Form FNS-10 Report of School Program Operations

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FORM APPROVED OMB NO. 0584-0002
Expiration Date: XX/XXXX
U.S. DEPARTMENT OF AGRICULTURE
FOOD AND NUTRITION SERVICE

4. TYPE OF SUBMISSION
("X" ONE)

1. STATE

REPORT OF SCHOOL
2. CALENDAR YEAR

PROGRAM OPERATIONS

A.

30 - DAY

B.

60 - DAY

C.

90 - DAY

D.

FOR FNS USE ONLY
CAL. YEAR

90 - DAY

TYP

STATE CODE

REVISION NO.

STATE AGENCY: Submit report according to the instructions 30 and 90 days
following the month being reported.
Send original to the Regional Administrator, Food & Nutrition Service.

MONTH

(1 = 1st rev., 2 = 2nd , etc.)

3. MONTH

E.

CLOSEOUT

F.

OTHER - (Describe)

PART A - (Complete Monthly)
ITEM
(Include Residential Child Care Institutions
(RCCIs) In Items 5 thru 8.)
5. NATIONAL SCHOOL
LUNCH PROGRAM
a. Total lunches served in the
NSLP
(Include all lunches reported in
5b)

FOR
FNS
USE
ONLY

NUMBER OF MEALS AND HALF-PINTS SERVED
PAID

FREE

REDUCED PRICE

TOTAL

AVERAGE DAILY MEALS

(A)

(B)

(C)

(D)

(E)

ACTUAL
ESTIMATED
TOTAL

b. Lunches served in school food
authorities that qualify the
state for additional payment

ACTUAL
ESTIMATED
TOTAL

c. Total afterschool snacks
ACTUAL
served in all approved schools
and sites. (Include in Col. B,
ESTIMATED
all free snacks reported in item
TOTAL
5d, below)
ACTUAL

d. Total afterschool snacks
served in area eligible
schools and sites

ESTIMATED
TOTAL

6. SCHOOL BREAKFAST
PROGRAM

ACTUAL
ESTIMATED

(Include schools with severe
need)

TOTAL

7. SCHOOL BREAKFAST
PROGRAM

ACTUAL
ESTIMATED

(Severe need only)

TOTAL

8. COMMODITY SCHOOLS

ACTUAL
ESTIMATED

(Lunches only)

TOTAL

9. SPECIAL MILK PROGRAM

ACTUAL

a. Schools

ESTIMATED

(Include Residential Child Care
Institutions)

TOTAL
ACTUAL

b. Nonresidential Child Care
Institutions

ESTIMATED
TOTAL
ACTUAL

c. Summer camps

ESTIMATED
TOTAL

Form FNS-10 (04-09) Previous editions are obsolete

SBU

Electronic Form Version Designed in Adobe 8.1Version

NO FURTHER MONIES OR OTHER BENEFITS MAY BE PAID OUT UNDER THESE PROGRAMS
UNLESS THIS REPORT IS COMPLETED AND FILED AS REQUESTED BY EXISTING REGULATIONS
(7 C.F.R. 210, 215, & 220)

PART B - (Complete Once A Year As Specified)
ITEM

FOR
FNS
USE
ONLY

NUMBER OF MEALS SERVED
PAID

FREE

REDUCED PRICE

TOTAL

AVERAGE DAILY MEALS

(A)

(B)

(C)

(D)

(E)

10. REPORT NO. OF MEALS SERVED
IN PRIVATE SCHOOLS ONLY
a. National School Lunch Program
b. Afterschool snacks (include area
eligible snacks reported in 10c.)
c. Afterschool snacks served in area
eligible schools & sites.
d. School Breakfast Program
(include severe need)
e. Severe Need School Breakfast
Program
11. REPORT NO. OF MEALS SERVED
IN RCCI'S ONLY
a. National School Lunch Program
b. NSLP - Snacks

OCTOBER

c. School Breakfast Program
(include severe need)
d. Severe Need School Breakfast
Program

OPERATING A PROGRAM THIS MONTH

NATIONAL
SCHOOL
LUNCH
(F)

NSLP SNACKS NSLP SNACKS
SCHOOL
SCHOOL
COMMODITY
(All schs &
BREAKFAST
LUNCH
(Area Elig.
sites; incl.
Only)
(Inc. Sev. Nd) (Sev. Nd Only)
Col. H)
(G)

(H)

(I)

(J)

(K)

12a. Number of Public Schools
b. Membership (Enrollment)
13a. Number of Private Schools
b. Membership (Enrollment)
14a. Number of Residential Child Care Institutions
b. Membership (Enrollment)
15. NUMBER OF CHILDREN APPROVED FOR:
a. Free Lunches - - TOTAL
b. Reduced-price Lunches - - TOTAL

JULY

16. NUMBER OF NONRESIDENTIAL
CHILD CARE INSTITUTIONS
17. NUMBER OF SUMMER CAMPS OPERATING
A PROGRAM FOR THE MONTH OF JULY
ONLY

18. REMARKS



I CERTIFY THAT THIS REPORT IS TRUE AND CORRECT TO THE BEST OF MY
KNOWLEDGE AND BELIEF.

20. SIGNATURE

21. TITLE

19. AGENCY
22. DATE SIGNED

SPECIAL
MILK
(L)

INSTRUCTIONS
(ALL ITEMS SELF-EXPLANATORY UNLESS NOTED BELOW)
For each applicable month, all schools, residential and nonresidential
child care institutions, and summer camps known to have operated
a program during the month being reported should be accounted for
on this report. The 30-day report should include "actual" data from
valid claims on hand, and "estimated" data for those claims which
have not been validated or received by the reporting due date. In
any event,data reported which is not based on valid claim data should
represent the best estimate of the reporting office of the actual level
of operation. The 30-day report is due in the FNS Regional Office
30 days following the month being reported.
A 60-day report is not required.
The 90-day report containing only valid final claim data must be submitted to the FNS Regional Office within 90 days following the
month being reported. The 90-day report must not contain
"estimated" data for any item.
For completion of the Form FNS-10, the following reporting schedule
should be followed:
1. Items 5 through 9, MONTHLY.
2. Items 10 through 16, ONCE A YEAR, October.
3. Item 17, ONCE A YEAR, July.
If any of the items do not apply to the State Agency's operation,
please leave appropriate spaces blank.
DEFINITIONS

(for the purpose of this report):

1. "Average Daily Meals" is the number of meals served on an
average day during the month being reported. It may be determined
in accordance with the following example: School A served for 20
days a total of 2,000 meals; 2,000 divided by 20 equals an average
of 100 meals served daily. School B served for 16 days a total of
2,400 meals; 2,400 divided by 16 equals an average of 150 meals
served daily. School C served for 30 days a total of 1,800 meals;
1,800 divided by 30 equals an average of 60 meals served daily.
One hundred (Average daily meals served for School A) plus 150
(Average daily meals served for School B) plus 60 (Average daily
meals served for School C) equals 310, total aggregate average
daily meals for the three schools.
The reporting office may use any valid method to determine the
number of average daily meals. The method chosen however,
should provide a result similar to the result obtained in the
calculation method cited above. Under normal circumstances, the
number of average daily meals should not vary appreciably from
one month to the next. If there is any significant monthly change
in the number of average daily meals served, it should be explained
in the "Remarks" section of the report.
Note: Unless all schools and residential child care institutions in
the State have the same number of food service operating days, do
not divide total meals served in the State by the number of calendar
school days in order to determine the number of average daily
meals for the State. This method will result in significant monthly
variations in the data reported, and is not an accurate measure of
the number of average daily meals.
In addition to the "Paid", "Free", and "Reduced Price" meals
reported each month, "Average Daily Meals" is the primary
element used by FNS during the fiscal year to project State
agency operational levels.
2. A "Commodity School" is a school that does not participate in
the NSLP but which operates a nonprofit lunch program and receives
donated foods, or receives donated foods and cash or services of a
value of up to 5 cents per lunch in lieu of donated food for processing and handling the foods.

3. A "Free Meal" is one which is served to a needy child determined
to be eligible for such meal under the eligibility criteria of the School
Food Authority or residential child care institution approved by the
State Agency.
4. "Free Milk" is milk served under the Special Milk Program to needy
children determined to be eligible for such milk under the eligibility
criteria of the School Food Authority or child care institution
approved by the State Agency.
5. Membership (Enrollment) - A pupil is a member of a school from
the date he presents himself/herself at school and is placed on the
current roll until he/she permanently leaves the school for one of
the causes recognized as sufficient by the State. The date of
permanent withdrawal should be the date on which it is officially
known that the pupil has left school, and not necessarily the first
day after the date of last attendance. Membership is obtained by
adding the total original entries and the total reentries and subtracting
the total withdrawals; it may also be obtained by adding the total
number present and the total number absent. This term is also known
as the number belonging. This same definition may be applied to
residential child care institutions.
Membership should be based on the State agency's best assessment
of available records for the month of October. Membership may be
determined either by using one operating day or by averaging
several or all operating days in October.
6. A "Nonresidential Child Care Institution" is a licensed nonschool
public or nonprofit private institution providing day care services
where children are not maintained in residence.
7. A "Paid Meal" is one which is served to a child who has not been
determined to be eligible to receive "free or reduced price meals,"
as defined herein.
8. A "Reduced Price Meal" is one which is served to a needy child
determined to be eligible for such meal under the eligibility criteria
of the School Food Authority or residential child care institution
approved by the State Agency. The reduced meal price must be less
than the full meal price and must be 40 cents or less for lunches and
30 cents or less for breakfasts.
9. A "Residential Child Care Institution" is a public or licensed
nonprofit private organization including but not limited to orphanages.
homes for the mentally retarded, etc., where children are maintained
in residence.
10. A "School" is an educational unit of high school grade or under
operating under public or nonprofit private ownership in a single
building or complex of buildings. When separately administered
elementary and secondary grade levels are housed in the same
building, each is considered a separate school. When both levels are
administered as one unit, it should be considered a single school.
11. A "School Food Authority" is the governing body which is
responsible for the administration of one or more schools and which
has the legal authority to operate a lunch program therein.
12. A school with "severe need" is a school which is approved for
School Breakfast Program reimbursement in excess of the specified
standard rates of reimbursement.
13. "Total Meals" and "Total Half-pints of Milk" are all free, reduced
price, and paid meals and all free and paid milk served during the
month being reported to all eligible children participating in the child
nutrition programs covered by this report.
14. A "site" is a nonschool facility participating under the agreement
of a School Food Authority and offering afterschool snacks.
15. "Area eligible" means a school or site located in the attendance
area of a school in which at least 50% of the enrolled children are
certified eligible for free or reduced price meals.

MONTHLY REPORTING

Note:

If complete valid claim data is not available for Items
5 through 9 by the due date, estimates will need to
be developed in order to complete the 30-day report.
While the reporting office may use whatever methods
are most suitable to their needs, the following method
is suggested:
For all claims not received for schools and institutions
known to be operating a program(s), adjust the most
recently received valid claim record available for a full
operating month for each reporting unit to the days of
operation for the current month. The sum of the
estimated outstanding claims should be reported on
the "estimated data" line. The sum of the valid claims
received should be reported on the "actual data" line.
The sum of estimated outstanding claims when added
to the tabulation of valid claims actually received
should be reported on the "total data" line.
It should be noted that this method may not be
appropriate for estimating data for the summer months,
the beginning of the fall school term, or any other
month affected by inclement weather, strikes, widespread illness, etc.
Any estimation method used by the reporting office
will be measured by FNS for accuracy. Reporting
offices should make reasonable adjustments for any
known program growth or decline.

Item
5a. Enter in appropriate columns the total number of lunches
served in schools and residential child care institutions to eligible
participants. Any lunches served to persons not eligible for
program participation or any served that do not meet the Lunch
Pattern Requirements are examples of lunches that must not be
reported. (Include all lunches reported in 5b.)
5b. Enter total number of lunches served in school food
authorities that qualify the State for additional payment.
5c. Enter in appropriate columns, the total number of
snacks served to eligible children in after school care
programs as authorized by regulation. Any snacks
served to persons not eligible for program participation or any
served that do not meet the meal pattern requirements are
examples of snacks that must not be reported.
5d. Enter in Column B, the total number of snacks served free
to children in afterschool care programs in area eligible schools
and sites. Any snacks served to persons not eligible for
program participation or any served that do not meet the meal
pattern requirements are examples of snacks that must not be
reported.
6. Enter in appropriate columns the number of breakfasts
served in schools and residential child care institutions to eligible
participants. Include breakfasts served in schools and residential
child care centers designated by the State Agency as Severe
Need programs. Any breakfasts served to persons not eligible
for program participation, or any served that do not meet at
least the basic meal requirements are examples of breakfasts
that must not be reported.
7. Following the same procedure as for Item 6, report only free
and reduced-price breakfasts served in the Severe Need Programs.
Those breakfasts should be included in Item 6. Report the total
of free and reduced-price Severe Need breakfasts in Column D of
Item 7.

Note: For Items 5, 6, 7, 8, 10, and 11, Column E, compute "Average
Daily Meals" in accordance with Definition No. 1.
9. Enter in appropriate columns by applicable outlet unit the number
of half-pints of milk served in the Special Milk Program (SMP) to
eligible participants. Milk served in nonpricing outlets should be
counted as paid milk served. Include SMP milk served in residential
child care institutions with milk served in schools.
ONCE-A-YEAR REPORTING
FOR THE MONTH OF OCTOBER
(90-day report only)
Item
10. Enter in appropriate columns the number of lunches, breakfasts
and snacks served in private schools to eligible participants.
Any meals served to persons not eligible for program participation,
or any served that do not meet at least the basic meal requirements
are examples of meals that must not be reported. For Item 10e,
report the total of free and reduced-price Severe Need breakfasts in
Column D.
11. Enter in appropriate columns the number of lunches, snacks,
and breakfasts served in residential child care institutions to eligible
participants. Any meals served to persons not eligible for program
participation, or any served that do not meet at least the basic meal
requirements are examples of meals that must not be reported. For
Item 11d, report the total of free and reduced-price severe need
breakfasts in Column D.
12. Enter in appropriate columns the number of public schools
participating in the child nutrition programs covered by this report.
Report in Column G the total number of public schools and sites
serving afterschool snacks, including area eligible schools and sites.
Report only the area eligible public schools and sites in Column H.
Enter in the appropriate columns the aggregate membership (enrollment) of participating public schools only.
13. Enter in appropriate columns the number of private schools
participating in the child nutrition programs covered by this report.
Report in Column G the total number of private schools and sites
serving afterschool snacks, including area eligible schools and sites.
Report only the area eligible private schools and sites in Column H.
Enter in the appropriate columns, the aggregate membership (enrollment) of participating private schools only.
14. Enter in appropriate columns the number of residential child care
institutions (public and private combined) participating in the lunch,
snack, breakfast, commodity, and milk programs and their aggregate
membership (enrollment).
15. Enter in Column F the number of children approved for free
lunches in public schools, private schools, and RCCIs, and the
number of children approved for reduced-price lunches in public
schools, private schools, and RCCIs.
16. Enter in Column L the number of nonresidential child care
institutions (public and private combined) participating in the
Special Milk Program.
ONCE-A-YEAR REPORTING
FOR THE MONTH OF JULY
17. Enter in Column L the number of nonprofit summer camps
(public and private combined) which served milk in the Special Milk
Program during the month of July.

8. Enter in appropriate columns the number of lunches served
to eligible participants. Include lunches served in both Commodity
schools and Commodity residential child care institutions. Any
lunches served to persons not eligible for program participation,
or any served that do not meet the requirements as set forth in
Part 210.10 of the NSLP regulations, are examples of lunches
that must not be reported.

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