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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 Homeless/Emergency Shelters Enclosed is the application packet for sponsors of Homeless/Emergency Shelters 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 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 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, which would be 15% in addition to the number of participants you have enrolled. Submit a copy of a valid Health/Fire Inspection 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 addresses 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 since 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 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 Civil Rights Data Collection Form The new Reimbursement Rates Effective July 1, 2011 CACFP Appeal Procedures Homeless Sponsor Monitoring 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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