APPENDIX A2.1
CHILD CARE CENTERS
Child Care Center Survey Instrument
IMPORTANT:
When completing this questionnaire, please think ONLY of the child care site at the address listed in the cover letter that came with the questionnaire packet.
Base your answers on your experiences with this site only.
We may ask some questions for which you don’t have the answer. If that’s the case, please contact your sponsoring organization, someone else in your organization, or other appropriate person to get the information. Thanks in advance for doing so!
Your Child Care Site’s Initial Participation in CACFP
1. In what year did your child care site first begin participating in CACFP?
|___|___|___|___|
Don’t know 
2. Thinking back on when you first applied to participate in CACFP, how long did it take from the time you first applied until your participation was approved?
Less than 7 days 
1 week to 4 weeks 
1 to 2 months 
Longer than 2 months 
Don’t know 
General Background on Your Child Care Site
3. Is the organization that administers your site private not-for-profit, for-profit, or is it a public agency, school or school district? (Check one box)
Private, not-for-profit 
Private for-profit 
Public agency, school, or school district 
Don’t know 
4. Is your child care site licensed?
Yes   GO TO QUESTION 5
No 
Don’t know 
4a. Why does your child care site not have a license? (Check one box)
 
We are license exempt 
Just don’t have a license  GO TO QUESTION 6
Don’t know 
5. How many total children is your child care site licensed to serve?
Number of children |___|___|
6. Which of the following age groups does your child care site serve? (Check all that apply)
0-12 months 
1 and 2 years 
3 through 5 years 
Older than 5 years 
7. Do you and/or your staff refer any children in your care to other community services they may need?
Yes 
 
 
GO TO QUESTION 8
No 
Don’t know 
7a. Which of the following services do you make referrals to? (Check all that apply)
The Special Supplemental Nutrition Program for
Women, Infants and Children (WIC) 
Health programs that provide medical, dental,
vision, hearing or speech screening 
Therapeutic services such as speech therapy,
occupational therapy or other services for
children with special needs 
Health insurance 
Child welfare or family support services 
The Supplemental Nutrition Assistance Program
or SNAP (previously referred to as the Food
Stamp Program) 
Head Start/Early Head Start 
Emergency food assistance programs (such as
food pantries, food banks, and soup kitchens) 
Housing or shelter services 
Other 
(Please specify)
Don’t know 
Your Child Care Site Schedule
8. How many days of the week is your child care site usually open?
Number of days |___|
9. Does your site have split (a.m./p.m.) child care sessions?
Yes   GO TO QUESTION 9a
No   GO TO QUESTION 10
9a. Please fill out the table below for your site’s morning session only. What hours does your site usually provide care for children each day of the week? If your site does not provide morning session child care on a particular day of the week, please check “My site usually does not provide A.M. child care on that day.”
| Day of the Week | Start time(AM) | End time(AM/PM) | My site usually does not provide A.M. child care on that day | 
| Monday | |___|___| : |___|___| AM | |___|___| : |___|___| AM/PM |  | 
| Tuesday | |___|___| : |___|___| AM | |___|___| : |___|___| AM/PM |  | 
| Wednesday | |___|___| : |___|___| AM | |___|___| : |___|___| AM/PM |  | 
| Thursday | |___|___| : |___|___| AM | |___|___| : |___|___| AM/PM |  | 
| Friday | |___|___| : |___|___| AM | |___|___| : |___|___| AM/PM |  | 
| Saturday | |___|___| : |___|___| AM | |___|___| : |___|___| AM/PM |  | 
| Sunday | |___|___| : |___|___| AM | |___|___| : |___|___| AM/PM |  | 
9b. Please fill out the table below for your site’s afternoon session only. What hours does your site usually provide care for children each day of the week? If your site does not provide afternoon session child care on a particular day of the week, please check “My site usually does not provide P.M. child care on that day.”
| Day of the Week | Start time | End time | My site usually does not provide P.M. child care on that day | 
| Monday | |___|___| : |___|___| PM | |___|___| : |___|___| PM |  | 
| Tuesday | |___|___| : |___|___| PM | |___|___| : |___|___| PM |  | 
| Wednesday | |___|___| : |___|___| PM | |___|___| : |___|___| PM |  | 
| Thursday | |___|___| : |___|___| PM | |___|___| : |___|___| PM |  | 
| Friday | |___|___| : |___|___| PM | |___|___| : |___|___| PM |  | 
| Saturday | |___|___| : |___|___| PM | |___|___| : |___|___| PM |  | 
| Sunday | |___|___| : |___|___| PM | |___|___| : |___|___| PM |  | 
GO TO QUESTION 11
10. What hours does your site usually provide care for children each day of the week? If your site does not provide child care on a particular day of the week, please check “My site usually does not provide child care on that day.”
| Day of the Week | Start time(AM/PM) | End time(AM/PM) | My site usually does not provide child care on that day | 
| Monday | |___|___| : |___|___| AM/PM | |___|___| : |___|___| AM/PM |  | 
| Tuesday | |___|___| : |___|___| AM/PM | |___|___| : |___|___| AM/PM |  | 
| Wednesday | |___|___| : |___|___| AM/PM | |___|___| : |___|___| AM/PM |  | 
| Thursday | |___|___| : |___|___| AM/PM | |___|___| : |___|___| AM/PM |  | 
| Friday | |___|___| : |___|___| AM/PM | |___|___| : |___|___| AM/PM |  | 
| Saturday | |___|___| : |___|___| AM/PM | |___|___| : |___|___| AM/PM |  | 
| Sunday | |___|___| : |___|___| AM/PM | |___|___| : |___|___| AM/PM |  | 
11. For all of Calendar Year 2014, how many weeks was your child care site scheduled to be open?
Number of weeks |___|___|
Enrollment at Your Child Care Site
12. In total, how many children are currently enrolled at your child care site? If your site has split sessions, please combine the enrollment from all sessions.
Number of children |___|___|___|
12a. How many children are enrolled for less than 30 hours per week?
Number of children |___|___|___|
12b. How many children are enrolled for less than 5 days per week? If applicable, include children counted in Q12a, above.
Number of children |___|___|___|
12c. How many children are enrolled for one or more weekend days? If applicable, include children counted in Q12a and Q12b, above.
Child care site does not operate on
weekends   GO TO QUESTION 13
Number of children |___|___|
Average Daily Attendance at Your Child Care Site
In answering the following set of questions, please think about actual child attendance during the past four weeks.
13. During the past four weeks, on a typical weekday how many enrolled children attended your child care site?
Number of children |___|___|___|
14. During the past four weeks, on a typical weekend day how many enrolled children attended your child care site?
Child care site does not operate on
weekends   GO TO QUESTION 15
Number of children |___|___|___|
15. Think about a typical week during the past four weeks. How many enrolled children attended your child care site for 5 or more days?
Number of children |___|___|___|
16. Think about a typical week during the past four weeks. How many enrolled children attended your child care site for less than 5 days?
Number of children |___|___|___|
Meal Service and Menus at Your Child Care Site
Please answer the questions in this section about only the meals and menus at your child care site.
17. Which of the following meals does your child care site serve on weekdays? (Check all that apply)
Breakfast 
Morning snack 
Lunch 
Afternoon snack 
Supper 
Evening snack 
18. Which of the following meals does your child care site serve on weekends? (Check all that apply)
Child care site does not operate on weekends 
Breakfast 
Morning snack 
Lunch 
Afternoon snack 
Supper 
Evening snack 
19. Please provide the total number of each type of meal and snack that were claimed for your child care site for CACFP in October 2014.
Breakfast |___|___|___|___|___|
Morning snack |___|___|___|___|___|
Lunch |___|___|___|___|___|
Afternoon snack |___|___|___|___|___|
Supper |___|___|___|___|___|
Evening snack |___|___|___|___|___|
20. Please provide the total number of each type of meal and snack that your child care site served to the children in October 2014, but were not claimed for CACFP.
Breakfast |___|___|___|___|___|
Morning snack |___|___|___|___|___|
Lunch |___|___|___|___|___|
Afternoon snack |___|___|___|___|___|
Supper |___|___|___|___|___|
Evening snack |___|___|___|___|___|
21. Does your child care site have any infants who receive breast milk while in your care? (Check one box)
We do not have any infants enrolled at our
child care site 
Yes 
No 
22. What are the sources of the menus used at your child care site? (Check all that apply)
Our own staff 
CACFP sponsor’s cycle menus 
CACFP State Agency 
A child care association 
A commercial vendor 
USDA federal CACFP website 
Other website 
Other 
(Please specify)
NOTE:
If you only checked one box in Q22, go to Q23. Otherwise, go to Q22a.
22a. What is the primary source of the menus used at your child care site? (Check one box)
Our own staff 
CACFP sponsor’s cycle menus 
CACFP State Agency 
A child care association 
A commercial vendor 
USDA federal CACFP website 
Other website 
Other 
(Please specify)
23. Are all, some, or none of the meals you serve prepared by another organization (e.g., a food bank, commercial food service vendor, or CACFP sponsor) and provided to your site as “ready to serve”? (By “ready to serve” we mean you can serve the meal as it was prepared for you with only minimal work such as heating it up or cutting it into portion sizes.)
All meals are provided to us by another
organization “ready to serve” 
Some meals are provided to us “ready to serve”
and some meals are prepared on site 
No meals are provided to us “ready to serve;”
all meals are prepared at our site   GO TO QUESTION 24
23a. Where are most of the meals you serve prepared? (Check one box)
At a central kitchen of my organization
or my CACFP sponsor 
A local school that is not my sponsor 
A commercial food service vendor 
A local restaurant or delicatessen with
a catering permit 
At a food bank or emergency kitchen 
At a homeless shelter 
At another community site 
Other 
(Please specify)
Languages Spoken at Your Child Care Site
24. Do any children currently enrolled at your child care site speak a language other than English?
Yes 
 
 
GO TO QUESTION 25
No 
Don’t know 
24a. Does your site have at least one person on staff who can speak the same language that these children speak?
Yes 
No 
24b. What languages do you and your staff speak when talking with the children at your child care site? (Check all that apply)
English 
Spanish 
Chinese 
French/Haitian Creole 
Tagalog 
Vietnamese 
Korean 
German 
Russian 
Miao/Hmong 
Arabic 
Japanese 
Other language 
(Please specify)
24c. What is the main language you and your staff speak when talking with the children at your child care site? (Check one box)
English 
Spanish 
Chinese 
French/Haitian Creole 
Tagalog 
Vietnamese 
Korean 
German 
Russian 
Miao/Hmong 
Arabic 
Japanese 
Other language 
(Please specify)
Children with Special Dietary Needs
25. Do any children enrolled at your child care site have special dietary needs?
Yes 
 
 
GO TO QUESTION 26
No 
Don’t know 
25a. What policies does your child care site have to accommodate these children’s dietary needs? (Check all that apply)
We require them to bring in a note from their
medical provider documenting their special
dietary needs 
We provide food substitutions for foods they
cannot eat 
We modify the daily meal pattern as needed 
We maintain a nut-free environment in our
child care program 
We allow children with special dietary needs
to bring food from home 
Other 
(Please specify)
Staffing at Your Child Care Site
As with the other sections of this survey, please answer the questions in this section only for your individual child care site. This is the site located at the address on the cover letter that came with the questionnaire.
26. How many employees, including you, work at your child care site? (Please count part-time and full-time staff equally.)
Total number of employees |___|___|___|
27. What is the usual number of children per adult at this site at 10:00 a.m. on weekdays, for groups of 3 to 5 year olds?
Number of children per adult |___|___|
28. Is the number of children per adult different during weekends or evenings that your child care site is in operation?
 
This child care site is not open weekends
 
GO TO QUESTION 29
or evenings 
No, it is not different during weekends or
evenings 
Yes, it is different during weekends or evenings 
28a. What is the usual number of children per adult for groups of 3 to 5 year olds served during weekends or evenings at this site?
Number of children per adult |___|___|
29. How many employees (counting part-time and full-time staff equally) at your child care site work on any of the following food service tasks: menu planning, food purchasing, food storage, food preparation, and/or food safety?
Number of employees |___|___|___|
None   GO TO QUESTION 30
29a. Among all of the employees that work on any of these food service tasks, how many have received training in food service as part of the mandatory annual CACFP training?
Number of employees |___|___|___|
29b. How many of these employees have received additional training in food service that was not part of the mandatory annual CACFP training?
Number of employees |___|___|___|
Internet Use at Your Child Care Site
30. Does your child care site have on-site access to the Internet?
Yes 
 
 
GO TO QUESTION 32
No 
Don’t know 
31. Does your child care site usually submit CACFP meal claim forms on paper, electronically, or in both formats?
Submit only paper claims   GO TO QUESTION 32
Submit only electronic claims 
Submit both paper and electronic claims 
31a. Who developed the system your child care site uses to electronically submit CACFP claims? (Check one box).
Private source 
 
 
GO TO QUESTION 32
State CACFP Agency 
CACFP Sponsoring organization 
Don’t know 
31b. What is the name of the system your child care site uses for submitting CACFP claims electronically?
Minute Menu 
Procare 
CACFP.Net 
Other 
(Please specify)
Don’t know 
| How Child Care is Funded for Your Site | 
32. How many children enrolled at your child care site have some or all of their care paid for by state or local child care subsidies (e.g. in the form of vouchers for the child, or grants or contracts with your program)?
Number of children |___|___|___|
33. How many children enrolled in your child care site have some or all of their care paid for by their families, including those who pay co-payments?
Number of children |___|___|___|
None   GO TO QUESTION 34
33a. What is the highest rate your program currently charges a family to enroll one infant (less than one year old) full-time?
$ |___|___| , |___|___|___|.|___|___| per  Hour 
½ day 
Full day 
Week 
Month 
Year 
Other 
(Please specify)
33b. What is the highest rate your program currently charges a family to enroll one child (age 1 year or older) full-time?
$ |___|___| , |___|___|___|.|___|___| per  Hour 
½ day 
Full day 
Week 
Month 
Year 
Other 
(Please specify)
33c. Does your child care site offer any child care discounts to families that pay for their care?
Yes 
No   GO TO QUESTION 34
33d. On what basis does your child care site offer these discounts?
Family income 
More than one family member currently
enrolled 
Another family member was previously
enrolled 
Children of people that work at the child care
site or sponsoring agency………………………… 
Other 
(Please specify)
34. Do you charge families for meals, separately from your basic child care fee?
Yes 
No 
Training and Assistance Provided by Your Sponsoring Organization
In this section, we are interested in the training and other assistance that your CACFP sponsor provided to your child care site during the past 12 months, as well as on what CACFP-related topics it would be helpful to receive more training or assistance.
35. During the past 12 months, did you and/or staff receive any training from your CACFP sponsor on CACFP issues?
Yes 
No   GO TO QUESTION 36
35a. During the past 12 months, what was the most common format that your CACFP sponsor used to provide this training? (Check one box)
Web-based 
In-person group classes or workshops 
One-on-one 
Other 
(Please specify)
35b. During the past 12 months, on what topics have you and/or your staff received training from your CACFP sponsor? (Check all that apply)
CACFP meal requirements 
CACFP recordkeeping requirements 
Preparing and filing monthly reimbursement
claims 
Family/child income eligibility 
CACFP monitoring requirements 
Defining serious deficiencies 
Maintaining confidentiality 
USDA civil rights requirements 
Appeals process for serious deficiencies 
Food purchasing 
Menu planning 
Food preparation 
Food safety/food service operations 
Nutrition 
Physical activity in child care 
Obesity prevention 
Best practices in child care 
Staff wellness 
Parent relations 
Recognizing abuse and neglect 
Other 
(Please specify)
35c. How satisfied are you with the training your child care site received from your CACFP sponsor?
Very satisfied 
Satisfied 
Neither satisfied nor dissatisfied 
Dissatisfied 
Very dissatisfied 
36. During the past 12 months, have you received any technical assistance from your CACFP sponsor?
Yes 
No   GO TO QUESTION 37
36a. On what topics did you receive technical assistance from your CACFP sponsor? (Check all that apply)
Menu planning/sample menus 
Food vendor contracts 
Staff training 
Budgeting 
Computer support 
Other 
(Please specify)
36b. How satisfied are you with the technical assistance available from your CACFP sponsor?
Very satisfied 
Satisfied 
Neither satisfied nor dissatisfied 
Dissatisfied 
Very dissatisfied 
37. Are there any food, nutrition, or CACFP-related topics on which you would like to receive more training or assistance?
Yes 
No   GO TO QUESTION 38
37a. On what topics would you like to receive more training or assistance from your CACFP sponsor? (Check all that apply)
CACFP meal requirements 
CACFP recordkeeping requirements 
Preparing and filing monthly reimbursement
claims 
Family/child income eligibility 
CACFP monitoring requirements 
Defining serious deficiencies 
Maintaining confidentiality 
USDA civil rights requirements 
Appeals process for serious deficiencies 
Food purchasing 
Food vendor contracts 
Menu planning/sample menus 
Food preparation 
Food safety/food service operations 
Budgeting 
Computer support 
Nutrition 
Physical activity in child care 
Obesity prevention 
Best practices in child care 
Staff wellness 
Staff training 
Parent relations 
Recognizing abuse and neglect 
Other 
(Please specify)
| Training Provided by Your Site to Your Staff | 
In the following questions, we’re interested in CACFP-related training that your site may have provided to your staff during the past 12 months (not training provided by your CACFP sponsor).
38. During the past 12 months, did your site provide any training to your staff on CACFP issues, such as meal patterns, nutrition, and eligibility for CACFP?
Yes 
 
 
GO TO QUESTION 39
No 
Don’t know 
38a. During the past 12 months, how many training sessions were provided by your site to your staff on CACFP issues?
Number of training sessions
on CACFP issues |___|___|
CACFP Monitoring Visits
39. During the past 12 months, how many times did your CACFP sponsor conduct a monitoring visit at your child care site?
Times during last 12 months |___|___|  IF = 0, GO TO QUESTION 45
40. How many of these monitoring visits were announced before the visit?
Number of monitoring visits
announced before the visit |___|___|
Don’t know 
41. During the past 12 months, approximately how many minutes, on average, did a CACFP monitoring visit last?
Minutes per visit |___|___|___|
42. During the past 12 months, which of the following enrollment-related topics were reviewed during a CACFP monitoring visit at your site? (Check all that apply)
Child care license is current 
Health and safety guidelines are followed 
A current enrollment record exists for each
child 
The number of children in attendance is less
than or equal to the licensed capacity 
Food allergies are documented 
Other 
(Please specify)
43. During the past 12 months, which of the following claiming and menu-related topics were reviewed during a CACFP monitoring visit? (Check all that apply)
Existence and accuracy of daily attendance
records 
Number of meals claimed compared to
licensed capacity 
Recording of daily meal counts and menus 
5-day reconciliation 
Menus for each mail claimed, including
infant meals 
Completion of menu production records
with quantities 
Compliance of infant menus with CACFP meal
pattern requirements 
Food receipts support the menu 
Other 
(Please specify)
44. During the past 12 months, which of the following meal-related topics were observed and/or reviewed during a CACFP monitoring visit? (Check all that apply)
Observed meal meets CACFP meal pattern
requirements 
Appropriate type of milk is served to
children 
Drinking water is available throughout the day 
Meals served match the menu 
Time of day meals and snacks served is
appropriate 
Type of meal service (family style vs. plated) 
Safe food handling practices 
Food allergies are accommodated 
Other 
(Please specify)
| Your Satisfaction with CACFP | 
45. Please rate your level of satisfaction with your CACFP sponsoring organization on the following factors: (Circle one number for each factor)
| Factor | VerySatisfied | Satisfied | Neither Satisfied nor Dissatisfied | Dissatisfied | Very Dissatisfied | Don’t Know | Not Applicable | 
| a. Availability of someone to help when needed | 1 | 2 | 3 | 4 | 5 | -8 | -9 | 
| b. Turnaround time for payment of my claims | 1 | 2 | 3 | 4 | 5 | -8 | -9 | 
| c. Review of my child care site | 1 | 2 | 3 | 4 | 5 | -8 | -9 | 
| d. CACFP sponsor’s use of technology | 1 | 2 | 3 | 4 | 5 | -8 | -9 | 
| e. Support of my child care site’s use of technology for the CACFP | 1 | 2 | 3 | 4 | 5 | -8 | -9 | 
46. How satisfied are you with the CACFP meal reimbursement levels?
Very satisfied 
Satisfied 
Neither satisfied nor dissatisfied 
Dissatisfied 
Very dissatisfied 
Don’t know 
| Your Perceptions of the CACFP | 
47. How does the money from CACFP reimbursements change the way your child care site provides services? (Check all that apply)
We can care for more children 
We can serve more snacks or meals to
children we serve 
We can serve higher quality meals 
We can improve the non-food related parts of our
program 
We can lower the fees we charge for our
program 
Other 
(Please specify)
48. The following is a list of possible benefits of the CACFP. Please rank the three benefits you consider to be most important, with “1” being the most important, “2” being the second most important, and “3” being the third most important. (Rank 3)
Rank
CACFP provides nutritious meals to children |___|
CACFP teaches me and my staff to plan and
prepare nutritious meals |___|
CACFP feeds children who would otherwise
have limited access to nutritious food |___|
CACFP helps children develop healthy eating
habits |___|
CACFP keeps down the cost of child care |___|
CACFP helps parents learn the importance of
healthy eating |___|
CACFP helps child care programs stay in
business |___|
CACFP is an important part of the social
safety net for children and families |___|
49. Overall, how would you rate your child care site’s level of burden to meet CACFP requirements? Think of burden as the amount of time and effort put into meeting the requirements.
Very low burden 
Low burden 
Neither high nor low 
High burden 
Very high burden 
50. Did you ever consider leaving CACFP?
Yes 
 
 
GO TO QUESTION 51
No 
Don’t know 
50a. What are the two main reasons you considered leaving CACFP? (Check 2 boxes)
Paperwork burden too high 
Not enough low-income children enrolled in
my program 
Difficult to comply with meal requirements 
Unannounced site monitoring visits 
Serious deficiency process 
Not enough support from my CACFP
sponsoring organization 
Meal reimbursement rates too low 
Other 
(Please specify)
Suggestions for Improving CACFP
51. Do you have any suggestions for improving the program support and oversight provided by your CACFP sponsoring organization?
Yes 
No   GO TO QUESTION 52
51a. Which of the following suggestions do you have for improving the program support and oversight provided by your CACFP sponsoring organization? (Check all that apply)
Offer better feedback during monitoring visits 
Provide more timely feedback on results of
monitoring visits 
Provide clearer information about follow-up
actions I need to take after a monitoring visit 
Provide clearer information about what
constitutes a serious deficiency 
Provide clearer information about the appeals
process for serious deficiency notices 
Provide better training on CACFP rules and
responsibilities 
Process reimbursements for claims in a more
timely fashion 
Focus monitoring visits on teaching not just
enforcement 
Make monitoring visits less invasive 
Other 
(Please specify)__________________________
52. Based on your experience, do you think any other areas of the CACFP need to be improved?
Yes 
No   Thank you!
52a. What suggestions do you have for improving CACFP?
Thank you for completing the questionnaire. Please return it in the enclosed postage-paid envelope to:
CACFP Sponsor and Provider Study
Westat
1600 Research Blvd.
Rm. _____
Rockville, MD 20850
	A2.1-
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | Annmarie Winkler | 
| File Modified | 0000-00-00 | 
| File Created | 2021-01-26 |