Claim for Reimbursement Worksheet-Child Care Food Program

							                  Georgia Department of Early Care and Learning
           Claim for Reimbursement Worksheet-Child Care Food Program
                                Day Care Homes

Institution Name                                        Month            Year

Street Address               City            State      Zip Code   Telephone

                              Daily Record of Meals Served
  Day of           Breakfasts          Lunches        Supplement     Supper
  Month               ( b)               (c )            (pm)         (e )
   (a)                                                    (d)
    1
    2
    3
    4
    5
    6
    7
    8
    9
   10
   11
   12
   13
   14
   15
   16
   17
   18
   19
   20
   21
   22
   23
   24
   25
   26
   27
   28
   29
   30
   31
  Totals
                      6C                7C               8C            9C