
Name Address DOH-3682 8/10 Additional Center Contact Alternate person in charge of this center on a daily basis PAGE 1 OF 4 HOURS/MEALS Schedule C1. Approval Type Each license registration or operating certificate as well as each location is considered to be a separate center and requires a separate application DOH-3682. I also certify that this center is not participating in the Child and Adult Food Program under any other organization. Please .
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How to fill out the Doh 3682 Form online
Filling out the Doh 3682 Form accurately is crucial for centers participating in the Child and Adult Care Food Program. This guide provides clear, step-by-step instructions to help you complete the form online with confidence.
Follow the steps to complete the Doh 3682 Form Successfully
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Provide the center name in the designated field, ensuring that the name reflects the official registered name used in your documentation.
- Fill out the street address and additional address information if needed, ensuring it is complete and accurate.
- In the License/Registration Information section, select the correct center type and fill in the associated license information, including the license number, effective date, and expiration date.
- Indicate the age range of participants and note if you provide childcare for infants under 12 months old by checking 'Yes' or 'No.'
- Input your contact details including names, phone numbers, emails, and titles for the center contact and any additional contacts.
- Complete the Hours/Meals section by checking boxes for the months and days of operation, as well as entering meal scheduling details including the start and end times of meal services.
- Register the number of enrolled participants in each income eligibility category and indicate if the center provides transportation.
- For ethnic/racial information, estimate and report the number of participants in each category as required by the form.
- Review the certification statement to confirm the accuracy of the provided information and digitally sign the form.
- Once all sections are completed and verified, you can save changes, download, print, or share the form as needed.
Start completing your Doh 3682 Form online today!
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