"Add-A-site Checklist - Independent Center Adding Sites/Becoming a Center Sponsor" - Georgia (United States)

Add-A-site Checklist - Independent Center Adding Sites/Becoming a Center Sponsor is a legal document that was released by the Georgia Department of Early Care and Learning - a government authority operating within Georgia (United States).

Form Details:

  • Released on November 1, 2015;
  • The latest edition currently provided by the Georgia Department of Early Care and Learning;
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Download "Add-A-site Checklist - Independent Center Adding Sites/Becoming a Center Sponsor" - Georgia (United States)

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ADD-A-SITE Checklist
BRIGHT FROM THE START
Georgia Department of Early Care and Learning
Independent Center Adding
Child and Adult Care Food Program
Sites/Becoming a Center Sponsor
2 Martin Luther King Jr., Drive, SE
Suite 754 East Tower
Atlanta, GA 30334
Institution Name _____________________ CACFP Agreement #___________
Instructions:
This checklist should be used when an Independent Center adds a site its CACFP Agreement that is legally owned,
operated and reports revenue to the FEIN of the approved independent center. If a second site is not owned and
operated by the same legal entity, the second site may submit a complete application as an independent center. In this
situation the Independent Center will become a Sponsoring organization of “affiliated” centers. This means that you
will become a “center sponsor”, sponsoring all affiliated centers under the auspices of the Program Agreement with
Bright from the Start.
As a center sponsor, there are additional application requirements, including but not limited to, the submission of a new
management plan, annual budget, and completing additional training. To get started, please contact the Application
Specialist. In preparation for this transition, please review the Sponsoring Organization Provisions section of the
CACFP regulations, 7 CFR 226.16 and Chapter 9 of the applicable handbook to become familiar with the requirements
of the sponsoring organization. Use the New Application Instruction Booklet to complete the documents needed in the
checklist. This booklet can be found on the Bright from the Start website.
Submit the checklist and all documents required to the address below.
Bright from the Start: Georgia Department of Early Care and Learning
Attn: Application Specialist- CACFP
2 Martin Luther King, Jr. Drive, Suite 754 East Tower
Atlanta, GA 30334
Preliminary Requirements:
Review the following items in their entirety and place a check beside each item to indicate completion. All the
documents can be accessed on the Bright from the Start website at http://www.decal.ga.gov/. The Program Contact
must complete the assessment and return with the Add-a-Site Package.
___1. Principal/Program Contact met the additional training requirements and completed the training assessment.
___ 2. Principal/Program Contact has read Section 16 of 7 Code of Federal Regulations 226.16
___ 3. Principal/Program Contact has read Chapter 9 of the Child or Adult Care Handbook, whichever is applicable to
the organization
Section I. Facility to be Added:
st
In 1
column, list the name of the facility for which an application is being submitted.
In 2nd column, if the facility is currently participating in the CACFP in direct agreement Bright from the Start, enter
the Bright from the Start Agreement #, or the last claim month reimbursement was received. If the facility is a new
facility that is not currently participating on the CACFP, leave this column blank.
column, indicate the date the Principal/Program Contact verified that the center’s Principal or staff
rd
In the 3
performing CACFP duties is not terminated and currently disqualified from participating in the CACFP. Refer to
DECAL’s policy guidance at http://www.decal.ga.gov/documents/attachments/Web-BasedUSDA-NDLInfo.pdf.
In the 4th column, indicate the anticipated date to begin claiming reimbursement for this center under your
sponsorship. Please reference CACFP policy # 8 when determining anticipated effective date to operate. Sign below
the table.
Page 1 of 5
Revised 11/2015
ADD-A-SITE Checklist
BRIGHT FROM THE START
Georgia Department of Early Care and Learning
Independent Center Adding
Child and Adult Care Food Program
Sites/Becoming a Center Sponsor
2 Martin Luther King Jr., Drive, SE
Suite 754 East Tower
Atlanta, GA 30334
Institution Name _____________________ CACFP Agreement #___________
Instructions:
This checklist should be used when an Independent Center adds a site its CACFP Agreement that is legally owned,
operated and reports revenue to the FEIN of the approved independent center. If a second site is not owned and
operated by the same legal entity, the second site may submit a complete application as an independent center. In this
situation the Independent Center will become a Sponsoring organization of “affiliated” centers. This means that you
will become a “center sponsor”, sponsoring all affiliated centers under the auspices of the Program Agreement with
Bright from the Start.
As a center sponsor, there are additional application requirements, including but not limited to, the submission of a new
management plan, annual budget, and completing additional training. To get started, please contact the Application
Specialist. In preparation for this transition, please review the Sponsoring Organization Provisions section of the
CACFP regulations, 7 CFR 226.16 and Chapter 9 of the applicable handbook to become familiar with the requirements
of the sponsoring organization. Use the New Application Instruction Booklet to complete the documents needed in the
checklist. This booklet can be found on the Bright from the Start website.
Submit the checklist and all documents required to the address below.
Bright from the Start: Georgia Department of Early Care and Learning
Attn: Application Specialist- CACFP
2 Martin Luther King, Jr. Drive, Suite 754 East Tower
Atlanta, GA 30334
Preliminary Requirements:
Review the following items in their entirety and place a check beside each item to indicate completion. All the
documents can be accessed on the Bright from the Start website at http://www.decal.ga.gov/. The Program Contact
must complete the assessment and return with the Add-a-Site Package.
___1. Principal/Program Contact met the additional training requirements and completed the training assessment.
___ 2. Principal/Program Contact has read Section 16 of 7 Code of Federal Regulations 226.16
___ 3. Principal/Program Contact has read Chapter 9 of the Child or Adult Care Handbook, whichever is applicable to
the organization
Section I. Facility to be Added:
st
In 1
column, list the name of the facility for which an application is being submitted.
In 2nd column, if the facility is currently participating in the CACFP in direct agreement Bright from the Start, enter
the Bright from the Start Agreement #, or the last claim month reimbursement was received. If the facility is a new
facility that is not currently participating on the CACFP, leave this column blank.
column, indicate the date the Principal/Program Contact verified that the center’s Principal or staff
rd
In the 3
performing CACFP duties is not terminated and currently disqualified from participating in the CACFP. Refer to
DECAL’s policy guidance at http://www.decal.ga.gov/documents/attachments/Web-BasedUSDA-NDLInfo.pdf.
In the 4th column, indicate the anticipated date to begin claiming reimbursement for this center under your
sponsorship. Please reference CACFP policy # 8 when determining anticipated effective date to operate. Sign below
the table.
Page 1 of 5
Revised 11/2015
(1) Legal and Doing Business
(2) Did the facility previously
(3) Date Verification of
(4) Anticipated
Name of Facility to Add
participate in the CACFP?
the NDL
Effective Date to
If yes, provide the last claim
Operate
month
______________________________________
_________________________________________
Signature and Title of Principal/Program Contact
Date
Section II. Forms/Documents due to Bright from the Start:
___ 1. ADD-A-SITE Checklist (Submit the entire checklist for each site)
Copy of original IRS letter assigning Federal Employer Identification Number (FEIN) to the entities’ legal
_ __2.
business name.
___ 3.
Most current registration filed on-line with the Secretary of State, indicating corporation officers.
(Government, Military Installations, and BOEs are exempt)
Deed or lease of center with legal name of business or owner’s name referenced in the document.
___ 4.
(Government, Military Installations, and BOEs are exempt)
___ 5. Center Site Application (Enter the site in CNP 2000 and submit a handwritten copy of the form.)
Section C-2 of Site application
a. ___ If charging a separate fee for meals, the center is considered a pricing center. If a pricing center,
the site must complete and submit a Written Free and Reduced Price Policy Statement (See site pricing
information in the application instruction booklet for more information or refer to 7 CFR 226.23(c) to
review what must be included in the policy statement.)
Section E-3 of Site Application - All organizations that contract out with another entity to prepare and deliver
meals must submit one of the following:
a. ___ Agreement to Furnish Food Service for Sites using a School Food Authority (Not applicable to
sites that prepare their own meals or have a central kitchen for sites owned by the same legal
entity)
b. ___ Procurement Documents for sites that intend to contract with a vendor
(Not applicable to sites that prepare their own meals, have a central kitchen for sites owned by
same legal entity, or use a School Food Authority) Include Procurement Checklist, Agreement to
Furnish Foods/Contract and Small Purchase Document.
Use Procurement Manual found on Bright from the Start website at
http://decal.ga.gov/Nutrition/HandbooksInstructions.aspx
___ 6. Roster of Food Program Participants (Form 7 or Form 8) – Adult Care Center or Child Care Center Roster of
Food Program Participants
a.
___ At Risk After School Program Roster of Food Program Participants
(If applicable, a
separate roster must be created solely for the children in the At Risk Program.)
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___ 7. Media Release for site(s) added (Use correct release depending on pricing/non-pricing programs.)
___ 8. Copy of completed pre-operational visit conducted with new site(s)
Section III. Forms/Documents regarding legal entity: Corporations, LLC, and Partnership ONLY:
If
the site is incorporated, a limited liability, or partnership, check the appropriate item and send in requested information.
(Based on the answer in item C-6 of the site application) (Government, Military, and BOE’s exempt)
___ 1. Copy of Certificate of Incorporation for Incorporated centers
___ 2. Copy of Certificate of Organization for Limited Liability Companies
___ 3. Copy of Certificate of Limited Partnership for partnerships
___ 4. Copy of Articles of Incorporation for Incorporated centers
___ 5. Copy of Articles of Organization for Limited Liability Companies
Section IV. FOR CHILD CARE PROGRAMS ONLY
Forms/Documents to determine eligibility for all Child Care Programs: To qualify for the CACFP, the child care
center must meet one of the following conditions. Place a check beside the eligibility method being used to qualify the
program and submit any documents requested under the item checked. Item 3 can only be used after determining the
child care center does not qualify under Item 2, Title XX/Pre-K Cat 1.
1. ___ Non-Profit child care centers (Check item 1 – no documents needed except for churches)
a. ___ If a church which has tax-exempt status under the umbrella of the national church affiliation,
submit the list attached to the IRS letter which contains the church’s name, or submit a letter from the
chief financial officer, or comparable person verifying that that subordinate church is included in the
tax-exempt status of the national organization along with item an above.
b. ___If a church or the parent organization has not filed for tax-exempt status with the IRS, submit the
Tax Exempt Status Certification for Churches form with section 2 completed and signed by the
financial officer of the organization.
2. ___ For-Profit child care centers qualifying by 25% of the enrolled children or licensed capacity (whichever is less)
receiving compensation under Title XX and/or Georgia Pre-K Category 1
a. ___ Submit copies of DFCS forms 69 or 77 that are signed by the DCFS representative, or Maximus
report for Title XX children
3. ___ For-Profit child care centers qualifying by 25% of the enrolled children or licensed capacity (whichever is less)
being eligible for Free and/or Reduced price meals based on the income stated on the Income Eligibility Statements
a. ___ Obtain complete Income Eligibility Statements for all children. Indicate each child’s eligibility on
the Roster of Food Program Participants that is submitted with the application. Do Not Submit the IES
forms.
Licensure/Alternate Approval Verification for all Child Care Centers: Place a check beside the item that applies to
each site for which you are making an application and submit the documents indicated under the item checked if
requested to do so. Refer to the section on licensing in the new application instruction booklet if you have questions
concerning licensure or exemptions from licensure.
1. ___ If licensed by Bright From the Start: Georgia Department of Early Care and Learning, check here and
submit copy of license (or approval to operate if new and no license has been received)
a. ___ Submit copy of most recent Inspection Report (within past 12 months)
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Revised 11/2015
2. ___ If licensed by the Department of Defense, check here and submit Certificate to Operate a Child
Development Program
a. ___ Submit copy of most recent Installation Child Care Evaluation Team Assessment
3. ___If approved by the U.S. Department of Health and Human Services to operate a Head Start program, submit
the following:
a. ___Head Start Performance Standard Review (Triennial or 360 Degree assessment) (Provide a copy of
the cover letter from the center’s most recent review)
4. ___If approved by any other Federal, State, or local entity, submit the current approval documentation from the
governing Federal, State, or Local authority.
5. ___ Alternate Licensure and Child Care Standards
If the child care center or emergency shelter is not approved by a Federal, State, or local authority, the center
must meet CACFP Child Care Standards in order to qualify for the program. The Georgia law requires all child
care programs to be licensed or exempt.
a. ___Alternate Licensure Self-Certification form (child care centers only)
b. ___Exemption Letter from Child Care Licensing
c. ___ Copy of Certificate of Occupancy
d. ___Child Care Standards Form
e. ___ Copy of a current health/sanitation permit or satisfactory report and fire inspection conducted by
local governing agency within the past 12 months. (BOE’s are exempt. SFSP sponsors transitioning to
at-risk may submit documentation of a current inspection obtained for SFSP camp site at same location
as at-risk site.)
f. Please select a response to the question below. _____ Yes _____ No
Are meals being prepared, i.e., cooked, altered, unpackaged, reheated, etc., in the space/location as
indicated on the health/food inspection that is being submitted with the application?
6. ___Center is an Emergency/Homeless, At Risk After-School Care, or Outside Schools Hours program and is
not required to have Federal, State, or local licensing.
a. ___Copy of Certificate of Occupancy
b. ___Exemption Letter from Child Care Licensing (Not applicable to Emergency/Homeless shelters)
c. Please select a response to the question below. _____ Yes _____ No
Are meals being prepared, i.e., cooked, altered, unpackaged, reheated, etc., in the space/location as
indicated on the health/food inspection that is being submitted with the application?
SECTION V. FOR ADULT CARE CENTERS ONLY
Forms/Documents to determine eligibility for Adult Care Programs: Submit any documents requested under each
section below.
Profit versus Non-profit: Place a check beside the eligibility method you are using to qualify for the program
___ Non-Profit adult care centers (Check item 1 – no documents needed except for churches)
1.
a. ___If a church which has tax-exempt status under the umbrella of the national church affiliation, submit
the list attached to the IRS letter which contains the church’s name, or submit a letter from the chief
financial officer, or comparable person verifying that that subordinate church is included in the tax-
exempt status of the national organization along with item an above.
Page 4 of 5
Revised 11/2015
b. ___If a church or the parent organization has not filed for tax-exempt status with the IRS, submit the
Tax Exempt Status Certification for Churches form with section 2 completed and signed by the
financial officer of the organization.
2.
___ For-Profit adult centers qualifying by 25% of the enrolled adults or licensed capacity (whichever is less)
receiving compensation under Title XIX
a. ___Submit Title XIX documentation (list from the Department of Medical assistance of those
participants receiving Medicaid funding).
Licensure/Approval for Adult Centers: Adult centers must be licensed or have approval from a Federal, State, or
Local authority, and must demonstrate they have met written standards of criteria. Refer to Bright from the Start
CACFP policy 33.
1.
___ Submit a copy of the valid license, or approval documentation from a governing Federal, State, or Local
authority (approval documentation may be in the form of certification, review instrument or approval letter If the
review instrument is not submitted, attach the written standards or criteria on which the center is evaluated). Note:
As of January 7, 2015, State law requires adult day care centers which provide adult care services to be
licensed and/or approved to operate by the Georgia Department of Community Health. Refer to Bright
from the Start Policy 33-Revision Effective Date 9/1/2015 for more information.
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its
Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on
race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or
funded by USDA.
Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American
Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have
speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made
available in languages other than English.
To file a program complaint of discrimination, complete the
USDA Program Discrimination Complaint
Form, (AD-3027) found online at:
http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of
the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to
USDA by mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington,
D.C. 20250-9410; fax: (202) 690-7442; or email: program.intake@usda.gov. This institution is an equal opportunity provider.
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