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It collects operating days and enrollment by child categories, food service shift details, serving times, and hours of operation constraints. Tier information requires school district and elementary school verification, plus provider certification acknowledging federal funds use, attached agreement conditions, and the consequences of misrepresentation.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/child-and-adult-care-food-program-site-information-day-care-home/536931/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/child-and-adult-care-food-program-site-information-day-care-home/536931.png","ImageObject",300,407,{"name":92,"@type":93},"Mary Man","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-10","2026-10-10",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What information is requested about the sponsor organization and provider?","Question",{"text":112,"@type":113},"The form requests the sponsoring organization name and the day care home provider information, including addresses, contact details, and transfer status at the end of the fiscal year.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which operating and meal service details must be filled out?",{"text":117,"@type":113},"It collects operating days per week, current enrollment totals, food service shift information, serving times for meals and snacks, and overall hours of operation (with a stated licensing limit).",{"name":119,"@type":110,"acceptedAnswer":120},"What is required for Tier I vs Tier II reimbursement?",{"text":121,"@type":113},"The form requires tier selection and school data to determine reimbursement status, including public school district and public elementary school information, followed by verification of school attendance area.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},536931,1791689546,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":81,"preview_page_count":4},7421720224475,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","FISCAL YEAR AGREEMENT NUMBER  \nISBEUSE ONLY  \nSITE NUMBER  \nNAME OF SPONSORING ORGANIZATION  \nDAY CARE HOME PROVIDER TRANSFER AT END OF FISCAL YEAR ONLY  \nILLINOIS STATE BOARD OF EDUCATION  \nNutrition and Wellness Programs Division  \n100 North First Street, W-270 Springfield, Illinois 62777-0001  \nChild and Adult Care Food Program SITE INFORMATION-DAY CARE HOME  \nNAME OF SPONSOR PROVIDER HAS TRANSFERRED FROM  \n\n|  | 1. NAME (First, Middle, Last) AND ADDRESS (Street, City, State, Zip Code) |  |  |  | 2. MAILING ADDRESS (Street, City, State, Zip Code)\u003Cbr>(If mailing address is the same as in 1 ., leave blank) |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n|  | 3. COUNTY |  | 4. TELEPHONE NUMBER (Include Area Code) |  |  | 5. FAX NUMBER |  |\n|  | 6. E-MAIL ADDRESS |  |  |  |  |  |  |\n|  | 7. PERIOD OF OPERATION BEGINNING DATE\u003Cbr>  /   /  \u003Cbr>CLOSING DATE\u003Cbr>  /   /   | 8.DCFS/MILITARY INFORMATION LICENSE EXPIRATION DATE\u003Cbr>  /   /  \u003Cbr>LICENSE NUMBER\u003Cbr>Check box for license exempt by military. |  | 9. TYPE OF HOME DAY CARE HOME\u003Cbr>EXTENDED DAYCARE HOME\u003Cbr>GROUP DAY CARE HOME |  | 10. LICENSE CAPACITY\u003Cbr>DAY  \u003Cbr>EXTENDED  \u003Cbr>NIGHT   | 11. ISBE/IDHS DATA ID.\u003Cbr>IDHS CHILD CARE SUBSIDY NUMBER |\n\nI I . APPLICATION I . SITE INFORMATION  \n|  | 12. OPERATING DAYS PER WEEK |  |  |  |  |  |  |  |  |  | 13. DAYS OF SERVICE: Provide the exact number of days food service is offered each month. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n|  | Sun. | Mon. |  | Tue. | Wed. | Thu. | Fri. |  | Sat. |  | Oct |  |  | Nov. | Dec. |  | Jan. |  |  | Feb. |  |  | Marc. |  | Apr. | May |  |  | June | July | Aug. |  |  | Sept. |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| I I I . PROGRAM DETAILS | 14. CURRENT ENROLLMENT |  |  |  |  | 15. FOOD SERVICE DATA |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 16. HOURS OF OPERATION (Cannot exceed DCFS license hours of operation.) |  |  |  |  |  |\n|  | ________\u003Cbr>________\u003Cbr>________\u003Cbr>________ |  | Own children (residing in home under the age of 13)\u003Cbr>Foster children (residing in home under the age of 13)\u003Cbr>Outside Children\u003Cbr>TOTAL\u003Cbr>ENROLLMENT |  |  | SHIFT |  |  |  | SERVING TIME (Two hours required between meals. ) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  | Breakfast |  |  | A. M.\u003Cbr>Snack |  |  | Lunch |  |  |  |  | P. M.\u003Cbr>Snack |  |  | Dinner |  |  | Evening\u003Cbr>Snack |  |  | DAY |  |  | OPEN |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | CLOSE |  |  |\n|  |  |  |  |  |  | First Serving |  | Begin: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  | End: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | NIGHT |  |  | OPEN |  |  |\n|  |  |  |  |  |  | Second\u003Cbr>Serving |  | Begin |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | CLOSE |  |  |\n|  |  |  |  |  |  |  |  | End: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  | 17. TIER INFORMATION-Select |  |  |  |  | only one\u003Cbr>Tier I Census |  |  | |  |  | Tier I Household Income |  |  |  |  |  |  | |  |  | Tier II All Lower |  |  |  | |  | Tier II Mixed |  |  | | Tier II All Higher |  |  |  |\n|  | \u003Cbr>Tier I School\u003Cbr>|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| AT IO | S","cbCaiktUokQxcrIa","https://ap.wps.com/l/cbCaiktUokQxcrIa","pdf",90561,"English","# Sponsor and Provider Information\n## Contact and Licensing Details\n# Operating Schedule and Enrollment\n## Operating Days per Week\n## Current Enrollment\n## Food Service Data and Serving Times\n## Hours of Operation\n# Tier Information and School Verification\n## Tier Selection\n## School District and Elementary School Details\n## Verification and Certification","[{\"question\":\"What information is requested about the sponsor organization and provider?\",\"answer\":\"The form requests the sponsoring organization name and the day care home provider information, including addresses, contact details, and transfer status at the end of the fiscal year.\"},{\"question\":\"Which operating and meal service details must be filled out?\",\"answer\":\"It collects operating days per week, current enrollment totals, food service shift information, serving times for meals and snacks, and overall hours of operation (with a stated licensing limit).\"},{\"question\":\"What is required for Tier I vs Tier II reimbursement?\",\"answer\":\"The form requires tier selection and school data to determine reimbursement status, including public school district and public elementary school information, followed by verification of school attendance area.\"}]","Child and Adult Care Food Program Site Information - Day Care Home | PDF",1791603613]