Form SFN59995 "Child and Adult Care Food Program Annual Information Certification - Independent Centers" - North Dakota

What Is Form SFN59995?

This is a legal form that was released by the North Dakota Department of Public Instruction - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2011;
  • The latest edition provided by the North Dakota Department of Public Instruction;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN59995 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Public Instruction.

ADVERTISEMENT
ADVERTISEMENT

Download Form SFN59995 "Child and Adult Care Food Program Annual Information Certification - Independent Centers" - North Dakota

Download PDF

Fill PDF online

Rate (4.5 / 5) 13 votes
RETURN TO:
CHILD AND ADULT CARE FOOD PROGRAM ANNUAL
Department of Public Instruction
INFORMATION CERTIFICATION - INDEPENDENT CENTERS
Child Nutrition and Food
Distribution Programs
NORTH DAKOTA DEPARTMENT OF PUBLIC INSTRUCTION
600 E. Boulevard Avenue, Dept. 201
CHILD NUTRITION AND FOOD DISTRIBUTION PROGRAMS
Bismarck, ND 58505-0440
SFN 59995 (7/2011)
Phone: (701) 328-2294
Center Name
If there have been changes to any of the items below, please contact our office.
This is to certify that the Center named above meets all of the requirements for renewing institutions contained in 7 CFR
226.6(b)(2). This entity certifies that:
The names, mailing addresses, and dates of birth of all current Center’s principals have been submitted to the State
Agency;
The Center itself, and the Center’s principals, are not currently on the CACFP National Disqualified list;
The list of any publicly funded programs that Center and principals have participated in the past seven year is current;
The Center itself, and the Center’s principals have not been determined ineligible for any other publicly funded
programs due to violation of that program’s requirements in the past seven years;
No principals of the Center have been convicted of any activity that occurred during the past seven years and that
indicated a lack of business integrity; and
The Center is currently compliant with the required performance standards of financial viability and management,
administrative capability, and program accountability as described in 7 CFR 226.6(b)(2)(vii):
Compliance with Performance Standards: Each renewing institution must submit information sufficient to
document that is financially viable, is administratively capable of operating the program in accordance with this
part, and has internal controls in effect to ensure accountability. To document this, any renewing institution must
demonstrate in its application that it is capable of operating in conformance with the following performance
standards. The State Agency must only approve the applications of those renewing institutions that meet these
performance standards, and must deny the applications of those that do not meet the standards.
Signature
Title
Date
RETURN TO:
CHILD AND ADULT CARE FOOD PROGRAM ANNUAL
Department of Public Instruction
INFORMATION CERTIFICATION - INDEPENDENT CENTERS
Child Nutrition and Food
Distribution Programs
NORTH DAKOTA DEPARTMENT OF PUBLIC INSTRUCTION
600 E. Boulevard Avenue, Dept. 201
CHILD NUTRITION AND FOOD DISTRIBUTION PROGRAMS
Bismarck, ND 58505-0440
SFN 59995 (7/2011)
Phone: (701) 328-2294
Center Name
If there have been changes to any of the items below, please contact our office.
This is to certify that the Center named above meets all of the requirements for renewing institutions contained in 7 CFR
226.6(b)(2). This entity certifies that:
The names, mailing addresses, and dates of birth of all current Center’s principals have been submitted to the State
Agency;
The Center itself, and the Center’s principals, are not currently on the CACFP National Disqualified list;
The list of any publicly funded programs that Center and principals have participated in the past seven year is current;
The Center itself, and the Center’s principals have not been determined ineligible for any other publicly funded
programs due to violation of that program’s requirements in the past seven years;
No principals of the Center have been convicted of any activity that occurred during the past seven years and that
indicated a lack of business integrity; and
The Center is currently compliant with the required performance standards of financial viability and management,
administrative capability, and program accountability as described in 7 CFR 226.6(b)(2)(vii):
Compliance with Performance Standards: Each renewing institution must submit information sufficient to
document that is financially viable, is administratively capable of operating the program in accordance with this
part, and has internal controls in effect to ensure accountability. To document this, any renewing institution must
demonstrate in its application that it is capable of operating in conformance with the following performance
standards. The State Agency must only approve the applications of those renewing institutions that meet these
performance standards, and must deny the applications of those that do not meet the standards.
Signature
Title
Date