BTG-210 – 214 Client Form Names, Documents and Questions

BTG-210 - 214 Client Form Names, Documents and Questions

Client Name

Client Specific Information

State 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

Webpage link

Client Logo

Link or Document

File – Client Logo

Max. 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 Form

Max. file size: 512 MB.

Medical Statement/Special Diet Form

File – Medical Statement/Special Diet Form

Max. file size: 512 MB.

Infant Enrollment Form

File – Infant Enrollment Form

Max. file size: 512 MB.

Enrollment form

File – Enrollment form

Max. 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/form

Max. file size: 512 MB.

Other Questions

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?

Are there any specific handwashing, kitchen sanitation, or food safety procedures?

To be approved, a new site must be: ___________(licensed, registered, or approved) to provide care at that physical location.

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?

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?)

Participants with disabilities age requirements and any additional requirements? (i.e. enrolled in a school with an IEP?)

Do afterschool programs operating in a school building require a license?

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