Use this form to submit a Child and Adult Care Food Program (CACFP) Serious Deficiency Process Notification Form.

Sponsors of Day Care Homes (DCH) and Unaffiliated Centers/Sites (Child Care Centers, At-Risk Centers, and Adult Day Care Centers) must use this form to submit a Serious Deficiency Process Notification to TDA.

There are five steps in the Serious Deficiency Process:

• Step 1. Serious Deficiency determination: The point at which the Sponsor determines the DCH Provider or Unaffiliated Center noncompliance(s) rise to the level of Serious Deficiency.
• Step 2. Notice of Serious Deficiency: A notification sent to the DCH Provider or Unaffiliated Center/Site informing them they have been determined Seriously Deficient.
• Step 3. Opportunity for Corrective Action: The time given to the DCH Provider or Unaffiliated Center/Site allowing them to fully and permanently correct the serious deficiencies. This step includes the Serious Deficiency Deferral, if applicable.
• Step 4. Notice of Proposed Termination and Disqualification: A notification sent to the DCH Provider or Unaffiliated Center/Site if they fail to fully and permanently correct the serious deficiencies. This notice allows the DCH Provider or Unaffiliated Center/Site to appeal the proposed actions.
• Step 5. Notice of Termination and Disqualification: A notification sent to the DCH Provider or Unaffiliated Center/Site if they fail to appeal the Notice of Proposed Termination and Disqualification, or they appeal and the Hearing Official upholds the Sponsor’s proposed actions.

Throughout the process above, every notice submitted to a DCH Provider or Unaffiliated Center/Site must be sent to TDA at the same time, using this CACFP Serious Deficiency Process Notification Form. Sponsors may not wait until the process is completed and send a copy of all letters to TDA at one time.

Failure to submit this form for each notice distributed could result in the Sponsor being placed in the Serious Deficiency Process.

NOTE: If a Sponsor determines there is an imminent threat to health or safety in a Day Care Home or Unaffiliated Center/Site, it must immediately inform the health or licensing authority and then take action that is consistent with the authority’s recommendation.

For more information on the SD process for DCH Providers and Unaffiliated Centers/Sites, refer to the CACFP Handbook Section 10600, Serious Deficiency Process for Sponsored Sites/Providers. Templates for SD-related notices sent to DCH Providers or Unaffiliated Center/Site can be found on the CACFP Administration/Forms page of SquareMeals.org.