Completing the CACFP Reimbursement Claim

1. Completing the CACFP Reimbursement Claim Wisconsin Department of Public Instruction Child and Adult Care Food Program (CACFP) ~ The Adult Care Component ~ http://fns.dpi.wi.gov/fns_adultmemos

2. CACFP Reimbursement Per calendar month basis Meals X Rates + Cash-in-lieu of Commodities Rate (currently $.2325) per lunch and supper State Agency Guidance Memo 2

3. The Elements of a CACFP Reimbursement Claim State Agency Guidance Memo 3A

4. The CACFP Reimbursement Claim • DPI requests submission of claim no later than the 15th of the month following the claim month. (Example – submit January 2014 claim by February 15th, 2014) • USDA federal regulation requires submission of claim within 60 calendar days from the last day of the claim month. (Example, submit January 2014 claim by March 29, 2014) • DPI requires non-profit agencies to submit their claims on-line; for-profit agencies must submit via paper (PI-1489-A)

5. Amendments (changes) to the CACFP Reimbursement Claim • Amendments for upward adjustments (i.e. adding meal counts): must submit within 60 calendar days from the last day of the claim month • Amendments for downward adjustments (i.e. deducting meal counts): may be submitted any time • Claim amendments may be made online until the claim is processed; they must be submitted by paper claim (via fax, email, or regular mail) once the claim has been processed

7. Enrollment Data

8. Enrollment Data Monthly enrollment data = totals on the HSIR for that month

9. Enrollment Data January 2014 I. Child and Adult Care Food Program Enrollment Data 6 5 17 28

10. Participation Data January 2014 6 17 28 5 II. Participation Data 1 21 23.8  24

11. Number of Meals Served to Eligible Adult Participants January 2014 6 28 5 17 II. Participation Data 1 21 24

13. Number of Meals Served to Eligible Adult Participants January 2014 6 28 5 17 II. Participation Data 1 21 24 478 923 445

14. Site Participation Data for Sponsoring Organizations 4 6 1 2 5 8 3 7 9 10

15. Participation Data for Sponsoring Organizations 15 10 29 54 2 21 45 1724 844 880

16. Required Edit ChecksSponsoring Organizations Only Must be completed for each site for each claim month. • Approved meal types • Total meals Example for 1st site: 28 x 21 x 2 = 1176 Claimed 923 meals = O.K. State Agency Guidance Memo 5A

17. Submitting the Reimbursement Claim Online • Required for all adult care centers except for-profit agencies • Retain a copy of the confirmation page from the internet claim site with other monthly claim documentation

18. The U.S Department of Agriculture prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department.  (Not all prohibited bases will apply to all programs and/or employment activities.) If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov. Individuals who are deaf, hard of hearing 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.