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, print or save fill-in PDF documents, the latest Adobe Acrobat Reader must be installed on your computer.
Brochures
- Building for the Future (FNS-317)- (Notification to parents about CACFP and its benefits)
- English (PDF)
- Spanish Version (PDF)
- Arabic Version (PDF)
- Bengali Version (PDF)
- Chinese Version (PDF)
- Haitian Creole Version (PDF)
- Italian Version (PDF)
- Korean Version (PDF)
- Polish Version (PDF)
- Russian Version (PDF)
- Yiddish Version (PDF)
- Good Nutrition Pays in Day Care Homes (Publication No. 4364) (PDF)
- Arabic Version (Publication No. 19322) (PDF)
- Bengali Version (Publication No. 19315) (PDF)
- Chinese Version (Publication No. 4385) (PDF)
- French Version (Publication No. 19320) (PDF)
- Haitian-Creole Version (Publication No. 19316) (PDF)
- Italian Version (Publication No. 19317) (PDF)
- Korean Version (Publication No. 19318) (PDF)
- Polish Version (Publication No. 19321) (PDF)
- Russian Version (Publication No. 4386) (PDF)
- Spanish Version (Publication No. 4384) (PDF)
- Urdu Version (Publication No. 19323) (PDF)
- Yiddish Version (Publication No. 19319) (PDF)
- Together We Can Raise Healthy Children Brochure
Forms
- Agreement Between the State and Sponsoring Organizations of Day Care Homes (DOH-3841) (PDF)
- Application for Close Out Payments for Sponsoring Organizations of Day Care Homes (DOH-5063) PDF FILL-IN FORMAT (PDF)
- Application for Start-Up or Expansion Payments for Sponsoring Organizations of Day Care Homes (DOH-3805) PDF FILL-IN FORMAT (PDF)
- Authorization for Online Health Commerce System (HCS) Account Creation (DOH-5158) (PDF)
- Child Enrollment Form for Day Care Homes (DOH-4419) (PDF)
- Child Meal Disallowance (CACFP-173) (PDF)
- Spanish Version (PDF)
- Continuous Application and Agreement for Day Care Home Participation (CACFP-3705) (PDF)
- Day Care Home Child Menu (CACFP-171) (PDF)
- Spanish Version (PDF)
- Day Care Home Infant Menu 6 Months to 1st Birthday (CACFP-199) PDF FILL-IN FORMAT (PDF)
- Five-Day Reconciliation Worksheet for Day Care Homes (Publication No. 19226) (PDF)
- Letter to Households - Income Eligibility Form Tier II Day Care Home Participant (DOH-4160) (PDF)
- Spanish DOH-4160es (PDF)
- Letter to Households - Income Eligibility Form Family Day Care Home Provider (DOH-4161) (PDF)
- Spanish DOH-4161es (PDF)
- Monitoring Checklist for Day Care Homes (DOH-5166) (PDF)
- On-Site Provider Addendum (DOH-5155) formerly CACFP-160 (PDF)
- Order Form for Sponsors of Day Care Homes (CACFP-3978) (PDF)
- Outside Employment Policy - Sample (CACFP-187) (PDF)
- Pre-Approval Checklist for Enrolled Caregivers and Day Care Home Providers (CACFP-106) (PDF)
- Provider Transfer Form (DOH-4219) (PDF)
- Reimbursement Rates For Day Care Homes (CACFP-124H) (PDF)
- Serious Deficiency Process for Providers - Handouts
Sample letters are available in RTF and are available by request. - Substitute Form W-9
NYS Office of the State Comptroller Substitute Form W-9 Request for Taxpayer Identification Number and Certification. - Suspension Handouts - Providers
Sample letters are available in RTF and are available by request.
Informational Charts and Guides
- 2010 Census Data for New York State (PDF)
- Child Meal Pattern (Publication No. 1259) (PDF)
- Arabic Version (PDF)
- Bengali Version (PDF)
- Chinese Version (PDF)
- French Version (PDF)
- Haitian-Creole Version (PDF)
- Italian Version (PDF)
- Korean Version (PDF)
- Polish Version (PDF)
- Russian Version (PDF)
- Spanish Version (PDF)
- Urdu Version (PDF)
- Yiddish Version (PDF)
- Claim Submission Deadline FFY 2022-2023 (PDF)
- Crediting Foods in CACFP (PDF)
- Arabic Version (PDF)
- Bengali Version (PDF)
- Chinese Version (PDF)
- French Version (PDF)
- Haitian-Creole Version (PDF)
- Italian Version (PDF)
- Korean Version (PDF)
- Polish Version (PDF)
- Russian Version (PDF)
- Spanish Version (PDF)
- Urdu Version (PDF)
- Yiddish Version (PDF)
- Infant Meal Pattern (Publication No. 1260) (PDF)
- Arabic Version (PDF)
- Bengali Version (PDF)
- Chinese Version (PDF)
- French Version (PDF)
- Haitian-Creole Version (PDF)
- Italian Version (PDF)
- Korean Version (PDF)
- Polish Version (PDF)
- Russian Version (PDF)
- Spanish Version (PDF)
- Urdu Version (PDF)
- Yiddish Version (PDF)
- Tier 1 Eligible Public Schools Outside of NYC - March 2020 (PDF)
- Tier 1 Eligible Public Schools in NYC - March 2020 (PDF)
