ࡱ>  bjbjR|R| o00  $222P&24\r !3333333$6d9*4u"\\""4H4$$$":3$"3$$/h0cˌ2X"03404/09"9 090""$"""""44$"""4""""9""""""""" : OCFS- 6021 (09/2016) PAGE 1 of 3 NEW YORK STATE OFFICE OF CHILDREN AND FAMILY SERVICES MENUS, MEALS AND SNACKS Child Day Care Centers and School Age Child Care Programs Program Name: FORMTEXT      Facility ID Number: FORMTEXT      This form may be used to meet requirements related to menus, meals, and snacks for children in care. Refer to OCFS Child Day Care regulations for information on related requirements. Information is also available on the agency website:  HYPERLINK "http://ocfs.ny.gov/main/childcare/default.asp" ocfs.ny.gov/main/childcare and may be available from your local child care resource and referral agency. Meals and snacks will be provided in the following way (check all that apply): The following will be provided and prepared onsite:  FORMCHECKBOX  Meals  FORMCHECKBOX  SnacksIf meals are prepared and provided on-site, attach to this form copies of sample menus for snacks (and for meals if meals are provided) or a copy of the current letter of approval from the NYS Child and Adult Food Program. Menus must cover a four week period and be reviewed and signed by an authorized reviewer as described in OCFS regulations. The following is attached (select one): FORMCHECKBOX  A sample menu* or  FORMCHECKBOX  Letter of approval from NYS Child and Adult Food Program The following will be provided by , but not prepared at, the program:   FORMCHECKBOX  Meals  FORMCHECKBOX  SnacksIf meals are provided but not prepared on-site, attach to this form copies of sample menus for snacks (and for meals if meals are provided) or a copy of the current letter of approval from the NYS Child and Adult Food Program. Menus must cover a four week period and be reviewed and signed by an authorized reviewer as described in OCFS regulations. In addition, a description of food service arrangements must be provided. The following are attached (check all that apply) FORMCHECKBOX  A sample menu* or  FORMCHECKBOX  Letter of approval from NYS Child and Adult Food Program and FORMCHECKBOX  A description of food service arrangements The parent will provide the following:   FORMCHECKBOX  Meals  FORMCHECKBOX  SnacksIf meals are not provided by the program, adequate nutritious supplemental food will be available in the event that no meal/snack or inadequate nutritional meal/snack is supplied by the parent.  . OCFS-6021 (09/2016) PAGE 2 of 3 Instructions for Sample Menu Template (page 3 of this form) The template on the following page may be used to meet the requirement for some programs to submit copies of sample menus for snacks, and for meals if meals are provided. This requirement can also be met by submitting a copy of the current letter of approval from NYS Child and Adult Food Program (CACFP). To determine whether or not the program must submit sample menus, refer to page one of this form. Menus must cover a four week period.. Day Care Centers menus must be reviewed and signed by an authorized reviewer as described below. Meal and snack menus must be reviewed for nutritional content, variety and quality at the time of initial application and once every 24 months. The reviewer must have one of the following qualifications: a federal CACFP program specialist responsible for reviewing and approving menus a person who has a bachelor's or master's degree with a major in food, and institutional management or a closely related field has completed a dietician internship certified as a registered dietician or has an equivalent state certification To develop menus, refer to USDA CACFP meal patterns and to OCFS regulations. USDA CACFP meal patterns are available from the US Department of Agriculture Food and Nutrition Service at  HYPERLINK "http://www.fns.usda.gov/cacfp/meals-and-snacks" http://www.fns.usda.gov/cacfp/meals-and-snacks . Your local child care resource and referral agency may also be a resource. Duplicate the sample menu template as needed. OCFS- 6021 (09/2016) PAGE 3 of 3 NEW YORK STATE OFFICE OF CHILDREN AND FAMILY SERVICES Sample Menu Template Program Name: FORMTEXT      Facility ID Number: FORMTEXT      Week (check one) FORMCHECKBOX 1  FORMCHECKBOX 2  FORMCHECKBOX 3  FORMCHECKBOX 4Authorized Reviewer Name: FORMTEXT      Signature:Date: FORMTEXT    /  FORMTEXT    /  FORMTEXT      MondayTuesdayWednesdayThursdayFridaySaturdaySundayBreakfast FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      AM Snack FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Lunch FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      PM Snack FORMTEXT       FORMTEXT     6 M N ٸٙxpeWLE hubh4jhubh4Uhubh45CJ^JaJhubh4^JaJht^JaJh4hGj^JaJh5CJ^JaJh{5CJ^JaJhGj^JaJh4hrCJ^JaJh4CJ^JaJh4h)>pCJ^JaJh6\CJ^JaJh"'@CJ^JaJh4hGjCJ^JaJhub5CJ^JaJh4hGj5CJ^JaJ  6 N  6 ^ :d(($If]:gdubd(($Ifgdub $da$gdGj$da$gdGjm$gdGj  4 6 8 L N P Z \ ^ ` ( * F d z |  õΧε{peppZh6\h_>CJ^Jh6\hCJ^Jh6\h$2CJ^Jh6\hCJ^Jh6\h(CJ^Jh6\h)} CJ^Jh6\h@nTCJ^Jjvhubh4Uhubh45CJ^JaJhubh4^JaJ hubh4 jhubh4UmHnHujhubh4Ujhubh4U^ `  H<,d(($Ifgdub dgd4kd$$Ifl\f!+f bV  t0644 lap(ytub  X Y Z e t u v z    , H J K µ犯~rgr]QCQ9hubhN5^Jh6\hN5>*CJ^Jh6\hN5CJ^Jhubh45^Jh6\h4CJ^Jh6\h45CJ^Jh6\h)%CJ^Jh6\hqyCJ^Jh6\hqCJ^Jh6\h10CJ^Jh6\h{CJ^Jh6\hN0JCJ^Jh6\h{0JCJ^J&jh6\hN>*CJU^Jh6\hN>*CJ^J jh6\hN>*CJU^J  J ~d(($Ifgdubqkd$$Ifl+(, t0644 lap ytubJ K ~d(($Ifgd6\qkdh$$Ifl+(, t0644 lap ytubK T U c d e u v mn!"#128:@AOPQ亱wsgh6\hN5CJ^JhNjhNU^JjhNU^JjhNU^JhNhN5^J hN^J hh^Jhhhh^JhubhN5^JjqhNhNU^JjhNhNU^JhNhN^JjhNhNU^J h6\^J' ~dxx$Ifgd6\qkd$$Ifl+(, t0644 lap ytub~d(($IfgdNqkdz$$Ifl+(, t0644 lap ytub|d(($IfgdNqkd$$Ifl+(, t0644 lap ytub~d(($IfgdNqkd$$Ifl+(, t0644 lap ytub   rs-./ijٿٿrhah h6\5^Jhubh6\5^Jj h6\U^Jh6\h6\5^Jj3 h6\U^Jjh6\U^Jh6\hN5^J h6\^J hN^Jhhhh^JhubhN5^JjhNhNU^JhNhN^JjhNhNU^Jj!hNhNU^J!~dxx$Ifgdhqkd $$Ifl+(, t0644 lap ytubi~d(($Ifgd6\qkd $$Ifl+(, t0644 lap ytubij~d(($Ifgd6\qkd $$Ifl+(, t0644 lap ytub~d(($Ifgd6\qkd $$Ifl+(, t0644 lap ytub ./0789   ˿ϹϹˏuj]Sh"'@CJ^JaJh4h)>pCJ^JaJhub5CJ^JaJh4h)>p5CJ^JaJ hZT^J hK^J h-^Jj]h6\U^Jj h6\U^Jjh6\U^J h6\^Jh6\h6\5CJ^Jh6\hubh6\5^JjG h6\h6\U^Jh6\h6\^Jjh6\h6\U^J |d(($Ifgd6\qkd $$Ifl+(, t0644 lap ytub8~d(($Ifgd6\qkdR $$Ifl+(, t0644 lap ytub89~dxx$Ifgd6\qkd$$Ifl+(, t0644 lap ytub;nZ{o\\\\ & Fhdx^hgdRm$ dxgd4gd dgd4qkdh$$Ifl+(, t0644 lap ytub  :;=>H^>FckmnȾ騜~u~lf`ZT hR^J hp^J hqJ|^J hq^Jh+BhIL^Jh+Bh!^Jh+BhqJ|^J h%k^J hea ^Jh+BhZT^Jh6\hea 5CJ^Jh6\h`$5CJ^JhubCJ^JaJhRCJ^JaJh4hrCJ^JaJh4CJ^JaJh"'@CJ^JaJh4h)>pCJ^JaJh6\CJ^JaJ RZo&()05Ji"#_`     !"񬣬}si}s}hRCJ^JaJh"'@CJ^JaJh4hrCJ^JaJhub5CJ^JaJh4hr5CJ^JaJh+Bh+l^Jh+Bhd)4^Jjht0JU^Jh+Bht0J^JhtjhtUhRht5^J hR^Jh%kht^Jh+Bht^J ht^J%Z&xj   <f$ Hxa$gd $ Ha$gdt  Hgdqgd! dxgdd)4 & Fhdx^hgdRm$ & Fhdx^hgdRm$ & FdxgdRm$ & FdxgdRm$"b<df}k}V}}D}V#jshubhU^JaJ(jhubhU^JaJmHnHu#jhubhU^JaJjhubhU^JaJhubh^JaJhubh5^JaJhRhr5;CJ^JhRhq5;CJ^Jhtht^Jh4hqCJ^JaJhubCJ^JaJh4hrCJ^JaJhCJ^JaJh4CJ^JaJf$ H(($If]^a$gdR$ H(($If]^a$gdR H(($Ifgdub H(($If]gdub:<>FHdfhpr嵩uaM&jKhRhR5U^JaJ&jhRhR5U^JaJ&j_hRhR5U^JaJhRh5^JaJ&jhRhR5U^JaJhRhR5^JaJ jhRhR5U^JaJhR^JaJhubh^JaJhubh5^JaJhubh^JaJjhubhU^JaJ 26BDXZ\`bhj~Ӳĝӑ}n\}}M\}}jFhRU^JaJ"jhRU^JaJmHnHujhRU^JaJhR^JaJjhRU^JaJhtht5^JaJ(jhubhtU^JaJmHnHu#jZhubhtU^JaJjhubhtU^JaJhubht^JaJhubht5^JaJhubh^JaJhRh^JaJkd$$Iflֈ f*818fl t t0644 lap<ytR46B H(($IfgdR$ H(($Ifa$gdub H(($Ifgdub    $ * , . 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