Child and Adult Care Food Program (CACFP)
SAMPLE PARENT LETTER FOR DAY CARE CENTERS AND HEAD START
Dear Parent or Guardian:
The ____________________________________ Day Care Center/Head Start Program is planning to seek
assistance for nutritious meals served under the Child and Adult Care Food Program (CACFP). The CACFP is
funded by the U.S. Department of Agriculture (USDA) and administered by the Connecticut State Department
of Education.
Our program may receive reimbursement for meals served to children meeting the eligibility criteria for free or
reduced-price meals. We must document the eligibility of these children by obtaining family size and income
data. Households with incomes at or below the level in “Gross Income Guidelines for Reduced-price Meals”
(see page 2) are eligible for free meals. Please complete, sign, date and return the attached application. The
information you provide will be treated confidentially and will be used only for eligibility determination.
Please provide the information requested on the enclosed Income Eligibility Application, and return as soon as possible.
We will use this information to decide the level of CACFP benefit your provider will receive. We may also inform
officials of other child nutrition, health and education programs of the information on your form to determine benefits for
those programs.
PARTICIPANTS CATEGORICALLY ELIGIBLE AS FREE FOR CACFP BENEFITS: Households receiving
Supplemental Nutrition Assistance Program (SNAP) (formerly known as Food Stamps) or Temporary Family Assistance
(TFA) benefits, and households with foster children are eligible for free CACFP meals.
SNAP or TFA: If you currently receive SNAP or TFA benefits for your child, you only need to list your child’s
name, SNAP or TFA case number, and sign and date the application.
Foster Children: If your household includes a foster child, you only need to list your child’s name, check the
foster child box, and sign and date the application. In accordance with the Healthy, Hunger-Free Kids Act of
2010, foster children who are the responsibility of the state or are formally placed by a state child welfare agency
or court are categorically eligible for free CACFP benefits. This provision does not apply to informal
arrangements or placements that may exist outside of state or court-based systems. Eligibility for formally
placed foster children is no longer determined based on their personal use income and a family size of one. The
child care institution must obtain documentation from an appropriate state or local agency documenting the
child’s foster status. Households with both foster and non-foster children may choose to include all children on
the same application. However, the presence of a foster child in the household does not convey eligibility for
free meals to all children in the household.
ALL OTHER HOUSEHOLDS: If your household income is at or below the level shown in the table on page 2, “Gross
Income Guidelines for Reduced-price Meals,” you must provide the following information for your application to be
processed.
Household Members: List the names of everyone who lives in your household. Include parents, grandparents,
all children, other relatives and unrelated people who live in your household.
Social Security Number: List the last four digits of the social security number of the adult household
member who signs the application. If the adult does not have a social security number, check () the box
next to the statement, “I do not have a SSN.”
Current Income: List the amount of income each person earned last month (BEFORE deductions for taxes,
social security, etc.), and where it is from, such as wages, retirement or welfare. If any household member’s
income last month was higher or lower than usual, list that person’s usual average monthly income.
SIGNATURE and DATE: An adult household member must sign and date the application.
REPORTING CHANGES: In accordance with the Child Nutrition and WIC Reauthorization Act of 2004, households
are no longer required to report changes in circumstances, e.g., increase in income, decrease in household size, or when
the household is no longer certified eligible for SNAP or TFA benefits. Once properly approved for free or reduced-
price benefits, a household will remain eligible for those benefits for a period not to exceed 12 months.
Connecticut State Department of Education Revised June 2016 Page 1 of 2