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Effective July 1, 2023, Child and Adult Care Food Program (CACFP) sponsors are to use the following forms and information to determine CACFP income eligibility and develop the One Month Enrollment Report (OMER).
The following letters and forms are posted on the CACFP website at: ODE CNP Confidential Income Statements (CIS) - Adult Day Care Centers
- 2023-2024 Confidential Income Statement – Adult Day Care Centers
- Instructions for Completing the CACFP Confidential Income Statement
- Letter to Household
- 2023-2024 Income Eligibility Guidelines (July 1, 2023 to June 30, 2024)
Reminder, sponsors have the flexibility concerning the effective date of certification for Program benefits. The date to be used to make this determination may be either the date the adult household member or applicant’s guardian signed the Confidential Income Statement or the date on which the sponsor official signs the Confidential Income Statement to certify eligibility of the participant. This flexibility applies only to eligibility determinations made through the application process of complete applications containing all required information at the time of submission. Sponsors must decide which date they will rely on as the effective date and apply this date to all Confidential Income Statements. However, if the date of the adult household member or applicant’s guardian is not within the month of certification or the immediately preceding month, the effective date must be the date of certification.
For more information, refer to the ODE CNP Guidance on Income Eligibility Determinations and Duration – Reissued April 7, 2014 memo available at Guidance on Income Eligibility Determinations and Duration
Download the Letter to Household from the ODE CNP website at ODE CNP Confidential Income Statements - Adult Day Care Centers and insert the appropriate information in the gray fillable fields prior to distribution. The Letter to Household must be distributed with the CIS.
Refer to the Child and Adult Care Food Program Policy and Procedure Manual, Chapter 3, Eligibility Determination and Chapter 21, Adult Day Care, for detailed instructions on the distribution and approval of CIS forms located at CACFP Policy & Procedure Manual. A training video is available for Chapter 3- Eligibility Determinations for Adult Day Care Programs.
The Free and Reduced Price Eligibility Charts are located on the Confidential Income Statements- Adult Day Care Centers Page.
The CIS “Sponsor Use Only” section is on the first page. Copy both sides of the CIS for distribution.
Please recycle unused forms from the previous year and replace them with the current forms.
If you have questions, please contact your assigned Child Nutrition Specialist.
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