Form FNS-892 Team Nutrition CACFP Organization With Change

Appendix 3: Online FNS-892 Team Nutrition CACFP Organizations With Change

Add a Team Nutrition CACFP Organization
https://www.fns.usda.gov/tn/node/add/cacfp

OMB Control Number: 0584-0642
Expiration Date: XX-XX-20XX
OMB BURDEN STATEMENT: The Food and Nutrition Service (FNS) is collecting this information in order to inform
Child Nutrition Programs (CNP) operators about the availability of Team Nutrition resources. This is a voluntary
collection and FNS will use the information to ensure targeted communications with program operators. This
collection does not request personally identifiable information that is subject to the privacy requirements
outlined at 5 U.S.C. §552a(e)3 of the Privacy Act of 1974. According to the Paperwork Reduction Act of 1995, an
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is
0584-0642. The time required to complete this information collection is estimated to average 15 minutes (0.25
hours) per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support,
1320 Braddock Place, 5th Floor, Alexandria, VA 22314. ATTN: PRA (0584-0642). Do not return the completed form
to this address.

Organization Information
Organization Name
Address
City
State
Zip Code
Phone Number
DUNS Number
Unique Entity Identifier (UEI)
Enrollment Date

Is this a multi-state institution?
No
Yes
Organization Webpage URL (http://www.example.com)

(field hidden, not required)

Appendix 3: Online FNS-892 Team Nutrition CACFP Organizations With Changes

Add a Team Nutrition CACFP Organization
https://www.fns.usda.gov/tn/node/add/cacfp

Organization Types (Select the type of Organization)
Sponsoring Organization
Independent At-Risk Afterschool Care Center
Independent Child Care Center
Emergency Shelter
Independent Adult Day Care Center

Number of Sites Under the Organization (Select all that
apply per State/territory of operation)
Child Care Center(s)
Day Care Home(s)
At-Risk Afterschool Care Center(s)
Adult Day Care Center(s)
Emergency Shelter(s)
Age Groups (Select the age group(s) served by your site(s))
0-11 months
1-2 years
3-5 years
6-12 years
13-18 years
Over 18 years (Adults)

Organization Point of Contact
Primary Contact Name
Position
Phone Number
Email
Alternate Contact Name
Position

Appendix 3: Online FNS-892 Team Nutrition CACFP Organizations With Changes

Add a Team Nutrition CACFP Organization
https://www.fns.usda.gov/tn/node/add/cacfp

Phone Number
Email

Nutrition and Wellness Activities at Your Site(s) (If you have
multiple sites, check if the statement applies to at least one of
your sites.)
Vegetable and/or fruit garden
N/A
Yes
No
Dedicated space or room to breastfeed or pump breastmilk for mothers of
infants/children in your care
N/A
Yes
No
Physical activity for children 6 years and older for at least 90 minutes in an 8-hour
period
N/A
Yes
No
Supervised tummy time every day for infants in short periods when they are awake
N/A
Yes
No
Physical activity for children 1-3 years old, allowing 60-90 minutes in an 8-hour period
N/A
Yes
No
Physical activity opportunities for adults throughout the day
N/A
Yes
No

Appendix 3: Online FNS-892 Team Nutrition CACFP Organizations With Changes

Add a Team Nutrition CACFP Organization
https://www.fns.usda.gov/tn/node/add/cacfp

Screen time of no more than 1 hour per day of high-quality media viewed with an
adult for children over the age of 2 years
N/A
Yes
No
Catered (vended) meals and/or snacks by an outside food vendor
N/A
Yes
No
Practice family style meal service at meals and/or snacks
N/A
Yes
No
In-house development of training materials for the CACFP, such as handouts,
worksheets, presentations, etc.
N/A
Yes
No
Use or creation of original recipes or menus for the CACFP
N/A
Yes
No

Please review the information you provided before submission.