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Sponsor CCC Transmittal

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					Date:          July 2011

Subject:       CACFP Application Packet for Fiscal Year (FY) 2012 (October 1, 2011 to
               September 30, 2012)

To:            Virginia CACFP Sponsors of Child Care Centers


Enclosed is the application packet for sponsors of Child Care Centers for the Virginia Child and
                  Adult Care Food Program (CACFP) for Fiscal Year (FY) 2012.

  You will receive an email with all documents except for the FNS 342A Form and the Site Data for
  Sponsor (Site List) included in this mailing. We will also post these documents on the VDH CACFP
   website. Hard copies of any documents are available upon request, please call 1-877-618-7282.

        PLEASE SUBMIT THE APPLICATION RENEWAL PACKET BY September                  1, 2011.
SPONSORS MUST COMPLETE ALL OF THE FOLLOWING:

Review the information on the enclosed FY 2011 Child/Adult Care Application for Participation
FNS-342A. Annotate any changes directly on the form in ink (Preferably in RED) to expedite
processing. These are examples of common changes:
   o Change in contact information
   o Change in enrollment data
   o Change in meal types
   o Change in Fiscal Year

Please make sure you indicate your DUNS Number; This is a new field that must be completed
on the FY 2011 Child/Adult Care Application for Participation FNS-342A.

Please make sure you sign and date on the last page of the FY 2011 Child/Adult Care
Application for Participation FNS-342A.
Review the information contained on the enclosed Site Data For Sponsor (Site List). Annotate
any changes or deletions on the form in ink (Preferably in RED).
   o Sign and date the site list at the top of the first page.
   o Indicate which meals you are planning to serve for each site with times listed by the
       meal types
   o Indicate the number of participants enrolled free, reduced and paid
   o Indicate your license capacity.

Submit a copy of a valid Department of Social Services license for each facility under your
sponsorship.

Complete the Abbreviated Management Plan and Budget 2012
   o Please designate a substitute person responsible for the program.
   o Provide the date of birth and address for all agency representatives.
   o Please enclose a copy of your monitoring schedule if not completing the monitoring
      section on the Abbreviated Management Plan and Budget 2012 form.
   o Make sure you provide your projected monthly and annual reimbursement. Take your
      CACFP reimbursement from October 2010 – March 2011, add all months together, and
      divide by 6 for average projected monthly reimbursement. Take that number and
      multiply by the number of operating months for your annual projected reimbursement.
   o Please be sure to complete the staffing chart
   o When completing the budget, include all food and administrative costs for CACFP in the
      chart provided.
   o When completing the budget, please make sure you transfer the appropriate numbers
      in your grand total. The Total CACFP Annual Cost should be the total of Food Service
      Operational Costs and Administrative Costs. The CACFP funding should be your agency’s
      estimated annual reimbursement.
   o In the budget, make sure you detail in the lines provided how you will use your excess
      funds from CACFP reimbursement or how you will supplement your CACFP program if
      your reimbursement will not cover all costs.

Sign and submit the Training Certification Form.

Sign and submit the Certification Statement.

ONLY COMPLETE IF THIS APPLIES TO YOUR SPONSORSHIP:

COMPLETE IF YOU ARE A MILITARY INSTITUTION: Submit a Delegation of Authority Letter
(Directions Enclosed)

COMPLETE IF YOU ARE ADDING A NEW SITE: Complete and submit a Center Application for
Participation for each new site to be added during FY2012. Follow the document, “Sponsor of
Centers Site Add Document Submission Checklist.” All information must be submitted for each
new site the sponsor is adding.
COMPLETE IF YOU ARE A SPONSOR OF 25 OR MORE CENTERS: Complete and submit the
Center-Monitor Ratio Sheet (copy enclosed if applicable).

FOLLOW THE DIRECTIONS BELOW IF YOU HAVE BANKING CHANGES:
1. Visit the Virginia Department of Accounts (DOA) website: www.doa.virginia.gov
2. CLICK 12th link on right - Electronic Data Interchange (EDI)
3. CLICK Trading Partner EDI Notification of Change (under Trading Partner Information); print
& submit.

COMPLETE IF YOU PURCHASE MEALS FROM A SCHOOL FOOD AUTHORITY (SFA): Submit a copy
of a newly signed SFA Agreement.

COMPLETE IF YOU PURCHASE MEALS FROM A FOOD SERVICE MANAGEMENT COMPANY (FSMC)
*** Consumer Price Index (CPI) change for centers contracting with a FSMC =2.18***: Submit
a copy of your new or renewed FSMC contract, with supporting procurement documentation.
(Enclosed is a copy of pages 1, 2, and 10 of your FSMC. If you are renewing your FSMC, please
complete the attached pages 1, 2 and 10 of your FSMC. If you have surpassed your 5 year
FSMC renewal you will need to go out for bid and complete the entire FSMC contract.)

COMPLETE IF YOUR SPONSORSHIP PURCHASES MEALS FOR YOUR CENTERS FROM AN SFA AND
A FSMC: Complete and submit a CACFP Center Food Service Summary.

    Please use the boxes next to each item in the above checklist to ensure all pertinent
 documents are returned. Please make a copy of all the completed documents submitted to
                                   VDH for your records.

                              Please mail original copies to VDH:

                                 Virginia Department of Health
                    Division of Nutrition, Physical Activity & Food Programs
                                    Attn: CACFP Application
                                 109 Governor Street 9th Floor
                                      Richmond, VA 23219

If you have any questions or require any assistance in completing your application information,
                 please call 1-877-618-7282 or email CACFP@vdh.virginia.gov.
  We appreciate the effort taken by all Sponsors to complete this packet in preparation for a
                                     successful FY 2012.


             Refer to the following page for a list of enclosures:
Enclosures for application submission:
      Child/Adult Care Application for Participation FNS-342A Application Form
      Site Data for Sponsor (Site List)
      Abbreviated Management Plan and Budget 2012
      Training Certification Form
      Certification Statement

   If applicable:
      Center-Monitor Ratio Sheet Site Add Documents
      SFA Agreement
      FSMC Contract
            o New FSMC
            o Renewing FSMC pages 1, 2, and 10 (Complete Highlighted)
      Center Food Service Summary
      Site Add Documents
            o Center Application for New Sites
            o Pre-approval Visit Form
            o Cash Agreement (unaffiliated sites)
            o No Cash Agreement (unaffiliated sites)
            o Statement of Responsibility (unaffiliated sites)

Enclosures for your reference (will also be available online):
      Building for the Future Flyer- Notice to Parents
      WIC Fact Sheet
      Civil Rights Data Collection Form
      The new Reimbursement Rates Effective July 1, 2011
      The new Income Eligibility Guidelines (IEG) Effective July 1, 2011
      The revised Income Eligibility Statement (IES)
      Letter to Households with new IES
      CACFP Appeal Procedures
      Child Care Sponsor Monitoring Form
      Delegation of Authority Letter (If Applicable)
      Enrollment Form
      SFA Instructions (If Applicable)
      FSMC Instructions (If Applicable)
      Center Food Service Summary (If Applicable)
      Site Add Documents (If Applicable)
             o Center Application for New Sites
             o Pre-approval Visit Form
             o Cash Agreement (unaffiliated sites)
             o No Cash Agreement (unaffiliated sites)
             o Statement of Responsibility (unaffiliated sites)

				
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