January 6, 2009
Forms instructions
 

Using the AccuTrak forms

1) Provider number. Write in your Provider number in the boxes along the left and fill in the corresponding number. (example: Provider number 123456)

 

2) Month. Bubble in the month you are claiming. (example: March)

 

3) Day. Write in the day and bubble in the corresponding number. (example 12th)

4) Meal items served. Write in what you served. (example for Lunch)

 

 

 

 

 

 

5) Infant menus (Milk) Bubble in the I,B,J for the age group of the infant 0-3,4-7,8-11 (example: Infant formula for 4 month old)

6) Attendance. Record the numbers of the children being served (1-35) in the bubbles. These numbers can be found on the Child Information Form that you receive each month.

(example: Children 1,2,5 and 22 were served at this meal)

 

 

7) Sign & date, send in the top copy and keep the bottom copy for your records.

How to Record Split-Shift Meals and Snacks

What is split-shift meal/snack service?

EXAMPLE: A provider serves breakfast to 6 children at 7:30am. After breakfast, 4 of them go to school. At 8:00am, a preschool child arrives and eats the same breakfast. This is an example of a split-shift meal.

To record split-shift meal/snack service:

First column:

For the first shift of children, fill in the first column just as you would for regular meal service: Day, Menu, and Attendance.

Next column:

Using the next column for the second shift, fill in the same Day and the Split Shift circle. (Fill in the Split Shift circle only in this second column, not in the first column.) Do not fill in the menu in the second column, since the second shift is served the same foods as those recorded for the first shift.

 

 

Fill in the numbers of all children still in care at the time of the second shift's meal/snack--even if they ate the meal/snack as part of the first shift. The computer will subtract from the second shift those children who were already claimed in the first shift.

 

Before submitting a claim that includes split shifts:

Before a provider may send in a monthly claim on which split-shift meal/snack service is recorded, the following 3 things must be done:

--The actual split-shift transition in the provider's home must be observed by the provider’s Monitor

--The provider's Shift Schedule form (see example on back) must be approved by the Monitor.

--A copy of the approved Shift Schedule form must be sent to the Office with each claim that includes split-shift meal/snack service.