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					                                2010-11 Child and Adult Care Food Program (CACFP) Worksheet
                Worksheet for Estimating Food Costs Expensable to the Department of Education (DOE)

District:
Provider:

Centers participating in CACFP are eligible to expense the actual costs of food for contracted eligible preschoolers up to the
sum of actual costs for meals not already reimbursed by CACFP for contracted eligible students.

Instructions:

1. On Table 1 below, enter the number of student contact days. This number may not exceed the number of district school
calendar days.
2. On Table 1, enter the number of contracted eligible preschoolers eligible for free and reduced rate meals. Centers in
districts with universal programs may also enter the number of contracted eligible preschoolers eligible for paid rate meals.
Estimate counts based upon center history.
3. The line "Estimated Total Allowable Expense (not covered by CACFP)" will calculate an estimation of the sum of costs
for meals served that are not reimbursed by CACFP for contracted eligible children.
Providers must maintain ongoing supporting documentation (family applications, tables reflecting actual costs submitted to
the district on quarterly reports, etc.) for review by district, DOE, and CACFP representatives during each contract period.


Table 1: Eligible DOE-Funded Students
Number of Student Contact Days                                                                                             0
Free Rate: Number of Contracted Eligible Students
Reduced Rate: Number of Contracted Eligible Students
Above Scale (Paid) Rate: Number of Contracted Eligible Students
Total: Number of Contracted Eligible Students                                                                              0


Table 2: Reduced Price Rate of Reimbursement
Meal Type           Rate to Expense        Number of          Student Contact         Total Reduced Price Rate
                        to DOE            Reduced Rate             Days                 Allowable Expenses
                                            Children
Breakfast                  $0.30                          0                    0                                       $0
Lunch                      $0.40                          0                    0                                       $0
Snack                      $0.37                          0                    0                                       $0
Sum of Reduced Price Rate Expensable Totals                                                                            $0


Table 3: Above Scale (Paid) Rate of Reimbursement
Meal Type           Rate to Expense Number of Paid Student Contact Total Above Scale Rate Allowable
                        to DOE       Rate Children      Days                  Expenses

Breakfast                  $1.20                          0                    0                                       $0
Lunch                      $2.43                          0                    0                                       $0
Snack                      $0.68                          0                    0                                       $0
Sum of Above Scale (Paid) Rate Totals                                                                                  $0

Estimated Total Allowable Expense (not covered by CACFP)                                                               $0


The above meal rates are based on "Child and Adult Care Food Program (CACFP) Per Meal Rates in Whole or Fractions
of U.S. Dollars Effective from July 1, 2009 - June 30, 2010" as per Federal Register / Vol. 74, No. 134 / Wednesday July
15, 2009 / Notices. Available at:
http://www.fns.usda.gov/cnd/care/ProgramBasics/Rates/ReimbursementRates_Current.htm.
                                                                  2010-11 Table 5: Director Salary Scale and Worksheet
                  District:                                            -         Provider:                                       -
Directions: All center directors must accurately complete the section below. First, under Educational Attainment, detail the highest degree(s) held including area(s)
of concentration, as well as any professional certificates held. Second, select the appropriate Tier Level from the drop-down box based on the Educational
Requirements listed below. Third, enter Years of Preschool Experience (defined as the number of years served as a preschool director). The total number of
classrooms (including those without contracted preschoolers) will automatically enter based on information provided on the 2009-10 Private Provider One-Year
Planning Budget Worksheet. All of this information should then be used to determine the recommended full-time, school calendar year salary for the director as per
the salary scale below.

Educational Attainment

                 Tier Level
              Years of Preschool Experience                                                                                         # Classrooms   0

                                                                                              Educational Requirements
                          Director's Academy and/or 15 Credit Hours Early Childhood Education, Business Administration/Accounting, or Education
Tier 1*
                          Administration.
Tier 2*                   Tier 1 and Bachelor's Degree.
Tier 3*                   Bachelor's Degree in Early Childhood Education, Business Administration/Accounting, Education Administration, or Related Field.
Tier 4*                   Graduate Degree or higher.
                          Graduate Degree or higher with a specialization in Early Childhood Education (specialization may be completed in either a Graduate or
Tier 5*
                          Bachelor's program) supplemented by 15 Credit Hours of Business Administration/Accounting or Education Administration.
*All credits/degrees must be obtained from an accredited college or university.

                                                NOTE: All figures below reflect full-time, school calendar year salaries for center directors.
                                                            Preschool
                                                            Experience    Classrooms          Tier 1         Tier 2        Tier 3         Tier 4    Tier 5
                                                             0-5 Years                        $5,257         $9,026        $9,631        $10,202   $10,774
                                                                          1                   $6,413        $11,012       $11,751        $12,447   $13,144
                                                                          2                  $11,671        $20,040       $21,382        $22,650   $23,917
                                                                          3                  $16,927        $29,066       $31,014        $32,852   $34,691
                                                                          4                  $21,606        $37,100       $39,586        $41,932   $44,279
                                                                          5                  $26,284        $45,134       $48,158        $51,012   $53,867
                                                                          6                  $30,753        $52,807       $56,345        $59,685   $63,024
           Schedule for Director Salary Scale




                                                                          7                  $35,221        $60,479       $64,532        $68,357   $72,181
                                                                          8-9                $39,690        $68,152       $72,719        $77,029   $81,339

                                                                          10-11              $40,515        $68,978       $73,544        $77,854   $82,164
                                                                          12-14              $41,340        $69,803       $74,369        $78,680   $82,990
                                                                          15 or more         $42,166        $70,628       $75,195        $79,505   $83,815


                                                            6-10 Years                        $5,520         $9,478       $10,113        $10,712   $11,311
                                                                          1                   $7,728        $13,269       $14,158        $14,997   $15,836
                                                                          2                  $12,984        $22,296       $23,790        $25,200   $26,610
                                                                          3                  $18,242        $31,323       $33,421        $35,402   $37,383
                                                                          4                  $22,920        $39,357       $41,994        $44,483   $46,972
                                                                          5                  $27,600        $47,391       $50,566        $53,563   $56,560
                                                                          6                  $32,067        $55,063       $58,753        $62,235   $65,718
                                                                          7                  $36,536        $62,736       $66,939        $70,907   $74,875
                                                                          8-9                $41,004        $70,409       $75,126        $79,579   $84,032

                                                                          10-11              $41,830        $71,234       $75,952        $80,405   $84,858
                                                                          12-14              $42,655        $72,060       $76,778        $81,231   $85,684
                                                                          15 or more         $43,481        $72,885       $77,602        $82,055   $86,509


                                                           11 and Above                       $5,783         $9,929       $10,595        $11,223   $11,851
                                                                          1                   $9,042        $15,526       $16,567        $17,548   $18,530
                                                                          2                  $14,299        $24,553       $26,198        $27,751   $29,303
                                                                          3                  $19,555        $33,580       $35,830        $37,953   $40,077
                                                                          4                  $24,234        $41,614       $44,402        $47,034   $49,665
                                                                          5                  $28,913        $49,647       $52,974        $56,114   $59,254
                                                                          6                  $33,382        $57,320       $61,160        $64,786   $68,411
                                                                          7                  $37,850        $64,992       $69,347        $73,458   $77,569
                                                                          8-9                $42,318        $72,666       $77,534        $82,130   $86,725

                                                                          10-11              $43,144        $73,491       $78,360        $82,956   $87,551
                                                                          12-14              $43,968        $74,316       $79,185        $83,780   $88,376
                                                                          15 or more         $44,794        $75,142       $80,010        $84,606   $89,202
                            2010-11 SCHEDULE A: Provider Personnel Detail
                                                  District:                              -                               Provider:                                                            -


DIRECTIONS:
1. Private providers must use this form to itemize salaries, benefits, and salary step (if applicable) for all state-funded positions (both Educational Program positions and
Administrative/Support positions) to be funded in 2010-11.
2. Both full-time and part-time employees must be included.
3. Full-time, school calendar year salary and benefit equivalent should be reported for all employees.
4. Do not include employees from 2009-10 who will not be employed in 2010-11.

*Compensation for certified teachers and teacher assistants in private provider or local Head Start settings must be comparable to that of a teacher or teacher assistant employed by the district board of education
and based on equivalent certification and credentials.



                                                                                                                                2009-10      2009-10      2010-11      2010-11
                                                                                                                                School       School       School       School
                                                                                                   Full-Time Salary Step (if   Calendar     Calendar     Calendar     Calendar
            Employee Name                                             Job Title                   Equivalent   applicable)   Year Salary Year Benefits Year Salary Year Benefits
SAMPLE: John Doe                                               Teacher                                    1.00           M3 $      45,000 $      9,000 $     47,000 $      9,000
SAMPLE: Jane Doe                                               Family Worker                              1.00           n/a $     27,500 $      4,015 $     28,600 $      4,290




                                                                                                                                                                                     Last modified on 2/25/2010, 5:33 PM
                                              2010-11 Private Provider One-Year Budget Planning Worksheet


Classrooms Serving Contracted Eligible Children:                                                          District Name:                                         -
Contracted Eligible Children:                                                                           Provider Name:                                           -
Other Students in Classrooms with Contracted Eligible Children:                    -                     Program Type:
All Other Classrooms:                                                                                 Non-profit Status:
All Other Children:                                                                                  Facility Ownership:
                                                                                                   DCF License Number:
Contracted Classrooms Eligible for Startup Funding:

District School Calendar Days:                                                     180
DOE Share of Annual Costs:                                                      73.47%

Total Budget Amount (provided by the district after a determination of district-wide costs)

                                                                                             DOE Share of
                                                                           Unit Cost /         Costs in
                                                                          Average Unit        Contracted
                        Expense                           FTE/ Quantity      Cost            Classrooms                           Total Cost

EDUCATIONAL PROGRAM COSTS
Teacher Salary                                                    0.00                         #DIV/0!                                                   #DIV/0!

Teacher Assistant Salary                                          0.00                         #DIV/0!                                                   #DIV/0!
Floating Teacher Assistant Salary                                 0.00                         #DIV/0!                                                   #DIV/0!

Teacher/Assistant Teacher Benefits                                                             #DIV/0!                                                   #DIV/0!

Substitute Teacher Stipend                                       0.00                          #DIV/0!                                                   #DIV/0!
Substitute Assistant Teacher Stipend                             0.00                          #DIV/0!                                                   #DIV/0!

Classroom Materials and Supplies                                   -                           #DIV/0!                                                   #DIV/0!
Classroom Technology                                               -                           #DIV/0!                                                   #DIV/0!
Startup Classroom Materials and Supplies                           -          $12,000           100.00%                                                      $0
Startup Classroom Technology                                       -           $2,450           100.00%                                                      $0
Field Trips w/ Transportation                                      -                            100.00%                                                      $0

Family Worker Salary                                               -                            100.00%                                                              $0
Family Worker Benefits                                             -                   $0       100.00%                                                              $0

                                                                           Unit Cost /       DOE Share of
                                                                          Average Unit      School Calendar
                        Expense                           FTE/ Quantity      Cost             Year Costs                          Total Cost
Food-Related Costs (CACFP participant, non-reimbursable costs)
Food (for contracted preschool children only)                                          $0       100.00%                                                              $0
Food Worker Salary (cook)                           -                                           100.00%                                                              $0
Food Worker Benefits (cook)                         -                                  $0       100.00%                                                              $0
Assistant Food Worker Salary (asst. cook)           -                                           100.00%                                                              $0
Assistant Food Worker Benefits (asst. cook)         -                                  $0       100.00%                                                              $0

Employer Payroll Taxes (For Educational Program Positions only)
Social Security (6.20%)                                                                                                                                  #DIV/0!
Medicare (1.45%)                                                                                                                                         #DIV/0!
Unemployment (2.80%)                                                                                                                                     #DIV/0!
Disability (0.50%)                                                                                                                                       #DIV/0!

SUBTOTAL, Educational Program Costs                                                                                                                       #DIV/0!




                                                                                                                           Last modified on 2/25/2010, 5:33 PM
                                                                             DOE Share of     DOE Share of
                                                                            School Calendar   Center-Wide
                      Expense                           FTE   Total Cost      Year Costs         Costs              Total Cost

ADMINISTRATIVE SUPPORT AND INDIRECT COSTS
SUPPORT COSTS
Director Salary                                                                 100.00%        #DIV/0!                                     #DIV/0!
Director Benefits                                                      $0       100.00%        #DIV/0!                                     #DIV/0!
Clerical Salary                                                                 100.00%        #DIV/0!                                     #DIV/0!
Clerical Benefits                                                      $0       100.00%        #DIV/0!                                     #DIV/0!
Custodian Salary                                                                100.00%        #DIV/0!                                     #DIV/0!
Custodian Benefits                                                     $0       100.00%        #DIV/0!                                     #DIV/0!
Social Security (6.20%)                                                                                                                    #DIV/0!
Medicare (1.45%)                                                                                                                           #DIV/0!
Unemployment (2.80%)                                                                                                                       #DIV/0!
Disability (0.50%)                                                                                                                         #DIV/0!

                                                                                              DOE Share of
                                                                             DOE Share of     Center-Wide
                      Expense                                 Total Cost     Annual Costs        Costs              Total Cost
INDIRECT COSTS
Rent, Mortgage, Other Space Costs                                                73.47%        #DIV/0!                                     #DIV/0!
Office Equipment>$2000 and Repair                                                73.47%        #DIV/0!                                     #DIV/0!
Office Materials and Supplies                                                    73.47%        #DIV/0!                                     #DIV/0!
Food-Related Paper Supplies                                                      73.47%        #DIV/0!                                     #DIV/0!
Cleaning Supplies                                                                73.47%        #DIV/0!                                     #DIV/0!
Food for Meetings                                                                73.47%        #DIV/0!                                     #DIV/0!
Building/Grounds Maintenance/Repair                                              73.47%        #DIV/0!                                     #DIV/0!
Utilities                                                                        73.47%        #DIV/0!                                     #DIV/0!
Telecommunications Services                                                      73.47%        #DIV/0!                                     #DIV/0!
Security                                                                         73.47%        #DIV/0!                                     #DIV/0!
Insurance                                                                        73.47%        #DIV/0!                                     #DIV/0!
Accounting Fees                                                                  73.47%        #DIV/0!                                     #DIV/0!
Payroll Preparation Fees                                                         73.47%        #DIV/0!                                     #DIV/0!
Advertising                                                                      73.47%        #DIV/0!                                     #DIV/0!
Staff Transportation                                                             73.47%        #DIV/0!                                     #DIV/0!
Profit, if Applicable (Max of 2.5% of Ed Costs)                                 100.00%         100.00%                                        $0
Subtotal of Above Administrative Support and Indirect Costs                                                                                #DIV/0!

Other Approved Budgeted Costs
(Insert item name or brief description on this line.)
(Insert item name or brief description on this line.)
(Insert item name or brief description on this line.)
(Insert item name or brief description on this line.)
(Insert item name or brief description on this line.)
   SUBTOTAL, Other Approved Budgeted Costs                                                                                                         $0

PROVIDER PROGRAM TOTALS
    Total Cost                                                                                                                              #DIV/0!
    Per-Pupil Cost                                                                                                                          #DIV/0!

DISTRICT ADJUSTMENTS (amounts withheld for items to be purchased by the district) FOR DISTRICT USE ONLY
(Describe expense to be adjusted and enter negative amount.)                                                                                    $0
(Describe expense to be adjusted and enter negative amount.)                                                                                    $0
(Describe expense to be adjusted and enter negative amount.)                                                                                    $0
(Describe expense to be adjusted and enter negative amount.)                                                                                    $0
(Describe expense to be adjusted and enter negative amount.)                                                                                    $0
   Total Cost Less District Adjustments                                                                                                     #DIV/0!
   Per-Pupil Cost Less District Adjustments                                                                                                 #DIV/0!




                                                                                                             Last modified on 2/25/2010, 5:33 PM
                                           Preschool Private Provider
                                               One-Year Program
                                              School Year 2010-11

                                PROVIDER STATEMENT OF ASSURANCES

    I, _________________________ (name), Director of __________________________ (the DHS-
    licensed provider), hereby assure that the following has occurred. If I cannot assure any of the activities
    below, justification will be included on a separate page.



    1. The provider agrees to meet the standards for educational programs set forth in New Jersey
    Administrative Code 6A:13A.

    2. The provider’s preschool program is aligned with the Early Childhood Education Program
    Expectations: Standards of Quality.

    3. Items on the attached provider budget are true and accurate, and the provider shall make expenditures
    in strict accordance with the approved budget.

    4. The provider’s activities and expenditures shall be subject to independent, external audit to ensure
    compliance with programmatic and fiscal requirements.

    5. The provider shall use the private provider one-year planning budget worksheet as the basis for their
    quarterly expenditure report.

    I certify that all the above items and any attached justification(s) are correct and complete.


______________________________________________________                _________________________
                       Director’s Signature                                         Date

				
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