Get Dss Form 16119 (aug 07).qxd - Scchildcare

This guide provides clear and step-by-step instructions on how to effectively fill out the DSS Form 16119 (AUG 07).qxd for the Child and Adult Care Food Program. Whether you are new to this process or just need a refresher, this guide aims to simplify your experience.

Follow the steps to complete the form online.

1. Press the ‘Get Form’ button to obtain access to the form and open it in the editing tool of your choice.
2. In the 'Statement of Authority' section, provide the agreement number associated with your institution. This is critical for record-keeping and processing.
3. Enter the name of the institution applying for the Child and Adult Care Food Program. Ensure this matches the official name used in your organization’s documents.
4. Fill in the institution’s address, including city, state, and zip code. Accuracy is key, as this information may be used for correspondence.
5. Identify any exceptions in regard to the institution's relationship to the program in the designated area. If there are none, you may note 'none' or leave blank as applicable.
6. List the individuals authorized to sign the agreement and all supporting documentation. Include their printed names and titles. Make sure this information is current and accurate.
7. In the section for claims for reimbursement, repeat the process of naming individuals authorized to sign and provide their titles as required.
8. Identify those authorized to represent the institution in matters concerning the CACFP contract similarly to previous steps, ensuring all names and titles are clearly stated.
9. At the bottom of the form, the chairman or owner must sign and date it. Below the signature, include their printed name and title.
10. Review the completed form for accuracy and completeness. Finally, save the changes, and you may choose to download, print, or share the form as needed.

Complete your DSS Form 16119 (AUG 07).qxd online today for a smooth application process.