Policy Memo 184

DOH-CACFP: Number 184 (03/16), Supersedes Number 166 (04/13)

TO: CACFP Sponsoring Organizations of Day Care Homes

FROM: Dwight LaDu, Director, Child and Adult Care Food Program

SUBJECT: Requirement for Collection of Annual Enrollment Forms

The purpose of this memorandum is to remind Sponsoring Organizations of Day Care Homes (Sponsors) of the requirement to collect annual enrollment information for each child in child care homes. This may be accomplished through the use of the CACFP Child Enrollment Form (DOH-4419) or a Sponsor-developed form that meets the requirements.

If a Sponsor-developed form is used it must meet the following criteria:

  1. It must be completed, signed and dated by the child's parent or legal guardian.
  2. It must include information on the child's normal days and hours of care, as well as the normal meals received while in care.
  3. A new enrollment form must be completed annually.

Children who are missing current enrollment forms are not payable and cannot be included on the Provider's monthly claim. The DOH-4419 may be ordered from CACFP.

CACFP recommends Sponsors develop a process for tracking the receipt and expiration of enrollment forms. Participants Report 10501 in CIPS can be used to identify children with expiring enrollment dates. It is important that monthly changes in enrollment information, such as changes in the days or hours of care, or added and dropped children, are updated in CIPS. Updating the system will enable Sponsors to efficiently track children's enrollment expiration dates.

You may contact a CACFP Homes Unit Nutritionist at 1-800-942-3858, Option 3 if you have further questions about the requirement for annual enrollment information.