PAGE 2 Agenda: Reasons for Updated Meal Patterns

*Meal patterns were updated to enhance the nutritional quality of meals and snacks and to address chronic diseases such as high blood pressure, heart disease and diabetes.

*American diets are high in added sugars, saturated fats and sodium.

*75% of American diets are low in vegetables, fruit and dairy.

*1 in 3 children is overweight or obese.

PAGE 8 Infant Age Groups and Solid Food [read slide]

(new infant food chart- H1 )

If you take a look at the new infant food chart, you will see that infants through 5 months of age receive only breast milk or formula.

*Delay the introduction of solid foods until around 6 months of age because:*Most infants are not ready to consume solid foods before 6 months of age; and*Introducing solid foods too soon increases the risk of obesity.

Looking at the 6 through 11 months age group, you will see that component serving size requirements, with the exception of breast milk or formula, start with zero. This allows providers flexibility when introducing solid foods to infants. All infants progress at different rates, and providers should work with parents to determine when each individual infant is developmentally ready to have a new food introduced to their diet. Always comply with parental wishes regarding the introduction of solid food (e. g. if a parent wants to introduce new foods at home before they are served at the child care, providers must comply with that request.

*American Academy of Pediatrics (AAP) Developmental Readiness Guidelines:*Able to sit in chair with good head control;*Opens mouth for food;*Moves food from a spoon into throat;*Doubled in weight.

*Breakfast, lunch and supper for infants 6-11 months of age consist of 3 components: 1. Breast milk, formula or a combination; 2. fruit, vegetable or a combination; 3. Grain or meat/meat alternate or a combination. (The

required grain, if a grain is served at breakfast, lunch or supper, is iron-fortified infant cereal).

PAGE 9 Breastfeeding and Infant Snack

(new infant menu- H2 ) and instructions

I have spent a fair amount of time creating an infant menu that covers all of the requirements. This is the most complicated menu because infants often eat foods that are not being eaten by all of the other infants in care, and the foods being served must be specified. Please discard the old infant menu, which we also called the infant production record; and use this menu starting October 1, 2017. The old menu does not capture the required information. You can create your own infant menu if you wish, but it must capture all of the information that is contained in the infant portion menu that I created.

*Document on-site breastfeeding.

*Document the fluid ounces of expressed breast milk and formula served to each infant.

*The quantity of breast milk served does not need to be documented when a mother breast feeds on-site.

*If a mother does not provide enough breast milk for a serving; the amount of breast milk served must be documented, as well as the amount of formula or milk served to supplement the breast milk in order to constitute a full serving.

*If an infant that is regularly breast fed usually consumes less than the minimum serving size per feeding, they may be offered less than the minimum serving size and additional breast milk must be offered at a later time if the infant will consume more. This flexibility encourages breast feeding and helps prevent wasting expressed breast milk.

*Parents may provide ONLY 1 component per day, including breast milk.

*Snack consists of 3 components for infants 6-11 months of age: 1. breast milk or formula; 2. grain; and 3. vegetable, fruit or a combination of both.

*The AAP recommends increasing infants' consumption of fruits and vegetables; therefore, a fruit and/or vegetable component has been added to snack for infants 6 through 11 months of age who are ready to accept them.*Juice is no longer creditable for infants.

*Cereal must not contain more than 6 grams of sugar per dry ounce.

*Infants 0-5 months of age should be served infant cereal because it is less likely to cause an allergic reaction and is more easily digested than ready to eat cereal.

*Ready to eat cereal is not creditable for infants except at snack, even after they start to eat the same food as the older children.

PAGE 10 Infants: Meat/Meat Alternates

*Cheese food and cheese spread are no longer creditable for infants. (Cheese food is 51% to 80% natural cheese and cheese spread is 51% to 75% natural cheese). These cheese products are high in sodium.

*Non-creditable cheese packaging states:*"imitation cheese"; or *"cheese food"; or *cheese product.

*Cottage cheese contains a lot of water so a 2 ounce serving of cottage cheese is required to make up a 1 ounce equivalent meat/meat alternate serving.

*AAP found no convincing evidence to delay the introduction of major food allergens such as whole eggs.

*Explain side-by-side comparison labels (H3). Manufacturers are required to change labels to the new format by July 26, 2018.

This label comparison applies to children of all ages and adults. The example of the new labels shows the serving size and calories per serving in larger bold print. The most important change is that the label will list added sugars. This will help a consumer to differentiate natural sugars from added sugars and make wiser food choices.

This yogurt information applies to children of all ages and adults.

*The yogurt sugar limit for WIC is higher than for CACFP, so a qualifying WIC yogurt may not be creditable.

*Yogurt must contain no more than 23 grams of sugar per 6 oz. serving, (activity H4).

There are 2 different methods for determining the sugar content in yogurt. One method is to use the chart and if the amount of sugar in the yogurt is within the sugar limits for the serving size, the yogurt is creditable. The chart shows serving sizes in ounces and in grams. The other method is to divide the grams of sugars by the serving size. If the serving size is in ounces, the number obtained by dividing the grams of sugars by the serving size must be

3.83 or less. If the serving size is in grams, the number obtained by dividing the grams of sugars by the serving size must be 0.135 or less.

PAGE 11 Feeding Infants

*Day Care Homes and Centers MUST OFFER to provide at least 1 brand of iron-fortified infant formula.

*Providers cannot delay CACFP enrollment to exclude infants.

*Food components begin with zero, (e. g. 0-4 tbsp. infant cereal), except breast milk and formula. This allows flexibility for the developmental readiness of each infant.

*Gradual introduction of solid foods; one at a time; over the course of a few days.

*Since solid foods are introduced gradually, it may be appropriate to serve solid food at only 1 meal per day as the infant adjusts to eating solid food.

*Infants should be fed based on eating habits/may change from day to day.

*Consult with parents before introducing new foods, and always follow parent guidance/preference.

*Most infants should be ready to consume food from all food groups by 7 to 8 months of age.

*AAP: Late introduction, (beyond 6 months of age), of foods may increase the risk of food allergies.

*Solid food should be prepared in the appropriate consistency for the age and development of the infant.

*Observe each infant closely for reactions as new foods are introduced to their diet.

PAGE 13 Age Groups

*A fourth age group has been added to the child meal pattern for children 13 years of age to 18 years of age.

*The 13-18 years of age group was added to acknowledge At Risk Center and Emergency Shelter participants.

*Children in this age group may require more food, but the serving sizes remain unchanged. The minimum serving size for children between the ages of 13 and 18 is the same as the minimum serving size for children between the ages of 6 and 12.Child Food Chart H5

The food chart for children ages 1 through 12 has been changed to show 5 components, since fruit and vegetables are now separate components at lunch, supper and snack. Serving sizes have not changed.

Child Portion Menu H6 and instructions

You will see that the portion menu for this age group is simpler than the infant menu. The breakfast section has been expanded to include the meat/meat alternates that can be used to replace the entire grain component up to 3 times per week. Since parents do not tend to provide food for older children, there is no section of the menu designed specifically for the purpose of listing parent-provided components. However, parents may provide up to 1 component per day and the meal is still reimbursable. You must document any parent-provided components and include the date that the component was provided, the name of the child for whom the component was provided and specify the component that was provided.

Adult Food Chart H7

The food chart for adults has been changed to show 5 components, since fruit and vegetables are now separate components at lunch, supper and snack. Serving sizes have not changed.

Adult Portion Menu H8 and instructions

The portion menu for adults does not have age groups. The breakfast section has been expanded to include the meat/meat alternates that can be used to replace the entire grain component up to 3 times per week. Families may provide up to 1 component per day and the meal is still reimbursable. You must document any family-provided components and include the date that the component was provided, the name of the adult for whom the component was provided and specify the component that was provided.

PAGE 14 Vegetables and Fruits: Separate Components

*Vegetables and Fruits are still treated as a single component at Breakfast, so for Breakfast providers can choose to serve a vegetable, a fruit or a combination of both.

*Lunch and Supper now consist of 5 food components.

*Fruits and vegetables are separate components at snack starting October 1, 2017, so a snack consisting of 1 fruit and 1 vegetable is a creditable snack.

*Many children do not eat enough vegetables. Creating a separate fruit and vegetable component requirement will help introduce children to vegetables at an early age when lifelong eating habits are being formed.

*Pureed fruits and vegetables used as part of a meal item (e. g. pureed carrots in a sauce used for macaroni and cheese) can count as a creditable vegetable as long as the dish also contains at least 1/8 cup of a recognizable vegetable per serving.

*FNS requires a recognizable fruit or vegetable in adequate amounts because meals served in Child Nutrition Programs are an education opportunity for children to learn to build a healthy plate.

*Two servings of different beans or peas (legumes) can count as a vegetable and as a meat alternate in the same meal if they are in separate dishes. (e. g. legumes may be served as part of a salad as a vegetable component and a distinctly different legume may be served as part of soup or chili as a meat alternate component). A full serving of the legumes included in each dish must be served to each child in order to claim both a vegetable and a meat alternate component.

PAGE 15 Vegetables and Fruits: 2 Vegetables

*Most children eat enough fruit. Allowing 2 vegetables at lunch and supper increases exposure to a wider variety of vegetables. *The serving size of a second vegetable must be at least the same serving size as the serving of fruit that it replaced. The lunch and supper meal pattern for children 6-12 years of age requires a 1/2 cup serving of vegetables and a 1/4 cup serving of fruit. Therefore, the serving size of a second vegetable served in place of the fruit component at lunch or supper, for children 6-12 years of age, must be at least 1/4 cup, to replace the entire fruit component.

*Food items that are mixtures of vegetables and fruit, such as carrot raisin salad can credit towards both the vegetable and fruit component at lunch and supper if each

PAGE 15 Continued

component is easily recognizable and each serving contains at least the minimum reimbursable serving size of 1/8 cup of carrots and 1/8 cup of raisins. A child 6-12 years of age would need to receive 1/2 cup of carrots and 1/8 cup of raisins (dried fruit)credits as twice the serving size, so 1/8 cup of raisins equals 1/4 cup of fruit) in a serving to have the carrot raisin salad credit as the entire vegetable and the entire fruit component.

*Vegetable mixtures can also credit towards the entire vegetable component and the entire fruit component if each component is easily recognizable and each serving contains at least the minimum serving size of 1 fruit and 1 vegetable. (1/2 cup of 1 of the vegetables and 1/4 cup of the other vegetable for children 6-12 years of age). The serving size of a serving of fruit does not differ from the serving size of a serving of vegetables at lunch and supper for any other age group.

*Vegetable mixtures in which the serving size of each vegetable cannot be determined (e. g. a store bought frozen mixture of peas and carrots) must be credited as a single vegetable.

*Must offer 2 different vegetables (e. g. 2 servings of carrots, even if they are prepared differently, would not be creditable).

*Vegetables are credited based on volume, except 1 cup raw leafy greens credits as 1/2 cup vegetable.

*1/4 cup of dried fruit credits as 1/2 cup of fruit.

*Tomatoes and avocados are vegetables.

PAGE 16 Vegetables and Fruits: Limits Juice

*Juice lacks dietary fiber.

*Limiting juice to once per day helps increase fruit and vegetable consumption.

*If juice is served more than one time per day, disallow the meal or snack (where juice was served) that has the lowest reimbursement.

*Juice blends and purees:*1. Are creditable as either a fruit or a vegetable, and may not credit as both a fruit and a vegetable in the same meal;*2. Are creditable as a fruit component if they contain more fruits than vegetables; and

PAGE 16 Continued

*3. Are creditable as a vegetable component if they contain more vegetables than fruits.

*Vegetables and fruits served in a smoothie are considered to be juice and are included in the restriction of juice being served no more than once each day.

*The once per day juice restriction applies to the center, not to the individual child or adult; so juice cannot be served at AM snack and PM snack even if the snacks are being served to 2 distinctly different groups of children or adults.

*If juice is served at 2 different lunch shifts to 2 distinctly different groups of children or adults, it can be served to both shifts because only 1 meal service contains juice.

QUESTIONS ABOUT FRUIT & VEGETABLE SECTION

PAGE 18 Grains

*The whole grain rich requirement does not apply to infants.

*If a provider serves only 1 meal per day, the grain served at that meal must be whole grain rich.

*At Risk sites that only serve a snack are not required to serve a grain, but any grain served must be whole grain rich.

*If a provider serves breakfast and lunch to 2 different groups of children or adults, only 1 meal must contain a whole grain-rich item because the requirement applies to the center or day care home, not to each child or adult participant.

*The menu must specify the whole grain product being served each day. Providers CAN write WG bread, WG pasta, etc. on the menu. Providers CANNOT write a statement on the menu that 1 grain/day is whole grain or whole grain rich because the WG component must be identified for parents to observe.

*If a monitor observes a meal where the menu lists the grain being served as whole grain-rich and the grain is not a whole grain, the meal with the lowest reimbursement where a grain item was served during that day would be disallowed.

*Monitors should notify providers that they will be required to keep the whole grain rich labels until the end of each day so that they can verify that a whole grain item was served.

*New FBG Grain Groups with grain based desserts removed (H9). WG Resources (H10). Tips for incorporating whole grains (H11) WIC bread list: package sizes and purchasing bread listed on check doesn’t apply to CACFP. This is a list of some specific brands of whole grain items. (H12).

PAGE 19 Whole Grain Rich

*Whole grain ingredients:*Cracked wheat or crushed wheat*Whole wheat flour*Graham flour*Bromated whole wheat flour*Whole durum wheat flour.

*Whole grain names:*1. "Whole" listed before grain*2. Berries or groats*3. Rolled oats and oatmeal*4. Brown rice, brown rice flour and wild rice.

(link to Whole Grains Council- Whole Grains A to Z http://wholegrainscouncil.org/whole-grains-101/whole-grains-z).

*Whole grains are the primary ingredient by weight and the other grains are whole grain or enriched.

*Whole grains are the second ingredient by weight and the first ingredient is water.

*Package lists FDA approved whole grain health claims.

*Non-Mixed Dishes (e. g. breads and cereals):*1. First ingredient is a whole grain;*2. First ingredient is water and second ingredient is a whole grain.

*If a whole grain is not the first ingredient but the combined weight of whole grains is more than the weight of the other grains. (e. g. enriched wheat flour = 40% of grain weight; whole wheat flour = 30% of grain weight; whole oats = 30% of grain weight. Combined weight of the two whole grain ingredients is greater (60%) than the weight of enriched wheat flour (40%)). A product meeting these criteria requires a CN label or product formulation statement.

*Mixed Dishes (e. g. pizza, breakfast burrito):*1. Whole grains are the primary ingredient by weight.*2. Keep a copy of the label or standardized recipe on-file.

*Whole Grain Health Claim*1. "Diets rich in whole grain foods & other plant foods & low in total fat, saturated fat, & cholesterol may reduce the risk of heart disease & some cancers."OR*2. "Diets rich in whole grain foods & other plant foods & low in saturated fat & cholesterol, may help reduce the risk of heart disease."

*Products displaying the whole grain stamp may not meet the whole grain rich criterion.

PAGE 20 Grains: Grain Based Desserts

*Filled with added sugar and saturated fat which increases the risk of chronic illness.

*Grain-based desserts include all grain products that contain sugar, with the exception of quick breads and muffins, (e. g. banana bread or pumpkin muffins).

*May ONLY be served as additional, non-creditable items (e. g. birthday cake).

*CACFP funds cannot be used to purchase additional, non-creditable items.

PAGE 21 Grains: Breakfast Cereals

*Write kind of cereal on Menu, (e.g. Cheerios).

*6 grams of sugar equals 21.2 grams per 100 grams.

There are 2 methods for determining if a cereal contains 6 grams or less of sugar per dry ounce.

*Use WIC approved cereal list (H13)

WIC requires 6 grams of sugar or less per dry ounce of cereal, so any cereal on this list of WIC approved cereals is creditable.

OR*Look at Nutrition Facts Label;*1. Find the serving size (Example: 28 grams);*2. Find the amount of sugar per serving (Example: 1 gram);*3. Calculate the amount of sugar per ounce (Example: 1 gram of sugar per serving divided by the serving size of 28 grams (1/28 = 0.036).*4. If the number is at or below the threshold of 0.212, the cereal is creditable. The cereal in the example is creditable because 0.036 is less than 0.212, (H14).

Yogurt, whole grains and sugar limits in cereal (H15)

PAGE 24 Meat/ Meat Alternates

*M/MA ounce equivalents to replace entire grain component up to 3 times per week (H16)

I sent this chart to all of you by e-mail to help you determine the serving size of meat/meat alternates that would be required to replace the entire grain component at breakfast up to 3 times per week. Make sure that you are serving the required amount of protein at breakfast. Always consider a week to be the same as a calendar week which is the time period between Sunday and Saturday.

*Tofu and soy products cannot be used as meat alternates in infant meals.

*Tofu:*1. Must be commercially prepared firm or extra firm to be a creditable meat alternate;*2. Must be easily recognized (visible) as a meat substitute.*3. Soft or silken tofu and tofu noodles are not creditable because they are not easily recognized as a meat substitute.*4. Non-commercial and non-standardized tofu & soy products are not creditable.*5. Keep CN label on-file when using tofu or soy products as meat alternates.*6. Must contain at least 5 grams of protein per 1 ounce equivalent serving.

*Nuts and seeds do not form a complete amino acid chain; so they can be used to meet only 1/2 of the meat/meat alternate component at lunch and supper, and must be paired with another meat/meat alternate.

*Acorns, chestnuts and coconuts are not creditable due to their low protein and iron content.

PAGE 25 Soy & Tofu Products

*Soy yogurt can be used as a dairy-free option without a note from a doctor.

*Soy yogurt must contain no more than 23 grams of sugar per 6 ounce serving.

*Soy milk that is not nutritionally equivalent to milk requires a note from a doctor.

PAGE 26 Meat/Meat Alternates: Yogurt

*If the serving size on the container of yogurt is located on the Sugar Limits chart, use the chart to determine if the yogurt is creditable. If the serving size is not in the Sugar Limits chart, divide the sugars by the serving size to determine if the yogurt is creditable.

*Gogurt has 24 grams of sugar per 6 oz. serving and is no longer reimbursable. Some of the pouches have less than 23 grams of sugar per 6 ounce serving, but all of the tubes that I researched have at least 24 grams of sugar per 6 ounce serving.

*Yogurt containers vary in size: 2 oz., 3.7 oz., 4 oz., 4.2 oz., 5.3 oz. and 7 oz. sizes are the most common.

*Greek yogurt contains less natural sugar (lactose) because it is strained and the liquid is drained.

*Non-commercial and non-standardized yogurt products are not reimbursable (e. g. frozen yogurt, drinkable yogurt, homemade yogurt, etc.).

*Adult Day Services Centers may serve 6 ounces (3/4 cup) of yogurt in place of 8 ounces (1 cup) of milk once per day.

*As a best practice, adults should be served water when yogurt is served in place of milk.

*Substituting yogurt for milk DOES NOT apply to children enrolled in Day Care Homes, Child Care Centers, Head Start Centers, Outside School Hours Child Care Centers, At Risk Afterschool Centers or Emergency (Homeless) Shelters.

PAGE 27 Fluid Milk

*Children MUST be served UNFLAVORED WHOLE milk from 1 year of age to 2 years of age.

PAGE 27 Continued

*A 1 month transition period is allowed to switch from iron-fortified formula to whole milk when a child reaches 1 year of age. Breast milk may be served to a child past their first birthday, for as long as the mother wishes to breast feed.

*Children must be served UNFLAVORED 1% OR SKIM MILK from 2 years of age to 6 years of age.

*A 1 month transition period is allowed to switch from whole milk to 1% or skim milk when a child reaches 2 years of age.

*Children 6 years of age to 18 years of age and adults must be served FLAVORED SKIM MILK or UNFLAVORED 1% or SKIM MILK.

*Flavored non-dairy milk substitutes cannot be served to children younger than 6 years of age (even if they are nutritionally equivalent to milk).

*Water must be OFFERED to children throughout the day, but cannot be served in place of milk.

*Menus must document percent fat content and flavored or unflavored milk.

*Adults: yogurt cannot be used in place of milk when it is used as a meat alternate in the same meal.

*Adults: milk is optional at supper.

PAGE 30 Food Preparation

*Deep-fat frying on-site is prohibited.

*Deep-fat frying on-site can be dangerous.

*Too many deep-fat fried foods may contribute to chronic illness.

*Purchasing pre-fried, flash-fried and par-fried foods from a manufacturer is allowed.

PAGE 31 Additional Provisions

*Water must now be offered several times throughout the day. This is in addition to making water available throughout the day.

*To better accommodate children and adults with special dietary needs that do not rise to the level of a medical disability, the meal pattern final rule allows reimbursement for meals that contain one component that is provided by a parent or guardian, or by, or on behalf of, an adult participant.

*Family style meal service is not required, but is highly encouraged.

Family Style Meal Service:

*Allows participants to serve themselves from common platters of food with the assistance of supervising adults, if needed.*Place enough food on each table to provide the required portions for everyone seated at the table.

*All of the meal components must be placed on the table, (e. g. if an apple is not placed on the table at the start of the meal and the children are told that they need to eat the other 4 components before they can be given the apple for “dessert”, this meal would not be reimbursable).

*Family style meal service may be used to serve 1 or several components if it is not practical to use family style meal service for the entire meal.

*Promotes social, emotional and motor skills.

*Encourages children to try new foods.

*Provides control over eating since allows refusal of food items and allows participants to take a smaller serving size.

*Optional for children and adults to serve themselves juice or milk.

Offer versus Serve:

*OVS allowed for Adult Day Services Centers and At Risk sites ONLY.

*Reduces food waste.

*Not appropriate for young children because they need time to explore flavors, textures, etc.

*In OVS, all the required meal components must be offered to each child or adult participant, and each child or adult participant may decline to take one or two of the meal components, depending on the meal being served.

*At Risk sites must offer all 5 components at Supper, and child may decline to take 1 or 2 of the components.

*Mixed component items containing 3 or more components may not be declined.

*A food component is one of the food groups that comprise a reimbursable meal.

*A food item is a specific food offered within a food component. (e. g. Turkey on whole grain bread is a food item that contains 2 food components).

*OVS is not allowed for snacks.

PAGE 34 Best Practices

*Optional

*Serve at least 1 fruit or vegetable at snack (required for developmentally ready infants 6-11 months of age).

*Serve a variety of fruits and choose whole fruits more often than juice.

*Provide at least 1 serving from each of the vegetable subgroups each week. (H17)

*Serve at least 2 servings of whole grain rich grains each day.

*Serve only lean meat, nuts and legumes.

*Limit processed meats to 1 serving per week.

*Serve only natural cheeses and low-fat or reduced-fat cheeses.

*Serve only unflavored milk to all age groups.

*Limit sugar content of flavored milk; no more than 22 grams of sugar per 8 ounce serving of milk. (H18)

*Support mothers who choose to breast feed; and provide a quiet, private area that is comfortable, safe and sanitary.

PAGE 37 Early Implementation

*Institutions that have Food Service Management Contracts and School Food Authority Contracts need to include both meal patterns in the contract for the upcoming year. (both contracts are available on our website). This will not apply if early implementation has been requested and granted by the State Agency.

*Institutions will be responsible for training FSMCs and assuring that FSMCs understand and comply with the revised Meal Pattern.

PAGE 38 Permissible Allowances

*Reimbursement when a mother breastfeeds on-site.

*Serve protein in place of entire grain component up to 3 times per week at breakfast.

PAGE 39 Non-permissible Allowances

*Other allowances cannot be implemented prior to October 1, 2017.

*At Risk sites must notify the CACFP State Agency before they begin using offer versus serve. The State Agency can withdraw the offer versus serve option for any At Risk or Adult Day Services site.

PAGE 40 Full Implementation

*Full implementation of the new meal pattern can begin before October 1, 2017 with State Agency approval on a case-by-case basis.

*Early implementation needs to be requested in writing with a detailed description of the processes that will be used to train all facilities and the monitoring procedures that will be implemented to assure compliance.

*State Agency approval will be granted or denied in writing. Do not begin early implementation before written approval is received.

*Meals that meet the current meal pattern requirements cannot be disallowed before October 1, 2017.

PAGE 42 Getting From Here to There

*Please schedule a training to train all of your facilities. I would recommend that the training be conducted on or before August 1, 2017 to give participants a couple of months to familiarize themselves with the new rules.

*Sponsors that have already trained their facilities should arrange another training if they learned anything new today.

*Day Care Home Sponsors can prove that the DCH providers are fully trained regarding the new meal pattern by requiring all providers to submit 4 weeks’ worth of menus that are in compliance with the new meal pattern. This will allow sponsors some time to address problems before October (when meals that do not meet the new meal pattern would need to be disallowed). These menus should be submitted to the Sponsor.

*All other institutions may submit 4 weeks’ worth of menus to their assigned Agreement Administrator for review prior to October, 2017, if they wish.

*Please contact us with questions and requests for technical assistance.

One Page Summaries Links (H19)