Child Care Center Name: ______________________________________________________
DONATED FOOD FORM
Federal regulations do not prohibit institutions and/or sites from receiving and serving donated food items
to eligible recipients participating in the CACFP. Donated items can be combined with the institution or
facility's purchased items to create a creditable meal and/or snack. However, institutions and/or facilities
cannot incur excess funds due to receipt of and serving donated food items.
The purpose of CACFP reimbursement is to subsidize costs incurred by institutions/facilities when
purchasing and serving high-quality creditable meals. Institutions/facilities that receive and serve only
donated food items, and submit monthly claims for reimbursement are not incurring costs; but rather are
incurring excess funds and are not operating a non-profit food service program. Failure to operate a nonprofit food service program is grounds for termination from CACFP.
At a minimum, the following information must be collected:
Donor’s Name (Print): ____________________________________________________
Date of Donation: _______________________________________________________
List each individual type of item below:
Item
(Include # of gallons for
milk)
Value of Donation
Quantity
Milk Only (Circle One Only)
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Whole Milk
Low-Fat (1%) Milk
Iron-Fortified Infant Formula
Alternative Milk : ______________
Whole Milk
Low-Fat (1%) Milk
Iron-Fortified Infant Formula
Alternative Milk : ______________
Whole Milk
Low-Fat (1%) Milk
Iron-Fortified Infant Formula
Alternative Milk : ______________
Whole Milk
Low-Fat (1%) Milk
Iron-Fortified Infant Formula
Alternative Milk : ______________
Date items were included to create a creditable meal service: __________________________
MINUTE MENU INSTRUCTIONS: Enter this as a receipt into Minute Menu with a value of
$0.00. Include this form with your monthly claims submission.
Verified at child care site by (signature): ____________________________________________