BTG-110 Client Specific Forms and Information Client Name Client Specific InformationState Agency Name and Abbreviation (and pronunciation if applicable) State Online System/Software Name (and pronunciation if applicable) Other state specific names for SNAP, TANF State agency webpage link Logo Link or DocumentFile – LogoMax. file size: 512 MB.Forms, Documents and Templates If applicable, please provide the specific document name, acronym and location where users can find it for each form-type listed below. Additionally, please provide the file so we can correctly reference and link them in the presentation where appropriate.Income Eligibility Form File – Income Eligibility FormMax. file size: 512 MB.Medical Statement/Special Diet Form and where can it be found File – Medical Statement/Special Diet Form and where can it be foundMax. file size: 512 MB.Creditable non-dairy beverage list File – Creditable non-dairy beverage listMax. file size: 512 MB.Infant Enrollment Form File – Infant Enrollment FormMax. file size: 512 MB.Pricing Policy Statement File – Pricing Policy StatementMax. file size: 512 MB.Enrollment Form File – Enrollment FormMax. file size: 512 MB.Daily Delivery Slip File – Daily Delivery SlipMax. file size: 512 MB.The form used to collect race/ethnicity data File – The form used to collect race/ethnicity dataMax. file size: 512 MB.Individual Infant Production Record and/or Daily Infant Production Record File – Individual Infant Production Record and/or Daily Infant Production RecordMax. file size: 512 MB.Civil Rights Complaint log, if applicable File – Civil Rights Complaint log, if applicableMax. file size: 512 MB.Claim for reimbursement due dates and instructions, if applicable File – Claim for reimbursement due dates and instructions, if applicableMax. file size: 512 MB.Monitoring review form File – Monitoring review formMax. file size: 512 MB.Letter to Household and where it can be located File – Letter to Household and where it can be locatedMax. file size: 512 MB.Other QuestionsPoint of service is required for homes with how many children? CACFP age requirements for participation?At Risk Afterschool age requirement and any exceptions? (i.e. if turning 19 during the school year, is the participant eligible until the end of the school year/graduation/21?)Emergency shelters age requirements?Participants with disabilities age requirements and any additional requirements? (i.e. enrolled in a school with an IEP?)Home providers are required to obtain a license to provide care if caring for more than how many children? Are there different categories or exceptions for home capacities (i.e. group/family)?Sample meal count or point of service record? Link or DocumentFile – Sample meal count or point of service record?Max. file size: 512 MB.TANF/SNAP benefit case numbers are how many digits? Do you have a state income eligibility guidelines form for us to use instead of USDA’s?Who develops monitoring forms and if they are available on a webpage, what is the link? Are all sites required to record meal counts at point of service? If not, what are the exceptions (i.e. homes with less than 12 children)?How long do institutions have to file claims and what is the monthly due date? (i.e. 60 days, 10th of the month) What percentage of unannounced site-level reviews must be conducted yearly? CAPTCHA
