Form FNS-44 Report of the Child and Adult Care Food Program

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FORM APPROVED OMB NO. 0584-0078
Expiration Date: 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

FOR FNS USE ONLY

A.

30 - DAY

B.

60 - DAY (Optional)

C.

90 - DAY

D.

90 - DAY

CAL. YEAR

MONTH TYPE

Revision No.
(1 = 1st rev.; 2 = 2nd , etc.)
E.

CLOSEOUT

F.

OTHER - (Describe)

STATE CODE

3. MONTH
5. REIMBURSEMENT METHOD
A.

Meals Served X Rates

B.

Meals Served X Rates
Compared to Actual Costs

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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 homes for which sponsors
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)

PART B

DAY CARE
HOMES ONLY
(B1)

8. No. of institutions or sponsors ......
ALL CHILD
CARE CENTERS

TIER I

TIER II

TIER II
Mixed

9. No. of outlets ................................
10. Average daily attendance of
outlets reported on line 9 ..............

PART C

REPORT IN OCTOBER/MARCH
PARTICIPATION

TIER II

All Higher All Lower

FOR PROFIT OUTSIDE SCH HEAD START
HRS CARE
CENTERS
CENTERS
CENTERS
(A)
(C)
(B)

AFTER
SCHOOL
AT-RISK
(D)

EMERGENCY
SHELTER
(E)

TOTAL
(F)

11. No. of institutions ........................

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 (04/09) Previous editions are obsolete

SBU

Electronic Form Version Designed in Adobe 8.1Version

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 - COMMODITY DATA

(Complete Only for
90-Day Report)

21. If State agency receives
only cash in lieu of
commodities, 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
commodity 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
COMMODITY
COMMODITY
COMMODITY
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 or sponsors .....

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

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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)
7. "Tier II All Higher" Home: A day care home where all
GENERAL
children are certified as eligible for the higher reimbursement
rate.
Part A is to be completed monthly. Part B is to be completed
only for the months of December, March, June, and Septem8. "Tier II All Lower" Home: A day care home where none of
ber. Part C lines 11, 12, 13, 18, 19, and 20 are to be
the children are certified as eligible for the higher reimbursement
rate.
completed only for the months of October and March. Part D
Line 21 is to be completed only for the 90-Day monthly re9. "Tier II Mixed" Home: A day care home enrolling at least
port. Part E is to be completed monthly. The FNS-44 must
one child in each reimbursement category (higher and lower).
be mailed to the Regional Administrator, Food and Nutrition
Service.
10."Higher": Meals claimed in day care homes at the higher
reimbursement rate.
Note: Items 2 and 3 refer to the reporting month.
11."Lower": Meals claimed in day care homes at the lower
reimbursement rate.

DEFINITIONS:

1. "Actual" - Meals for which claims have been approved
for reimbursement for the month.
2. "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.
3. "Total" - The sum of ACTUAL data and ESTIMATED
data.
4. "Reporting Month" - The month for which the FNS-44
is being reported. The month in which meals were
actually served.
5. "Outlets" - Any sponsored facility or independent center
where meals were actually served.
6. "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.

12."After School 'At-Risk' Center": A facility 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 after school care program.
13."Outside School Hours Care Center": A public or private
nonprofit organization or for profit center approved to
provide meal service to enrolled children (through the age of 12)
outside of school hours.

TYPE OF SUBMISSION
"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.
"60-Day Report" - A 60 - day report is not required.
"90-Day Report" - The 90 - Day Report must be submitted to
the FNS Regional Office within ninety 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.
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"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)

(Estimates for missing data should be included on the 30-Day report.)

Line 6
Sponsors of Day Care Homes must be grouped in
Blocks A thru D according to the number of homes
each sponsor administers. 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.
(Count sponsors only once.)
Line 7 - Example

Column C - Complete Quarterly - Enter the number of Adult
Day Care Sponsors with an approved agreement that
operated during the reporting month.
Line 9
Column A - Enter the number of Centers, including eligible
For Profit Centers, Outside School Hours Care
Centers, Head Start Centers, After School 'At-Risk' Centers,
and Emergency Shelters that were eligible and that operated
during the reporting month. Report in Column A child care
centers operated by institutions in 8(A) and 8(B2).
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 family day care homes that operated under institutions reported in 8(B1) and 8(B2) during the report 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

Column B2- Complete Quarterly - Enter the number of
institutions or sponsors with an approved agreement that
operated both Child Care Centers and Day Care Homes
during the reporting month.

1 - 50

51 - 200

201 - 1000

1000 +

(A)

(B)

(C)

(D)

TOTAL

Column C - Enter the number of Adult Day Care Centers
that operated during the reporting month.
Line 10

W

40

40

X

50

125

Y

50

150

250

Z

50

150

800

300

1,300

TOTAL

190

425

1,050

300

1,965

175
450

* Sponsor W's 40 homes would be enterd 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.
* * * * 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.
PART B (Lines 8 - 10)
(Estimates for missing data should be included on the 30-Day report.)

Line 8
Column A - Complete Quarterly - Enter the number of institutions
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, After-School 'At-Risk' Centers, and Emergency Shelters.

Enter the Average Daily Attendance 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 For Profit Centers (Column A),
Outside School Hours Care Centers (Column B), Head Start
Centers (Column C), After School 'At-Risk' Centers (Column
D), or Emergency Shelters (Column E) with an approved agreement that operated 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 for the month of March.)
Sponsors administering several types of facilities shall be
entered in each column that is appropriate.
Line 12
Enter the number of For Profit Centers (Column A),
Outside School Hours Care Centers (Column B), Head
Start Centers (Column C), After School 'At-Risk' 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.

Column B1 - Complete quarterly - Enter the number of Day Care
Home Sponsors with an approved agreement that operated only
Day Care Homes during the reporting month.
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Line 18

PART E (Lines 22-60)

Enter the number of For Profit Adult Day Care Centers (Column
A), and all other Adult Day Care Centers (Column B) with an
approved agreement that operated during the months of October
and March. (These figures Line 18 Columns A and B are
subsets of the figure appearing in Line 8, Column C for the
month of March.)
Line 19
Enter the number of For Profit Adult Day Care Centers (Column
A), and all other Adult Day Care Centers (Column B) that
were eligible and that operated during the reporting month.
(These figures, Line 19 Columns A and B are subsets of 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.

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.) For Lines
49 through 51, also include SNACKS served to
children in after school At-Risk programs in both Column
A1(All), and separately in the "At-Risk Only" Column (A2).
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

PART D
Line 21
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 commodities. Enter in 21B
the total number of lunches and suppers for Child Care
Centers which receive USDA entitlement commodities. Enter
in 21C the total number of cash-in-lieu lunches and suppers
for Family Day Care Homes. Enter in 21D the total number
of lunches and suppers for Family Day Care Homes which
have elected to receive donated commodities. Enter in
21E the total number of lunches and suppers served in
Adult Day Care Centers which receive cash-in-lieu of donated
commodities. Enter in 21F the total number of lunches and
suppers for Adult Day Care Centers which have elected to
receive donated commodities. Enter in 21G the sum of Items
21A through 21F.

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
(Enter the line totals of Columns A1 (All), B, and C.)
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
suppers reported on Page 2 "Part E" for Child Care Centers,
Family Day Care Homes, and Adult Care Centers receive
cash-in-lieu assistance.

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