The DOH-3688 is an Income Eligibility Application for New York families whose children attend a CACFP-participating child day care center. Day care centers use it to verify whether each family qualifies for free, reduced-price, or full-pay meal reimbursements under the Child and Adult Care Food Program. Accurate completion ensures your center receives the correct level of federal funding.
Any family with a child enrolled in a CACFP-participating day care center must submit a DOH-3688. Each household submits one application covering all children in care and all adults contributing to household income. Foster parents follow a shorter process focused only on the foster child's care.
Section A applies to households receiving SNAP, Medicaid, SSI, or other qualifying federal assistance. Enter your program case number in Section A and skip the income details.
Section B applies to all other households. You must list every household member, their relationship to the child, and their total gross monthly income from all sources, including wages, tips, and self-employment earnings.
Gather these documents before starting the CACFP DOH-3688 form:
Start by listing all household members and their relationships to the child in care. Next, determine whether Section A or Section B applies to your household. Report all gross monthly income accurately for Section B, including wages, child support, and Social Security payments. An adult household member must then sign and provide their Social Security number. Return the completed form directly to the day care center. Do not mail it to the state. The center notifies you of your eligibility category within a few business days.
Centers and families often need other documents alongside the DOH-3688. A child care payment letter documents tuition arrangements between parents and providers. Centers track accidents using a child care incident report. Families seeking broader support can start with a financial assistance application. For confirming payments already made, use a childcare receipt.
| Question | Answer |
|---|---|
| Form Name | Cacfp Form Doh 3688 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | CACFP Income Eligibility Form, DOH 3688, CACFP Enrollment Form |
