USDA Child and Adult Care Food Program

This center offers healthy meals to all enrolled children as part of our participation in the US Department of Agriculture’s (USDA) Child and Adult Care Food Program (CACFP).  The CACFP provides reimbursements for healthy meals and snacks served to children enrolled in child care.  A household with income less than or equal to the income chart for reduced-price meals below is eligible for free or reduced-price meals.

To help us comply with the requirements of the CACFP, completion of the Meal Benefit Income Eligibility Form is required.  For White Birch Center to be considered eligible for free and reduced-price meals based on income, an application must contain complete documentation of eligibility information including total current household income, names of all household members, the social security number of the household member who signs the application, and the signature and date of the adult household member who completed the application.  The information is kept confidential and is available only to staff directly connected with administering the CACFP.

Privacy Act Statement

(this explains how we will use the information you give us) – The Richard B. Russell National School Lunch Act requires the information on this application.  You do not have to provide the information but if you do not, we cannot approve the participant for free or reduced-price meals.  You must include the last four digits of the Social Security Number of the adult household member who signs the application.   The Social Security Number is not required when you apply on behalf of a foster child or you list a Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) Program or Food Distribution Program on Indian Reservations (FDPIR) case number for the participant or other (FDPIR) identifier or when you indicate that the adult household member signing the application does not have a Social Security Number.  We will use your information to determine if the participant is eligible for free or reduced-price meals, and for administration and enforcement of the Program.

Non-Discrimination Statement

(This explains what to do if you believe you have been treated unfairly) – “In accordance with Federal Law and US Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age or disability.  To file a complaint of discrimination, write USDA, Director, Office of Adjudication, 1400 Independence Ave SW, Washington DC 20250-9410 or call toll free (866) 632-9992 (voice).  Individuals who are hearing impaired or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339 or (800) 845-6136 (Spanish).  USDA is an equal opportunity provider and employer.”