosnian Version) (PDF, 1.9MB, 1pg.)
- (Karen Version) (PDF, .97MB, 1pg.)
- (MaiMai Version) (PDF, 922KB, 1pg.)
- Crediting Foods in CACFP (PDF, 1.96MB, 56pg.)
- Infant Meal Pattern (CACFP-103) (PDF, 48.4KB, 1pg.)
- (Versión en español) (PDF, 48.4KB, 1pg.)
- (Bosnian Version) (PDF, 1.9MB, 1pg.)
- (Karen Version) (PDF, .97MB, 1pg.)
- (MaiMai Version) (PDF, 922KB, 1pg.)
- Tier 1 Eligible Public Schools in Upstate NY - March 2009 (PDF, 589KB, 69pg.)
- Tier 1 Eligible Public Schools in NYC - March 2009 (PDF, 438KB, 33pg.)
- Zip Code Areas Served - Listing by Family Day Care Home Sponsor (PDF, 296KB, 92pg.)
Sample Menus
- Easy and Economical Snack Ideas (PDF, 125KB, 1pg.)