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OMB APPROVED NO. 0584-0055
Expiration Date: XX/XX/XXXX
U.S. DEPARTMENT OF AGRICULTURE
FOOD AND NUTRITION SERVICE
REPORT OF THE CHILD
AND ADULT CARE
FOOD PROGRAM
STATE AGENCY: Submit report according to
the instructions 30 AND 90 days following
the month being reported. Send original to
the Regional Administrator, Food and
Nutrition Service.
4. TYPE OF SUBMISSION
("X" ONE)
1. STATE
2. CALENDAR YEAR
5.
A.
30 - DAY
B.
60 - DAY (Optional)
C.
90 - DAY
D.
90 - DAY
FOR FNS USE ONLY
CAL. YEAR
MONTH TYPE
Revision No.
(1 = 1st rev.; 2 = 2nd , etc.)
3. MONTH
E.
CLOSEOUT
F.
OTHER - (Describe)
STATE CODE
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this collection of information is 0584-0055. The time required to complete this information
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needed and complete and review the information collection.
PART A - (NO. HOMES)
DAY CARE
HOMES
REPORT MONTHLY
51 - 200
201 - 1000
1001 +
TOTAL
(A)
(B)
(C)
(D)
(E)
CENTERS &
HOMES
(B2)
ADULT CARE
TOTAL
(C)
(D)
6. No. of sponsoring organizations
of day care homes administering
between ...................................
7. No. of day care homes for which
sponsoring organizations are eligible
to receive reimbursement based on
rate for .............
REPORT QUARTERLY
(Dec., March, June and Sept.)
PARTICIPATION
1 - 50 HOMES
CHILD CARE
CENTERS ONLY
(A)
DAY CARE
HOMES ONLY
(B1)
8. No. of institutions (see definition)
9. No. of outlets ..............................
ALL CHILD
CARE CENTERS
TIER I
TIER II
TIER II
All Higher All Lower
TIER II
Mixed
10. Average daily attendance of
outlets reported on line 9 ..............
REPORT IN OCTOBER/MARCH
FOR-PROFIT
CENTERS
(A)
PARTICIPATION
PART B
PART C
OUTSIDE
SCH-HRS
CARE
CENTERS
(B)
HEAD
START
CENTERS
(C)
EMERGENCY
AT-RISK
AFTERSCHOOL SHELTERS
(D)
TOTAL
(E)
(F)
11. No. of institutions (see definition)
12. No. of outlets ............................
13. Average daily attendance of
outlets reported on line 12 ............
I CERTIFY that this report is true and correct to the best of my knowledge and belief.
14. SIGNATURE
15. TITLE
16. DATE SIGNED
17. ADMINISTERING AGENCY
FORM FNS-44 (08-13) Previous Editions Obsolete
SBU
Electronic Form Version Designed in Adobe 10.0 Version
NO FURTHER MONIES OR OTHER BENEFITS MAY BE PAID OUT UNDER THESE PROGRAMS UNLESS
THIS REPORT IS COMPLETED AND FILED AS REQUESTED BY EXISTING REGULATIONS (7 C.F.R. 226)
PART C (CONTINUED)
ADULT DAY CARE
REPORT IN OCTOBER/MARCH
ALL OTHER ADULT
CARE CENTERS
(B)
FOR-PROFIT CENTERS
PARTICIPATION
(A)
19. No. of outlets ............................
20. Average daily attendance of
outlets reported on line 19 ............
PART D - USDA FOODS DATA
(Complete Only for
90-Day Report)
21. If State agency receives
only cash in lieu of
USDA Foods, mark an "X"
in Col. A. If not, report
in Cols. A thru G the
total number of lunches
and suppers served during
the month in centers and
homes receiving
USDA Foods assistance
(report actual data).
CHILD CARE CENTERS
DAY CARE HOMES
ADULT DAY CARE
A. CASH-IN- B. ENTITLEMENT C. CASH-IN- D. ENTITLEMENT E. CASH-IN- F. ENTITLEMENT
USDA FOODS
USDA FOODS
USDA FOODS
LIEU
LIEU
LIEU
ASSISTANCE
ASSISTANCE
ASSISTANCE
ASSISTANCE
ASSISTANCE
ASSISTANCE
PART E (Complete Monthly)
(A) CHILD CARE
CENTERS
REDUCED
PAID
REDUCED
FREE
PAID
REDUCED
FREE
PAID
BREAKFASTS
FREE
MEAL TYPE
LUNCHES
(C)
18. No. of institutions (see definition)
REPORT MONTHLY
SUPPERS
TOTAL
(A1) ALL, (A2) AtInc. At-Risk Risk Only
ACTUAL
22
ESTIMATED
23
TOTAL
24
ACTUAL
25
ESTIMATED
26
TOTAL
27
ACTUAL
28
ESTIMATED
29
TOTAL
30
ACTUAL
31
ESTIMATED
32
TOTAL
33
ACTUAL
34
ESTIMATED
35
TOTAL
36
ACTUAL
37
ESTIMATED
38
TOTAL
39
ACTUAL
40
ESTIMATED
41
TOTAL
42
ACTUAL
43
ESTIMATED
44
TOTAL
45
ACTUAL
46
ESTIMATED
47
TOTAL
48
(B) DAY CARE HOMES
TIER I
TIER II
HIGHER
LOWER
(C) ADULT
DAY
CARE
G. TOTAL
D. TOTAL
Sum of Cols. A1+B+C
PAGE 2
PART E (Complete Monthly)
(A) CHILD CARE
CENTERS
REDUCED
PAID
SNACKS
FREE
MEAL TYPE
(A1) ALL, (A2) AtInc. At-Risk Risk Only
ACTUAL
49
ESTIMATED
50
TOTAL
51
ACTUAL
52
ESTIMATED
53
TOTAL
54
ACTUAL
55
ESTIMATED
56
TOTAL
57
TOTAL MEALS FREE
58
TOTAL MEALS REDUCED
59
TOTAL MEALS PAID
60
(B) DAY CARE HOMES
TIER I
TIER II
HIGHER
LOWER
(C) ADULT
DAY
CARE
D. TOTAL
Sum of Cols. A1+B+C
REMARKS
INSTRUCTIONS
(All items self-explanatory unless noted below)
GENERAL
Part A is to be completed monthly. Part B is to be completed
only for the months of December, March, June, and
September. Part C lines 11, 12, 13, 18, 19, and 20 are to be
completed only for the months of October and March. Part D
Line 21 is to be completed only for the 90-day report. Part E is
to be completed monthly. The FNS-44 must be submitted to the
Regional Administrator, Food and Nutrition Service.
Note: Items 2 and 3 refer to the reporting month.
DEFINITIONS:
"Actual" - Meals for which claims have been approved
for reimbursement for the month.
"Estimated" - Projection of the number of meals that
were served and are expected to be approved for
reimbursement for which claims have not been received or
approved by the reporting due date.
"Total" - The sum of ACTUAL data and ESTIMATED
data.
"Reporting Month" - The month for which the FNS-44
is being reported. The month in which meals were
actually served.
"Outlet" - Any sponsored facility, whether a day care home or
sponsored center, or any independent center where meals
were actually served.
"Institution" - Any independent center or sponsoring
organization of day care homes, child care centers, at-risk
afterschool care centers, outside-school-hours care centers,
emergency shelters, or adult day care centers which enters into
an agreement with the State agency to assume final
administrative and financial responsibility for Program
operations.
"Independent Center" - Any single child care center, at-risk
afterschool center, outside-school-hours care center, emergency
shelter, or adult day care center which enters into an agreement
with the State agency to assume final administrative and financial
responsibility for program operations.
"Sponsoring Organization" - Any public, private nonprofit, or forprofit organization which enters into an agreement with the State
agency to assume final administrative and financial responsibility
for program operations in two or more sponsored facilities.
"Facility" - A sponsored center or a day care home.
"Tier I" Home - A day care home located in a lowincome area, as specified by Program regulations, or a
home in which the provider's household income is at
or below 185% of the Federal income eligibility guidelines.
"Tier II All Higher" Home - A day care home which is not a "Tier I"
home and in which all children are certified as eligible for the
higher reimbursement rate.
"Tier II All Lower" Home - A day care home which is not a "Tier
I" home and in which none of the children are certified as eligible
for the higher reimbursement rate.
"Tier II Mixed" Home - A day care home which is not a "Tier I"
home and in which at least one child in each reimbursement
category (higher and lower) is enrolled.
"Higher" - Meals claimed in day care homes at the higher ("Tier I")
reimbursement rate.
"Lower" - Meals claimed in day care homes at the lower
("Tier II") reimbursement rate.
"At-Risk Afterschool Care Center" - An outlet located in a lowincome area and approved by the State agency, in accordance
with Program regulations, to be reimbursed at the "free" rate for
snacks or meals served to children through the age of 18 who
participate in the facility's afterschool care program.
"Outside School Hours Care Center" - An outlet approved to
provide meal service to enrolled children (through the age of 12)
enrolled in child care during hours outside of school.
PAGE 3
PART B (Lines 8 - 10)
TYPE OF SUBMISSION
(Estimates for missing data should be included on the 30-Day report.)
"30-Day Report" - Due in FNS Regional Offices on the last
day of the month following the month being reported. This
report may contain ESTIMATED and ACTUAL data.
Line 8
"60-Day Report" - Not required.
"90-Day Report" - Must be submitted to the FNS Regional Office
within 90 days following the month being reported. This is a "final"
report and must consist of ACTUAL data only.
"Revised 90-Day Report" - Submit revisions to the latest 90-day
report in accordance with FNS instructions.
"Closeout Report" - Submit the Annual Financial Reconciliation
(closeout) of Program Grants Report in accordance with FNS
instructions.
"Other Reports" - Submit other reports in accordance with FNS
instructions. Use the "Remarks" section if necessary to describe
the purpose of the report.
PART A (Lines 6 - 7)
Column A - Complete quarterly - Enter the number of institutions
(including both independent centers and sponsoring
organizations) with an approved agreement that operated
only Child Care Centers during the reporting month. Child Care
Centers include For-Profit Centers, Outside School Hours Care
Centers, Head Start Centers, 'At-Risk' Afterschool Care Centers,
and Emergency Shelters.
Column B1 - Complete quarterly - Enter the number of Day Care
Homes sponsoring organizations with an approved agreement
that operated only Day Care Homes during the reporting month.
Column B2- Complete Quarterly - Enter the number of
sponsoring organizations with an approved agreement that
operated both Child Care Centers and Day Care Homes
during the reporting month.
(Estimates for missing data should be included on the 30-Day report.)
Column C - Complete Quarterly - Enter the number of Adult
Day Care institutions with an approved agreement that
operated during the reporting month.
Line 6
Line 9
Sponsors of Day Care Homes must be grouped in
Blocks A thru D according to the number of homes
each sponsor administers (count sponsors only once).
Example: If 20 sponsors administer from 1 to 50
homes, then the number 20 is entered in Block A.
If nine Sponsors administer from 51 - 200 homes,
then enter nine in Block B.
Line 7 - Example
Column B - Enter in the appropriate space the total number
of Tier I, Tier II All Higher, Tier II All Lower, and Tier II
Mixed Day Care Homes that operated under sponsoring
organizations reported in 8(B1) and 8(B2) during the reporting
month. (See definitions).
Sponsor W administers 40 homes
Sponsor X administers 175 homes
Sponsor Y administers 450 homes
Sponsor Z administers 1,300 homes
HOMES
SPONSOR
1 - 50
51 - 200
201 - 1000
1000 +
(A)
(B)
(C)
(D)
TOTAL
W
40
X
50
125
Y
50
150
250
Z
50
150
800
300
1,300
TOTAL
190
425
1,050
300
1,965
40
175
450
* Sponsor W's 40 homes would be entered in Column A.
* * The first 50 homes of Sponsor X would be entered in
Column A. The remaining 125 homes would be
entered in Column B.
* * * The first 50 homes of Sponsor Y are entered in Column
A. The next 150 homes would be entered in Column B.
The remaining 250 homes would be entered in Column
C.
****
Column A - Enter the number of independent and sponsored
Centers, including eligible For-Profit Centers, Outside-SchoolHours Care Centers, Head Start Centers, 'At-Risk' Afterschool
Care Centers, and Emergency Shelters that were eligible and that
operated during the reporting month. Report in 9A both the
independent centers reported in 8(A) and all sponsored centers
reported in 8(B2). The number reported in 9A must either be
equal to or greater than the number reported in 12(F).
Column C - Enter the number of independent and sponsored
Adult Day Care Centers that operated during the reporting month.
Line 10
Enter the Average Daily Attendance (ADA) of Outlets that were
entered on Line 9. ADA for the reporting month is computed by
adding the ADA for each Outlet that operated.
Report in Column B the ADA for Day Care Homes by type
of home.
PART C (Lines 11 - 13, AND 18 - 20)
Line 11
Enter the number of Institutions with an approved agreement that
operated For-Profit Centers (Column A), Outside School Hours
Care Centers (Column B), Head Start Centers (Column C), 'AtRisk' Afterschool Care Centers (Column D), or Emergency
Shelters (Column E) during the months of October and March.
(These figures, Line 11 Cols. A, B, C, D, and E are subsets of the
figures appearing in Line 8(A) and 8(B2) for the month of March).
Sponsors administering several types of facilities shall be
entered in each column that is appropriate.
Sponsor Z's first 50 homes would be entered in Column
A. The next 150 homes would be entered in Column B.
The next 800 homes would be entered in Column C.
The remaining 300 homes would be entered in Column
D. The State totals of Columns A thru D are now
entered under the appropriate headings on Line 7.
PAGE 4
Line 12
Enter the number of independent and sponsored For-Profit
Centers (Column A), Outside-School-Hours Care Centers
(Column B), Head Start Centers (Column C), 'At-Risk' Afterschool
Care Centers (Column D), or Emergency Shelters (Column E)
that were eligible and that operated during the reporting month.
(These figures, Line 12 Columns A, B, C, D, and E are subsets of
the figure appearing in Line 9, Column A for the month of March).
Line 13
Enter the Average Daily Attendance of Outlets that were
entered on Line 12.
Line 18
Enter the number of institutions with an approved agreement that
operated For-Profit Adult Day Care Centers (Column A), and all
other Adult Day Care Centers (Column B) during the months of
October and March. (These figures, Line 18, Columns A and B
should equal the figure appearing in Line 8, Column C for the
month of March).
Line 19
Enter the number of independent and sponsored For-Profit Adult
Day Care Outlets (Column A), and all other Adult Day Care
Outlets (Column B) that were eligible and that operated during the
reporting month. (These figures, Line 19, Columns A and B
should equal the figure appearing in Line 9, Column C for the
month of March).
Line 20
Enter the Average Daily Attendance of Outlets that were
entered on Line 19.
PART D
PART E (Lines 22-60)
Column A
Enter the ACTUAL, ESTIMATED, and TOTAL number of
FREE, REDUCED, and PAID BREAKFASTS, LUNCHES,
SUPPERS and SNACKS served in Centers.
(Include in Col. A, for all meal categories, For-Profit
Centers, Outside-School-Hours Care Centers,
Head Start Centers, and Emergency Shelters.) In Column A2
(Lines 22, 31, 40, 49), enter only the actual number of free At-Risk
breakfasts, lunches, suppers and snacks served. This will
be a subset of the total number of meals reported in Column A1
(all, including At-Risk meals).
Column B
Enter the ACTUAL, ESTIMATED, and TOTAL number of
BREAKFASTS, LUNCHES, SUPPERS, and SNACKS
served in Day Care Homes. Report these meals in the
appropriate column, either Tier I or Tier II.
Column C
Enter the ACTUAL, ESTIMATED, and TOTAL number of
FREE, REDUCED, and PAID BREAKFASTS, LUNCHES,
SUPPERS, and SNACKS served in all Adult Day
Care Centers.
Column D
Line 21
(Enter the line totals of Columns A1 (All), B, and C).
Complete only for the 90-day report. Enter in 21A the total
number of lunches and suppers for Child Care Centers which
receive cash-in-lieu of donated USDA Foods. Enter in 21B
the total number of lunches and suppers for Child Care
Centers which receive USDA Foods. Enter in 21C the total
number of cash-in-lieu lunches and suppers for Day Care
Homes. Enter in 21D the total number of lunches and suppers
for Day Care Homes which have elected to receive donated
USDA Foods. Enter in 21E the total number of lunches and
suppers served in Adult Day Care Centers which receive cash-inlieu of donated USDA Foods. Enter in 21F the total number of
lunches and suppers for Adult Day Care Centers which have
elected to receive donated USDA Foods. Enter in 21G the sum
of Items 21A through 21F.
Line 58 - Sum of Lines 24, 33, 42, 51
Line 59 - Sum of Lines 27, 36, 45, 54
Line 60 - Sum of Lines 30, 39, 48, 57
If the State agency receives only cash-in-lieu assistance, then
mark an "X" in Item 21A. This indicates that all lunches and
Day Care Homes, and Adult Care Centers receive
cash-in-lieu assistance.
PAGE 5
| File Type | application/pdf |
| File Modified | 2013-08-08 |
| File Created | 2013-08-08 |