NC CACFP Coronavirus (COVID-19) 2020-2021 Nationwide Waiver Request Form

These waivers are in effect through June 30, 2021

The Child and Adult Food Program (CACFP) has been granted seven nationwide waiver requests by the United States Department of Agriculture (USDA) Food and Nutrition Service (FNS) to provide CACFP operators the maximum flexibility during this pandemic. Please complete the waiver request form below to request one or more waivers below for your institution. Each waiver request form must be approved or denied prior to the institution implementing any or all the flexibilities listed below.

First Name *

Last Name *

Email Address *

Institution Name *

Institution Agreement Number *

Confirm Institution Agreement Number *

Institution County *

Confirm your contact information in NC CARES is accurate: *

Yes

No

Please complete the below email address field(s) if you would like for copies of the email notifications about this Waiver Request to go to any of the below contacts that you have listed in NC CARES. Please note that this is optional.

Primary Contact Email Address 🛈

Executive Director/Owner Email Address 🛈

Claim Preparer Email Address 🛈

Authorized Individual Email Address 🛈

Is your Institution open at this time? *

Yes

No

If yes, in what capacity?

Are you aware of any barriers that may prevent you from serving meals to your participants? If yes, please provide examples. *

If requesting waivers, how will you ensure program integrity is maintained (food safety, recordkeeping, cost documentation, etc)? *

What forms of advertisement will be used to notify households of continued meal availability during this time? *

Which waiver(s) are you requesting? *

Non-Congregate Feeding

Parent or Guardian Pickup (Required if Requesting Non-Congregate Feeding)

Meal Pattern Requirements

Meal Service Times

Sponsoring Organization On-Site Monitoring

Waiver of Area Eligibility Requirements - ARAM only

Dual Enrollment in ARAM and SFSP/SSO

IF PURSUING NON-CONGREGATE FEEDING WAIVER:

What meal distribution methods are you hoping to employ? (Select all that apply)

Grab and go

Delivery

Backpacks/Boxes

Other Other

If you are planning to utilize non-congregate feeding, who will pick up meals and/or snacks?
(Select all that apply)

Parent/Guardian

Participant

How many days worth of meals/snacks are you disbursing at once?

IF PURSUING MEAL PATTERN REQUIREMENTS WAIVER:

Has your food vendor/distributor/caterer notified you of any shortages or have you experienced shortages in your grocery store?

Yes

No

N/A

Which food COMPONENTS are currently in short supply?

Meal pattern waiver requests must be justified by real, not anticipated, shortages.

IF PURSUING MEAL SERVICE TIMES WAIVER:

Please explain how the modification of meal service time benefits meal provision.

IF PURSUING ON-SITE MONITORING WAIVER:

Please indicate below that you understand the only flexibility available for sponsors at this time is the ability to conduct monitoring visits offsite.

Yes

No

N/A

IF PURSUING AREA ELIGIBILITY REQUIRMENTS WAIVER - ARAM ONLY:

Institutions must explain how newly eligible facilities are targeting benefits to children in need, for example, children who may be newly eligible for benefits due to the impacts of COVID-19.

IF PURSUING DUAL ENROLLMENT IN CACFP & SFSP/SSO:

Have you uploaded complete and accurate Dual Enrollment Certification to your NC CARES application, as required?

Yes

No