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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) - Centers
- 2023- 2024 Confidential Income Statement – Centers and Family Day Care Home Providers (English and Spanish)
- Letter to Household (English and Spanish)
- 2023- 2024 Income Eligibility Guidelines (July 1, 2023 to June 30, 2024)
Important Notes:
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 parent or 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 parent or guardian signature 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 fillable Letter to Household from the ODE CNP website at ODE CNP Confidential Income Statements - Centers and insert the appropriate information in the gray fillable fields prior to distribution. The Letter to Household must be distributed with the CIS.
The CIS heading includes “Child Care Centers/Family Day Care Providers”. This dual-purpose form is the correct form for Child Care Centers, Head Start, and Outside-School-Hours Centers, including pricing and non-pricing programs.
The CIS “Sponsor Use Only” section is on the first page. Copy both sides of the CIS for distribution to parents.
Refer to the Child and Adult Care Food Program Policy and Procedure Manual, Chapter 3, Eligibility Determination for detailed instructions on the distribution and approval of CIS forms located at CACFP Policy and Procedure Manual. Training videos are available for Chapter 3- Eligibility Determinations and Approving Confidential Income Statements on the ODE CNP CACFP Training Center.
The Free and Reduced Price Eligibility Charts are located on the 2023- 2024 Confidential Income Statements- Centers Page.
Note on approving CIS Forms: If the family receives Employment Related Day Care (ERDC) benefits and completes a CIS form, compare the case number on the CIS to the ERDC case number. The Department of Human Services (DHS) uses the same case number for ERDC and Temporary Assistance to Needy Families (TANF). However, benefit recipients only qualify for one of those two programs. The ERDC case number cannot be used to determine eligibility.
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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