"The Child and Adult Care Food Program (CACFP) Household Contact Form" - Georgia (United States)

The Child and Adult Care Food Program (CACFP) Household Contact Form 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 July 1, 2020;
  • The latest edition currently provided by the Georgia Department of Early Care and Learning;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Georgia Department of Early Care and Learning.

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Download "The Child and Adult Care Food Program (CACFP) Household Contact Form" - Georgia (United States)

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Bright from the Start:
Georgia Department of Early Care and Learning
The Child and Adult Care Food Program (CACFP)
Household Contact Form – Sponsor Use Only
Section I
Institution Type: Center Sponsor
Administrative Sponsor
Day Care Home Sponsor
Date of Contact:
Time Contact Made:
Monitor Name:
Reason for Contact:
Enrollment/Attendance Verification
Systemic Irregularities in Program operations
Suspicious Claiming Patterns
Section II
Name of Institution:
Agreement Number:
Address:
Site Name:
Site Type:
Child Care Center
Family Child Care Learning
Home
Section III
Parent/Guardian Name:
Parent Contact Phone #:
Address:
Names of Children Enrolled for
Care:
Days of Care: S
M
T
W
TH
F
S
Hour of Care:
am
Month in Question:
Meal Types: B
AM
L
PM
S
Hour of Care:
pm
Dates in Question:
Section IV
Was child(ren) in care as specified and claimed by site?
Yes
No
Comment(s):
Did child(ren) participate in the meal services as indicated by site on date(s) in question?
Yes
No
Comment(s):
Is the information on the Enrollment Form (acquired by the center/home) accurate and current?
Yes
No
Comment(s):
Section V
Reclaimed Assessed:
Yes
No
Meal Types:
B
AM
L
PM
S
July 2020
Bright from the Start:
Georgia Department of Early Care and Learning
The Child and Adult Care Food Program (CACFP)
Household Contact Form – Sponsor Use Only
Section I
Institution Type: Center Sponsor
Administrative Sponsor
Day Care Home Sponsor
Date of Contact:
Time Contact Made:
Monitor Name:
Reason for Contact:
Enrollment/Attendance Verification
Systemic Irregularities in Program operations
Suspicious Claiming Patterns
Section II
Name of Institution:
Agreement Number:
Address:
Site Name:
Site Type:
Child Care Center
Family Child Care Learning
Home
Section III
Parent/Guardian Name:
Parent Contact Phone #:
Address:
Names of Children Enrolled for
Care:
Days of Care: S
M
T
W
TH
F
S
Hour of Care:
am
Month in Question:
Meal Types: B
AM
L
PM
S
Hour of Care:
pm
Dates in Question:
Section IV
Was child(ren) in care as specified and claimed by site?
Yes
No
Comment(s):
Did child(ren) participate in the meal services as indicated by site on date(s) in question?
Yes
No
Comment(s):
Is the information on the Enrollment Form (acquired by the center/home) accurate and current?
Yes
No
Comment(s):
Section V
Reclaimed Assessed:
Yes
No
Meal Types:
B
AM
L
PM
S
July 2020