Meal reimbursement to adult day care centers is based on the claiming category of each participant at the center. The claiming category is determined by obtaining family size and household income data from the participant, a family member, or a legal guardian and comparing this information to the income eligibility guidelines. Based on the income eligibility guidelines, the participant is classified as eligible for the free, reduced, or paid meal-claiming category.

Income information obtained from the participant, family member, or legal guardian is critical to your center’s participation in the Child and Adult Care Food Program (CACFP). Every year, the participant, a family member, or legal guardian must be given the current Participant Letter and the Income Eligibility Form (IEF) to complete; however, completion of an IEF is not required. It is recommended that these two items be included in the center’s enrollment packet. These documents are available on the CACFP website.

The IEF, also known as the Meal Benefit Form, is available in 33 languages and can be found at the USDA website.

IEF income information is confidential! It must be kept in a secure location.

The sample participant letter provides the required information about CACFP and instructions for completing the IEF.

Remember: The participant is not required to complete the IEF. If there is no IEF completed for an enrolled participant, they must be claimed in the paid meal category.

This letter is updated for each claim year, July 1 through June 30. Be sure to use the most current participant letter with the IEF.

Child and Adult Care Food Program
Participant Letter – Non-pricing
Adult Day Care Centers
July 1, 2026 through June 30, 2027

Dear Participant/Family Member/Legal Guardian:

Our center is currently participating in the Child and Adult Care Food Program. This program reimburses the center for the partial cost of meals provided to participants and allows the center to provide nutritious meals without increasing the center's fees to you. If your yearly income is equal to or below federal income guidelines, the participant may be eligible for free or reduced-price meals.

To apply for free or reduced-price meal benefits, you must complete the attached form. Your application for free or reduced-price meal benefits cannot be approved unless the attached application is completed according to the directions provided. You should notify the center if any family member(s) of the household becomes unemployed. A participant may be eligible for free or reduced-price meals during the period of unemployment.

Sincerely,
Center Owner/Director

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the State or local Agency that administers the program or contact USDA through the Telecommunications Relay Service at 711 (voice and TTY). Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Mail Stop 9410, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.

USDA is an equal opportunity provider, employer, and lender.

In accordance with federal civil rights law and USDA civil rights regulations and policies, the USDA, its agencies, offices, employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the state or local agency that administers the program or contact USDA through the Telecommunications Relay Service at 711 (voice and TTY). Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:

1. Mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Mail Stop 9410, Washington, D.C. 20250-9410;
2. Fax: (202) 690-7442; or
3. Email: program.intake@usda.gov.

USDA is an equal opportunity provider, employer, and lender.

Reduced-Price Meals – 185%

Free Meals – 130%

Note: Only provide the income guidelines for reduced-price meals to the parents. The reduced-price yearly income guidelines are included on the Parent Letter.

Using the Income Eligibility Guidelines

The income eligibility guidelines are used to categorize the household income reported on the IEF into either the free, reduced-price, or paid meal category.

For example:

• If the monthly income for a family of two is $2,292 or less, the center would claim the participant at the free rate.
• If the household income for a family of two is between $2,292 and $3,261 per month, the center would claim the participant at the reduced-price meal rate.
• If the household income for a family of two is $3,262 or more per month, the center would claim the participant at the paid meal rate.

Meal reimbursement rates are based on household size and income, as noted on each Income Eligibility Form (IEF), compared to the current Income Eligibility Guidelines. The three meal reimbursement rates (categories) are free, reduced-price, and paid and are determined as a percentage of the poverty guidelines.

An IEF must be on file at the center for each participant claimed for free and reducedprice meals. If the participant, family member, or legal guardian does not choose to complete the IEF, then the participant must be claimed in the paid category.

Income information must be kept confidential.

If a participant is unable to complete the IEF and if no family member or guardian is available to complete the IEF, the center may complete the IEF on behalf of the participant if the participant is eligible for free meals. A participant is categorically eligible for free meals if he/she is a Medicaid, Supplemental Security Income (SSI), or Supplemental Nutrition Assistance Program (SNAP) recipient. The center must have documentation of the participant’s categorical eligibility on file.

All IEFs must be kept for three federal fiscal years plus the current contract year after the date the final claim for the fiscal year was submitted. If audit findings have not been resolved, the IEF must be kept as long as necessary to resolve the issues raised by the audit.

Effective Dates

Adult day care centers have flexibility concerning the effective date of certification for program benefits. The date to be used to make this determination may be either the date the participant, family member, or legal guardian signed the IEF or the date on which the center representative signs the form to certify the eligibility of the participant. However, if the date of the participant's signature is not within the month of certification or the immediately preceding month, the effective date must be the date the center representative signs the form. Adult day care centers must decide which date they will rely on as the effective date and apply this date consistently to all IEFs received.

• The IEF should be considered current and valid until the last day of the month, on which the form was approved, signed, and dated by the center representative one year earlier. This means an IEF that was approved on September 12, 2024 is valid until the last day of September 2025. A new IEF must be completed by the participant, family member, or legal guardian in the “anniversary” month each year. Reuse of an expired IEF or use of correction fluid or other means to alter the IEF will invalidate the form.
• Centers may not re-evaluate old IEFs when new income guidelines are issued in July. In addition, the center may not request that a new IEF be completed sooner than the one-year anniversary. The only exception is if the participant is currently approved in the paid or reduced-price meal category and the household income is reduced and or household size increases. It may benefit the center to request that another IEF be completed since the household may be approved for a different meal reimbursement rate.
• If the participant, family member, or legal guardian completes the IEF before the actual date of enrollment for care, the center should collect a new IEF from the participant, family member, or legal guardian if more than two months have lapsed. For example, John Jones completed the IEF in January 2025. However, John did not enroll and start attending the center until May 2025. A new IEF must be completed for John at the time he actually started attending the center since more than two months lapsed between the completion of the form and the actual enrollment date.

The center representative must review, sign, and date the IEF as soon as it is received from the participant, family member, or legal guardian. Failure to do so may result in the reclassification of the participant from the free or reduced category to the paid category.

Participant Letter

The participant letter and a blank IEF must be given to the participant, family member, or legal guardian. The letter and the instructions outline the required information needed for completing the form. This letter is updated each year. Be sure to use the most current participant letter with the IEF.

Pricing programs (centers that charge a separate fee for meals) do not use this participant letter. Contact the Child and Adult Care Food Program (CACFP) office at 800-733-6251 for a copy of the pricing letter.

Income Eligibility Guidelines

The United States Department of Agriculture (USDA) updates the income eligibility guidelines yearly. When reviewing IEFs, use the most current income guidelines.

Once approved for free or reduced-price meal benefits, a participant is eligible for those benefits for one full year after the IEF has been signed and dated, regardless of changes in income or household size that may occur throughout the year. Centers may not re-evaluate IEFs when new income guidelines are issued in July of each year. For example, if a participant, family member, or legal guardian completes an IEF in January 2025, eligibility will be based on income guidelines issued in July 2024. When the new income guidelines are issued in July 2025, the center may not re-evaluate the IEF completed in January 2025 using the new income guidelines. The eligibility must continue to be based on the income guidelines in effect at the time the form was initially completed and reviewed.

If, during a monitoring review, it is found that participants were incorrectly classified or the IEF has expired, the center will have to pay money back to the CACFP. Therefore, it is very important that IEFs are reviewed carefully.

Meal Reimbursement Rates Information

Meals are reimbursed in adult day care centers according to the meal category (free, reduced-price, or paid) determined by an accurately completed and approved IEF. The meal reimbursement rates are effective from July 1 through June 30. The reimbursement rates include the value of commodities or “cash-in-lieu of commodities,” which facilities receive as additional assistance for each lunch or supper served to participants in the program. The current meal reimbursement rates are located on the CACFP website.

Pricing Programs Only

An institution is operating a pricing program if a separately identifiable charge is made for a meal(s) served to enrolled participants. Federal regulations require that the participant letter contain certain information. A sample letter to the participant for pricing institutions is available upon request from the Missouri Department of Health and Senior Services–Community Food and Nutrition Assistance.

Parts 1, 2, and 4 of the IEF are required to be completed, except if Medicaid, SSI, or SNAP benefits are documented, then only Parts 1 and 4 are required.

Part 1: Enrollee Information

• List the first and last names of the participant enrolled at the center.
• List the participant’s complete date of birth (month/day/year).
• If the participant receives Medicaid, Supplemental Security Income (SSI), or Supplemental Nutrition Assistance Program (SNAP [formerly Food Stamps]), mark the box provided and enter the appropriate case number in the space provided. Participation in these programs automatically classifies the participant as eligible for free meals, and the family member or the guardian does not need to complete Part 2.

Part 2: Household and Income Information

• Report income by payment cycle (i.e., weekly, monthly, etc.) for each household member.
• List all household members. A household member is defined as the adult participant, and if residing with the adult participant, the spouse and dependents of the adult participant. Functionally impaired adults living with their parents are considered a "family" separate from their parents.
• Report gross wages in the space provided. This includes all income before taxes and before other deductions.
• Report welfare, child support, alimony, pensions, retirement, social security, and other income in the space provided, if applicable.

Part 3: Racial Ethnic Information – Completion Is Voluntary

Part 4: Signature

• Sign the form. If the adult participant cannot sign the form, the guardian must sign the form and indicate the relationship to the adult participant in the space provided.
• For the IEF to be valid, you must provide the last four digits of the participant’s social security number, unless the participant is an SSI, SNAP, or Medicaid recipient. If the participant does not have a social security number, write “none” in the space provided.
• Date the form.
• Print the full name of the participant.
• Provide a complete mailing address.
• Provide home phone number and work phone number.
• The IEF cannot be approved for free or reduced-price meals unless the form is signed and dated by the participant, family member, or legal guardian.
• The participant, family member, or legal guardian must fully complete the IEF. The center representative shall not complete any of the information on the IEF. Exceptions will be granted if the participant is unable to complete the IEF and if no family member or guardian is available to complete the form. In this instance, the center may complete the IEF on the participant's behalf if the participant is categorically eligible for free meals.
• The IEF is effective from the first date of the month that the form was signed and dated.

Note: The participant, family member, or legal guardian completing the IEF must attest to the fact that the information provided is correct, that it is being given in connection with the receipt of federal funds, that institution officials may verify information, and that deliberate misrepresentation may subject the individual to prosecution under applicable state and federal laws.

• Each participant, family member, or legal guardian shall be given the participant letter and an IEF on a yearly basis. If the participant, family member, or legal guardian does not return the completed form, the participant must be classified as paid.
• The IEF shall be reviewed by the center representative to determine if all Parts (1-4) of the application have been completed. The IEF is not valid if not fully completed by the participant, family member, or legal guardian.
• The center representative must ensure that the participant’s full name and date of birth are listed on the IEF.
• If the participant, family member, or legal guardian checks that the participant receives Medicaid, Supplemental Security Income (SSI), or Supplemental Nutrition Assistance Program (SNAP [formerly Food Stamps]) and enters the case number in the space provided, the participant is automatically eligible for free meals and the participant, family member, or legal guardian does not have to complete Part 2.
• If the participant, family member, or legal guardian did not report a Medicaid, SSI, or SNAP case number, they must complete all entries in Parts 2 and 4 to determine free or reduced-price eligibility.
• Check that the participant, family member, or legal guardian listed all household members. A household member is defined as the adult participant, and if residing with the adult participant, the spouse and dependents of the adult participant. Functionally impaired adults living with their parents are considered a "family" separate from their parents.
• Check that the participant, family member, or legal guardian listed each household member and indicated gross monthly income by source before any deductions are made. Current income is defined as income received during the month prior to the application. If the prior month's income is not representative of the household's annual rate of income, the household should report projected annual income.
• Completion of the Racial Ethnic Information (Part 3) is not mandatory, and the failure to complete this information shall not affect the classification of the participant.
• The participant, family member, or legal guardian completing the IEF must sign Part 4 to certify that the information provided is correct, that it is being given in connection with the receipt of federal funds, that institution officials may verify information, and that deliberate misrepresentation may subject the individual to prosecution under applicable state and federal laws. If the adult does not have a social security number, "none" should be written in the space provided. The IEF cannot be approved for free or reduced-price meals unless it is fully completed, signed, and dated by the participant, family member, or legal guardian.
• The participant, family member, or legal guardian must fully complete the IEF. The center representative shall complete only the section labeled "For Center Use Only."
• The center representative shall determine the participant’s claiming category by completing the bottom section of the IEF marked “For Center Use Only”. The IEF is effective from the first day of the month the form was signed and dated.

Center Representative Instructions for Completing the “For Center Use Only” Section

• Enter the total household size and total income.
• Indicate if eligibility status is based on household income by marking the payment cycle as reported in Part 2 (year, month, 2 times a month, every 2 weeks, or weekly).
• Indicate if the eligibility status is based on Medicaid, SSI, or SNAP benefits. Check to make sure the eight-digit case number is provided; if the participant’s SNAP number is a ten-digit case number, the first two zeros do not need to be entered on the form. If the participant is receiving Medicaid, SSI, or SNAP benefits, the participant is automatically eligible for free meals.
• Determine claiming status based on the income eligibility guidelines and indicate whether the participant’s claiming category is free, reduced, or paid.
• Sign the form.
• Date the form.

The participant must be claimed in the Paid category if:

• The information given by the participant, family member, or legal guardian is incomplete.
• The income does not meet eligibility criteria for free or reduced-price meals.
• The participant, family member, or legal guardian does not sign and date the form.
• The last four digits of the social security number of the person signing the form are missing, and the participant is not a Medicaid, SSI, or SNAP recipient.
• The SNAP number is not a valid eight-digit number.
• The participant, family member, or legal guardian chooses not to disclose their income or complete the IEF.
• The center representative did not fully complete, sign, and date the form.

These common mistakes can be very costly!

• Participants are classified incorrectly.
• Meal classifications are based on old income guidelines.
• Eligibility determination is incorrectly checked.
• The IEF is outdated (valid until the last day of the month in which the form is dated, one year earlier).
• The form is not signed and dated by an authorized center representative.
• The participant, family member, or legal guardian's signature and/or date is missing in Part 4.

Other mistakes include:

• The IEF is submitted to the center with missing information.
• Total household income is added incorrectly.
• The total number in the household is incorrect.
• The last four digits of the social security number are not provided when the IEF is based on household income (not required if case numbers are included for Medicaid, SSI, or SNAP benefits).
• Free or reduced-priced meals are claimed before the approved IEF is on file.