Updated Eligibility Forms for Adult Care Agencies

This Management Bulletin (MB) notifies Child and Adult Care Food Program (CACFP) Adult Care Center sponsors that the California Department of Social Services (CDSS) has simplified and updated eligibility template forms. The CDS encourages agencies currently using CDS-provided template forms to immediately begin using these updated versions.

Background

In order to claim meals at the free and reduced-price reimbursement rates in the CACFP, the CDS requires agencies to retain documentation verifying participants’ free or reduced-price eligibility. These documentation requirements are described in Title 7, Code of Federal Regulations, Part 226.23(e).

In order to assist agencies in collecting this information, the CDSS provides several template forms for agencies’ use.

Updated Forms

The forms described below are available in the Download Forms section of the Child Nutrition Information and Payment System (CNIPS).

Meal Benefit Form for Adult Participants

Agencies may use this form to document the eligibility of all participants. It replaces the previous template forms entitled Participation/Categorical Eligibility Application (NSD 7101A) and Participation/Income Eligibility Application (NSD 7101C). The Meal Benefit Form for Adult Participants is available as Form ID CACFP 52 in the CNIPS.

Adult Letter to Households

Agencies must give a letter to participants when they distribute the Meal Benefit Form. The letter informs participants that the center participates in the CACFP offered by the U.S. Department of Agriculture (USDA) and serves meals at no separate charge to eligible enrolled adults. The CDSS has updated the letter to include the current eligibility scale. The Adult Letter to Households is available as Form ID CACFP 53 in the CNIPS.

Adult Agency Enrollment/Eligibility Roster

Agencies may use the Adult Agency Enrollment/Eligibility Roster to document the enrollment and eligibility of participants as part of the one-month eligibility study required each October.

Agencies using the fixed percentage method of claiming reimbursement establish their fixed percentages for the entire year with the data reported from the one-month eligibility study in October. Agencies may change their fixed percentages, if desired, at any time during the year by completing another monthly eligibility study. Agencies using the actual count method of claiming reimbursement are required to conduct eligibility studies each month.

The roster replaces the previous template form entitled Participation/Categorical Eligibility Alternative Documentation (NSD 7101B). The Adult Agency Enrollment/Eligibility Roster is available as Form ID CACFP 44 in the CNIPS.

Questions

If you have questions regarding using these forms to certify eligibility of participants, reporting changes in CACFP eligibility, or any other questions regarding this MB, you should contact the CACFP specialist assigned to your agency. You will find a list of contact information for specialists on the Child and Adult Food Care Program Contact List or in the Download Forms section of the CNIPS. You can also contact the CACFP Office Technician by email at CACFPinfo@dss.ca.gov to be directed to your specialist.

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