Missouri Department of Health & Senior Services Applications & Forms
How to Apply - Complete instructions for:
Adult Day Care Centers - Licensed
After School Programs
Child Care Centers - Licensed or License-Exempt
Homeless Shelters
Family Child Care Homes - Licensed
CACFP Applications & Forms
CACFP 1 Application and Management Plan for Participation in the Child and Adult Care Food Program (CACFP) |
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CACFP 2 Application/Center Information for the Child and Adult Care Food Program (CACFP) |
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CACFP 205 Income Eligibility Form for Child Care Centers |
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CACFP 208 Statement of Affiliation, for not-for-profit organizations |
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CACFP 209 Application Budget – Child Care or Adult Day Care Center, Outside School Hours Center, Emergency Shelter or At-Rist After School Snack Program |
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CACFP 210 Menus, required with all CACFP applications |
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CACFP 213 Daily Attendance Record |
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CACFP 214 Documentation of Non-profit Food Service (Updated - Summary of Salary Expenses) |
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CACFP 215 Individual Infant Meal Record 0 Through 3 Months |
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CACFP 216 Individual Infant Meal Record 4 Through 7 Months |
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CACFP 217 Individual Infant Meal Record 8 Through 11 Months |
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CACFP 218 Menu - USDA Requirements (5 days letter size) |
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CACFP 218 A Menu - USDA Requirements - 7 Days (letter size) |
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| CACFP 218 AA Menu - USDA Requirements -7 Days (legal size) | |
| CACFP 218 B Menu - USDA Requirements for Shelters (letter size) | |
| CACFP 218 BB Menu - USDA Requirements for Shelters (legal size) | |
CACFP 220 Enrollment Roster |
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CACFP 221 Time In/Time Out Record |
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CACFP 222 Training Documentation |
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CACFP 223 Production Records, Breakfast and Lunch/Supper |
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CACFP 224 Monthly Attendance Time In/Time Out Record |
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CACFP 225 Meal Count (Monday thru Friday - letter size) |
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CACFP 225A Meal Count (Sunday thru Saturday - legal size) |
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CACFP 225B Shelter Meal Count (Sunday thru Saturday - letter size) |
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CACFP 226 Beneficiary Data Report |
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CACFP 227 Medical Food Substitution Record |
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CACFP 229 Enrollment Form for Child Care Centers |
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SCCR-CACFP [Joint] Child Care Enrollment Form (MO 580-2994) |
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CACFP 404 Sponsored Centers Site Visit Report |
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CACFP 501 Income Eligibility Form for Adult Care Centers |
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CACFP Income Eligibility Guidelines |
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Vendor Input/ACH-EFT Application – SAM II (required for new applicants and to change direct deposits) |
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CACFP Network User Access Request Form |
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Carlton Carrot’s Menu Template |
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Contracting for Food Service - Instructions and Prototypes |
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Daily Menu Planning and Production Record for At-Risk Programs |
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Food Chart - Adult |
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Food Chart - At-Risk After School |
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Food Chart - Children |
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Food Chart - Infants |
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Four Components in Menu Planning |
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Infant Feeding Preference - Centers |
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Infant Feeding Preference - Homes |
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Meal Count Record (Tally) for At-Risk Programs |
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Monthly Donated Food Log for Shelters |
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Non-Discrimination Policy Statement (Pricing Centers Only) |
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Shelter Meal Count (Sunday thru Saturday - letter size) |
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Shelter Resident Roster by Month |
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Shelter Resident Roster by Period |
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Snack and Supper Menus for at-risk programs |