Valid Child and Adult Care Food Program (CACFP) At-Risk Unaffiliated Site Questionnaire/Attestation

Please read this guidance and form instructions carefully.


Policy

Child and Adult Care Food Program (CACFP) Contracting Entities (CEs) must maintain operational oversight and have full control over the management and administration of the food program at all unaffiliated sites under their sponsorship for the duration of their program participation (7 CFR 226.16(d)). CACFP CEs sponsoring At-Risk sites may contract with a unitized meal vendor (vended meal provider) or Food Service Management Company (FSMC) to manage food service operations at a site, but the vendor/FSMC must:

  • Be properly procured by the CE; and
  • The CE must have a signed and TDA-approved Contract for Purchased Meals with the vendor/FSMC.


Unitized meal vendors and FSMCs must not represent themselves as an unaffiliated site. A signed Permanent Agreement (site agreement) between a CE and a meal vendor/FSMC in lieu of a properly procured Contract for Purchased Meals is not valid, and sites established under such agreements cannot claim meals for reimbursement.


To ensure that all unaffiliated sites are valid and under the CE’s operational control, all CEs sponsoring unaffiliated At-Risk sites must attest via this form that all sites meet one of the following requirements:

  • Site agreements are signed by staff affiliated with the location where the meals are being served (for example, if the unaffiliated site is a school, then school staff are responsible for direct oversight of the CACFP At-Risk program); or
  • If the site agreement is with an organization not affiliated with the location of service (for example, at an apartment complex), the organization signing the permanent site agreement:
  • Is providing a comprehensive Afterschool Program, including congregate enrichment activities and food service. NOTE: CACFP funds cannot be used to procure supplies, staff, or materials associated with the enrichment.
  • Must have a signed Memorandum of Understanding between the site level organization managing the At-Risk program and the location of service approving the operation of an At-Risk program onsite. A copy of this agreement must be maintained by the CE and provided at the time of site application.

Form Instructions

For each unaffiliated At-Risk site under its sponsorship, the CE must be able to address the following questions in this form to meet compliance. Once this attestation form is submitted, TDA may reach out to you for more information


NOTE: CEs may submit this form multiple times. For example, you may submit this form for the sites you know meet compliance while investigating sites for which you are uncertain. Any new unaffiliated sites added after submittal of this form will require submittal of this form for the new site before that site application can be approved.

Select
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2. Do you have unaffiliated sites under your sponsorship that are managed by staff affiliated with the location of service?*

The site agreement will be signed by staff of the location where meals are served.

*If only submitting this form on behalf of new sites, select [Submitting for new sites only].

Select
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NOTE: You may submit this form again with only new proposed sites if that is more convenient.

3. Do you have unaffiliated sites under your sponsorship that are managed by a sub-sponsor?*

A sub-sponsor is an organization that signs the site agreement but is not legally affiliated with the site where the At-Risk Program and CACFP meal service is taking place.

*If only submitting this form on behalf of new sites, select [Submitting for new sites only].

Select
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NOTE: You may submit this form again with only the new proposed sites if that is more convenient.

4. For every unaffiliated site listed in both Questions 2 and 3 above, you must attest to the following statements. If during an Administrative Review, TDA discovers any non-compliance with the below attestation statements, meal disallowances and closure of the site may result:

Options to Continue Service at Invalid Site

To minimize impact to students/children at sites no longer valid, CEs are encouraged to do one of the following:

  • Establish an unaffiliated site agreement with either the organization affiliated with the location of service or the organization responsible for managing the afterschool program enrichment.
  • Establish an affiliated site at the location, properly procuring a Food Service Management company or unitized meal vendor in accordance with federal regulation and TDA guidelines.
  • Encourage the sub-sponsoring organization that is currently running the meal service to apply directly with TDA as its own Contracting Entity.


NOTE: The sub-sponsor would need to provide non-program sources of income to pass financial viability to be its own CE.

Check that each of the following statements is true:

First Name

Each party acknowledges and agrees that information in this form is attested to by the name entered in the field above and shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.


After the form is submitted, you will receive a confirmation email message with a copy of your submitted response. Please save the email for your records.

First Name

Contact Position/Role*

example@example.com

Include Area Code

Phone
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