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Tennessee Department of Human Services (DHS) Form HS-1965A Revised January 2011 Child and Adult Care Food Program (CA CFP) Application for Participation and Management Plan for Sponsor of Affiliated.

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How to fill out the TN HS-1965A online

Filling out the TN HS-1965A is an important step for organizations wishing to participate in the Child and Adult Care Food Program (CACFP). This guide will provide you with clear and detailed instructions for completing this form online.

Follow the steps to successfully complete the TN HS-1965A.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. In Section A, input your Sponsor Information. This includes the name of the sponsoring organization, any operating names, agreement number, employer identification number, mailing address, contact person details, and type of organization. Ensure that you fill out all required fields accurately.
  3. Answer the eligibility questions regarding past disqualifications and convictions in Section A. Carefully select 'Yes' or 'No' and provide detailed explanations if necessary.
  4. In Section B, Financial Viability, attach a comprehensive financial statement. This should detail all expenditures and sources of income for the last fiscal year or include your last audit report.
  5. For Section C, Budget, enter the number of sponsored facilities and estimated reimbursements. Complete the sections detailing operational and administrative labor costs, including position duties. Make sure to list all relevant costs accurately.
  6. Continue filling out the subsequent sections (D through K) as they relate to administrative capabilities, program accountability, and compliance. Ensure all personnel information, training schedules, and claim checks are included.
  7. Once all sections are complete, review the document for accuracy. Save your changes and prepare to download or print the completed form.

Complete the TN HS-1965A online today and ensure your organization can participate in the CACFP!

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