Form H1602 PDF Details

Are you a business owner or contractor who is required to file Form H1602? If so, you may be wondering what information is required on the form and how to complete it correctly. This article will provide an overview of the information needed on Form H1602 and instructions for completing it. Note that this article is not exhaustive, and you should always consult your tax advisor for specific guidance relating to your tax situation. The purpose of Form H1602 is to report the amount of any Indiana withholding tax that was deducted from payments made to nonresident individuals for services performed in Indiana. The form must be filed by the payer (the person or company making the payment) and must include the name, address, and social security number (or individual taxpayer identification number) of each nonresident individual who received a payment for services performed in Indiana. In addition, the form must list the total amount paid to each nonresident individual and the amount of

QuestionAnswer
Form NameForm H1602
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namestda form h1602 instructions, H1602, tda form 1602, XIX

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Texas Department of

Adult Day Care Food Program

 

 

 

Form H1602

Agriculture

 

 

 

 

 

 

 

October 2011

 

 

 

 

 

 

Monitor Review

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Sponsoring Organization

 

 

 

 

 

 

 

 

 

CE ID

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Review

 

 

Time of Arrival

 

Time of Departure

 

 

Date of Last Review

 

 

 

 

 

 

 

 

 

AM

PM

 

 

 

 

AM

PM

 

 

 

Site Type

 

 

 

 

 

 

 

 

Type of Review

 

 

 

 

 

 

Public or Private Non-Profit

For-Profit (Title XIX/XX)

 

Announced

Unannounced

 

 

Monitor Name

 

 

 

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Site Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Site Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Person Interviewed at Site

 

 

 

 

 

Title of Person Interviewed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. Meal Service

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Meal Count – Complete the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Breakfast

 

AM Snack

 

Lunch

 

PM Snack

Supper

Evening Snack

 

 

following for the meal observed:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Beginning Time of Meal Service

 

 

 

 

 

 

 

 

 

 

 

 

 

Ending Time of Meal Service

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of Meals Prepared

 

 

 

 

 

 

 

 

 

 

 

 

 

Number

 

To Enrolled Adults

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of

 

As Seconds

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Meals

 

To Program Adults

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Served

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Non-program

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

Was the menu served the same as posted for today?

....................................................................................................

 

 

 

 

 

 

 

Yes

No

 

 

If not, were substitutions consistent with USDA requirements?

 

 

 

 

 

 

Yes

No

3.

Are all items on Form H1654 completed on a daily basis?

 

 

 

 

 

 

Yes

No

4.

Are menu substitutions correctly documented?

 

 

 

 

 

 

 

Yes

No

5.

Are the times meals are served consistent with the times indicated on Site Application - Centers?

 

Yes

No

6.

Is the combination of meals/snacks claimed consistent with CACFP regulations?

 

 

Yes

No

7.

Does the site supply all meal components?

 

 

 

 

 

 

 

Yes

No

 

 

If no, explain

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

Are there doctors’ statements on file for participants with disabilities and/or medical or

 

 

 

 

 

 

 

special dietary needs?

 

 

 

 

 

 

 

 

 

N/A

Yes

No

9.

Have variations in meal patterns been approved?

 

 

 

 

 

 

N/A

Yes

No

B. Civil Rights

Complete the chart by inserting the ethnic and racial categories of CACFP participants

 

Ethnic Category

 

 

Racial Category

 

 

 

Number of

Hispanic or

Not Hispanic

American

Asian

 

Black or

Native Hawaiian

 

White

Participants

Latino

or Latino

Indian or

 

 

African

or Other Pacific

 

 

 

 

 

 

Alaskan Native

 

 

American

Islander

 

 

 

Current Enrollment

 

 

 

 

 

 

 

 

 

 

Actual Participation

 

 

 

 

 

 

 

 

 

 

1. Based on your observation, is there any discrimination by race, color, national origin, sex, age or disability?

Yes

No

Form H1602

Page 2/10-2011

C. Meal Analysis

1.Production: Complete the following information for the meal observed and calculate the amount of each component used. Consult the CACFP handbook for meal patterns.

 

Food Items Served

Amount Prepared

No. of Servings per

Amount Needed

+ OR -

 

 

 

Amount Prepared

 

 

Milk

Meat or Meat Alternative

Vegetables and/or Fruit (two or more)

Whole Grain or Enriched

Bread or Bread Alternative

Other Foods

2.Was a sufficient quantity of each component prepared to meet meal pattern

requirements for the number of participants? ...............................................................................................................

Yes

No

3. Type of meal service:

Family Style

Unit (Cafeteria Style)

Offer vs. Serve

4.Were all required components served? .......................................................................................................

5.Describe what happens to plate waste and leftovers.

Yes No

D. Record Keeping

1.Licensing

a.Is the current license/certification posted?

b.What is the current licensed capacity? .............................................................................................................................................................................................................................

Yes No

c. Does today’s attendance exceed the capacity? ......................................................................................................

If yes, explain.

Yes No

d. Is the site subject to licensing standards other than DADS? ...................................................................................

2. Enrollment – Does each participant have an enrollment form on file? ..........................................................................

3. Attendance – Is attendance recorded daily on Form H1535 (Daily Meal Count and Attendance Record)?..................

4. Meal Count

a. Is Form H1535 (Daily Meal Count and Attendance Record) completed at the time of

meal services on a daily basis?...............................................................................................................................

b. Is the monthly meal count being recorded on Form H4502? ...................................................................................

5. Eligibility

a. Is there a current (completed within the last 12 months) CACFP Meal Benefit Income Eligibility Form

(Adult Care Form) for each participant claimed in free and reduced-price meal category? .....................................

b. b. Are the participants being claimed in the correct eligibility category (free, reduced-price, or paid),

including full-time, part-time, and drop-in participants? ...........................................................................................

c. Is there adequate documentation to ensure that at least 25% of the total enrollment or

licensed capacity received Title XIX/XX benefits? (for-profit facilities only) ............................................................

d. If a pricing program, is there any indication of overt identification? .........................................................................

Yes No

Yes No

Yes No

Yes No Yes No

Yes No

Yes No

Yes No Yes No

6. Previous Monitoring Reviews

 

a. Were problems identified at the last monitoring review?

N/A

b. If yes, were they corrected?

c. If no, why not?

 

Form H1602

Page 3/10-2011

Yes No

Yes No

7. Records Retention – Is the site maintaining records per TDA requirements/regulations? ............................................

Yes No

E. Training

1. Have site staff that perform key activities received CACFP training for the current Program Year?

Yes

No

a. If yes, is documentation on file that contains the required components?

Yes

No

b. Were all required areas covered?

Yes

No

c. If no, when is the site training scheduled?

2.If the site is new this Program Year, did the site staff that perform key activities receive

 

training over the required areas and subtopics before beginning the program?

 

Yes

No

 

Is there documentation of file that contains the required components?

 

Yes

No

F. Five-Day Reconciliation

 

 

 

 

1.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Compare Meal Counts to Attendance and Enrollment

 

 

 

 

 

 

 

 

 

 

Date:

Date:

Date:

Date:

Date:

 

 

B Meal Count =

B Meal Count =

B Meal Count =

B Meal Count =

B Meal Count =

 

 

AM Meal Count =

AM Meal Count =

AM Meal Count =

AM Meal Count =

AM Meal Count =

 

 

L Meal Count =

L Meal Count =

L Meal Count =

L Meal Count =

L Meal Count =

 

 

PM Meal Count =

PM Meal Count =

PM Meal Count =

PM Meal Count =

PM Meal Count =

 

 

S Meal Count =

S Meal Count =

S Meal Count =

S Meal Count =

S Meal Count =

 

 

E Meal Count =

E Meal Count =

E Meal Count =

E Meal Count =

E Meal Count =

 

 

Attendance =

Attendance =

Attendance =

Attendance =

Attendance =

 

 

Enrollment =

Enrollment =

Enrollment =

Enrollment =

Enrollment =

 

F. Five-Day Reconciliation, continued

2. Are there any days when meal counts by type exceed attendance? ............................................................................

a. If yes, what is the explanation?

Form H1602

Page 4/10-2011

Yes No

b.Is the explanation reasonable?................................................................................................................................

i.If no, do meals need to be disallowed? ..............................................................................................................

ii.Document by type the number of meals disallowed.

Yes No

Yes No

3. Are there any days when meal counts by type exceed enrollment? .............................................................................

a. If yes, what is the explanation?

Yes No

b.Is the explanation reasonable?................................................................................................................................

i.If no, do meals need to be disallowed? ..............................................................................................................

ii.Document by type the number of meals disallowed.

Yes No

Yes No

G. Findings, Recommendations and Commendations

1.List problems identified. Document areas in which the site is performing well.

2.Recommendation – Indicate corrective action needed:

H. Signature

Signature – Monitor

Date

Signature – Site Representative

Date

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