BTG-210 - 214 Client Form Names, Documents and Questions Client Name Client Specific InformationState Agency Name and Abbreviation (and pronunciation if applicable) Sponsor's full Name and Abbreviation (and pronunciation if applicable) Name of agency and abbreviation who approves site licenses/registration State Online System/Software Name (and pronunciation if applicable) Other state specific names for SNAP or TANF Webpage link Client Logo Link or DocumentFile – Client 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 File – Medical Statement/Special Diet FormMax. file size: 512 MB.Infant Enrollment Form File – Infant Enrollment FormMax. file size: 512 MB.Enrollment form File – Enrollment formMax. 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.State or sponsor version of approved non-dairy beverages list/form File – State or sponsor version of approved non-dairy beverages list/formMax. file size: 512 MB.Other QuestionsDoes your state have an Adult Day Care Program? Any additional state specific guidelines?How does claim submission work and what is the deadline for claim submission?Are your sponsored sites strictly Head Start programs?Are all sites required to record meal counts at point of service? If not, what are the exceptions?Does your state refer to the reimbursement rates of free, reduced-price, or paid as anything else, such as: A, B, and C?Does your state include any additional protected classes within civil rights? If yes, please list.How does your agency refer to after school programs? If you sponsor homes, how many types of licensed homes and what are their capacities? (i.e. group day care homes caring for up to 12 children, family day care homes caring for up to 6 children)Adult care age requirements and any additional requirements? (i.e. care plan supporting a disability?) If adult care does not apply, would you like references to adult care requirements removed?CAPTCHA
