"Child and Adult Care Food Program at-Risk 5-day Reconciliation Form" - Arizona

This Arizona-specific ""child and Adult Care Food Program at-Risk 5-day Reconciliation Form" - Arizona" is a document released by the Arizona Department of Education.

Download the fillable PDF by clicking the link below and use it according to the applicable legal guidelines.

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Download "Child and Adult Care Food Program at-Risk 5-day Reconciliation Form" - Arizona

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State of Arizona
Department of Education
Child and Adult Care Food Program
AT – RISK 5-DAY RECONCILIATION
Sponsor Name/Address:
Site Name/Address (if different):
CTDS #:
Telephone Number:
Contact Person(s):
Title(s):
Date:
Meal Service Time:
5 Day Reconciliation
In the table below, report the total number of meals claimed for each of the 5 days prior to today (based on the meal
count sheets for previous 5 days).
1 Day Before
2 Days Before
3 Days Before
4 Days Before
5 Days Before
Meal
Date:
Date:
Date:
Date:
Date:
PM Snack
Dinner
In the table below, report the total number of participants in attendance for each of the 5 days prior to today (based
on sign in/out or attendance sheets for previous 5 days).
1 Day Before
2 Days Before
3 Days Before
4 Days Before
5 Days Before
Meal
Date:
Date:
Date:
Date:
Date:
PM Snack
Dinner
Compare the tables above.
1) Are there any discrepancies between the numbers claimed and the numbers in attendance?
Yes
No
If yes, describe:
2) Are the counts for today consistent with the past 5 days?
Yes
No
If no, explain why:
This institution is an equal opportunity provider and employer.
State of Arizona
Department of Education
Child and Adult Care Food Program
AT – RISK 5-DAY RECONCILIATION
Sponsor Name/Address:
Site Name/Address (if different):
CTDS #:
Telephone Number:
Contact Person(s):
Title(s):
Date:
Meal Service Time:
5 Day Reconciliation
In the table below, report the total number of meals claimed for each of the 5 days prior to today (based on the meal
count sheets for previous 5 days).
1 Day Before
2 Days Before
3 Days Before
4 Days Before
5 Days Before
Meal
Date:
Date:
Date:
Date:
Date:
PM Snack
Dinner
In the table below, report the total number of participants in attendance for each of the 5 days prior to today (based
on sign in/out or attendance sheets for previous 5 days).
1 Day Before
2 Days Before
3 Days Before
4 Days Before
5 Days Before
Meal
Date:
Date:
Date:
Date:
Date:
PM Snack
Dinner
Compare the tables above.
1) Are there any discrepancies between the numbers claimed and the numbers in attendance?
Yes
No
If yes, describe:
2) Are the counts for today consistent with the past 5 days?
Yes
No
If no, explain why:
This institution is an equal opportunity provider and employer.
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