Completing the CACFP Reimbursement Claim Wisconsin Department of

Completing the CACFP Reimbursement Claim Wisconsin Department of Public Instruction Child and Adult Care Food Program At Risk After School Meals Emergency Shelters Guidance Memorandum #3 C http: //fns. dpi. wi. gov/fns_centermemos

Claim Documentation − − Attendance/Participation Records Days of Operation Time of Service Meal Count Records Dated Menus (listing substitutions, changes, updates, etc. ) − Production Records • At Risk sites only − Infant Meal Records, if applicable • Emergency Shelters Only − Recipes − Child Nutrition Labels/Product Analysis Sheets − Original Food receipts, invoices etc.

Claim Deadline Dates Claiming Month January February March April May June July August September October November December Last Day for Online Submission April 1 (March 31 on leap years) April 29 May 30 June 29 July 30 August 29 September 29 October 30 November 29 December 30 January 29 March 1 (February 29 on leap years)

On-Line Claiming • Required • Maintain confirmation page from the internet claim site

Online Confirmation Page

Participation Data II. Participation Data 1 20

Average Daily Attendance (ADA) 21. 1 22

Number of Meals Served to Children II. Participation Data

Number of Meals Served to Children: At Risk After School II. Participation Data 539 546 555 356 150 506

Number of Meals Served to Children: Emergency Shelter 23 14 63 100

Site Participation Data for Sponsoring Organizations 1 1234 1235 2 3 AR ABC Elementary AR ABC Middle School 4 5 6 30 17 25 150 75 20 60 500 325 650 325 105 85 7 8 9 10 11 12 N/A

Site Participation Data for Sponsoring Organizations 105 2 20 85 650 325 975

Average Daily Attendance • Use daily attendance records, NOT meal counts • Total children in attendance/days of operation=ADA • Round all fractions up to the next whole number for ADA

Claim Due Dates • Claim submission deadline of 60 days after the end of the claim month

The U. S Department of Agriculture prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities. ) If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http: //www. ascr. usda. gov/complaint_filing_cust. html, or at any USDA office, or call (866) 632 -9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U. S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S. W. , Washington, D. C. 20250 -9410, by fax (202) 690 -7442 or email at program. intake@usda. gov. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877 -8339; or (800) 845 -6136 (Spanish). USDA is an equal opportunity provider and employer.