Appendix P: Form FNS-742

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FORM APPROVED OMB #0584-0026
Expiration Date 01/31/2010

SFA ID#

[INSERT STATE AGENCY NAME]

SFA NAME

SCHOOL FOOD AUTHORITY
VERIFICATION SUMMARY REPORT

TYPE OF SFA

Public

Private

SCHOOL YEAR

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it contains a valid OMB control number. The valid OMB number for this
collection is 0584-0026. The time required to complete this information collection is 6 minutes per response, including the time to review instructions, search existing data resources, gather the data
needed, and complete and review the information collection.

I. Enrollment, Application and Eligibility Information
(Pre Verification)
1. Type of Free/Reduced Price Application Used
Individual Student

Household

Report items 2 through 5 as of the last
operating day in October

II. Results of Verification, by Application Type
6. Type of Verification Used

Both
A.
All Schools

Basic
B.
Provision 2/3 Schools
WHICH ARE NOT
OPERATING A
BASE YEAR

Alternate-Random

Alternate-Focused

No Verifications Performed

A. FREE
ELIGIBLE
based on
FS/TANF/
FDPIR
Application
(Categorically
Eligible)

B. FREE
C.
ELIGIBLE
REDUCED
based on
PRICE
Income/
ELIGIBLE
Household Size
Application
(Income
Eligible)

Items 7 through 11 are required and
are reported as of the date of
completion of the verification process
(see instructions). Item 12 is optional
and is reported as of February 15.

2. Number of schools and RCCIs
operating the NSLP and/or SBP
3. Number of enrolled students with access
to the NSLP (or SBP for SBP only schools)
A.
B.
7. No Change
# of Students # of Approved Applications

# applications
# students

4. Total FREE ELIGIBLE reported
4-1. # approved as FREE ELIGIBLE who are not
subject to verification (directly certified, homeless
liaison list, income-eligible Head start, pre-K Even
start, residential students in RCCIs, non-applicants
approved by local officials)

8. Responded,
Changed to Free

# applications
# students

4-2. #approved as FREE ELIGIBLE based on FS/
TANF/FDPIR case number submitted on an
application (Categorically Eligible)

9. Responded,
Changed to
Reduced Price

# applications

4-3. # approved as FREE ELIGIBLE based on
income/household size information submitted on an
application

10. Responded,
Changed to
Paid

# applications

11. Did Not
Respond

# applications

4-4. # FREE ELIGIBLES reported for Provision 2/3
Schools WHICH ARE NOT OPERATING A BASE
YEAR

# students

# students

4. Total REDUCED PRICE ELIGIBLE
reported

5-1. # reduced price eligibles reported for Provision
2/3 schools WHICH ARE NOT OPERATING A BASE
YEAR
FORM FNS-742 (2/04)

# students

12. Reapplied and
# applications
Reapproved on
or Before Feb.15

SBU

# students

Electronic Form Version Designed in Adobe 7.1 Version

INSTRUCTIONS FOR COMPLETING THE
SFA VERIFICATION SUMMARY REPORT
ALL SFAS WHICH OPERATE THE NATIONAL SCHOOL LUNCH PROGRAM (NSLP) AND/OR THE SCHOOL BREAKFAST
PROGRAM (SBP) MUST COMPLETE THIS REPORT ANNUALLY EXCEPT: 1) SFAs which ONLY administer the program in
Residential Child Care Institutions (RCCIs) which do not have day students; 2) SFAs which claim for all schools based on claiming
percentages established through a population survey; 3) SFAs which do not have any free or reduced price eligible students.

I. Enrollment, Application, and Approval Information (Pre-Verification)
1. Indicate the type of application used for students who are applying for Free/Reduced Price Meal benefits.
Report Items 2 through 5 as of the last operating day in October.
2 - 3. Enter the TOTAL number of NSLP/SBP schools and the number of students with access to the NSLP (or the SBP if the SFA does
not operate the NSLP) for the SFA in column A. If the SFA has schools which are operating under Provision 2/3 for lunch (or for
breakfast if the SFA does not operate the NSLP) WHICH ARE IN A NON-BASE YEAR, enter the number/enrollment of 1) the Provision
2/3 NON BASEYEAR lunch schools plus 2) any Provision 2/3 NON BASE YEAR schools which only operate the SBP in Column B.
4. In Column A, enter the TOTAL NUMBER OF FREE ELIGIBLE STUDENTS that the SFA reported as of the last operating day in
October.
4-1.In Column A, enter the TOTAL NUMBER OF STUDENTS approved as FREE ELIGIBLE whose approval Is not
subject to verification. This includes students who are directly certified based on information from the FS/TANF/
FDPIR agency, children on the homeless liaison list, income eligible Head Start, pre-K Even Start, residential
students in RCCIs, and non-applicants who are approved by local officials. DO NOT INCLUDE the calculated number
of free eligibles who are reported for Provision 2/3 schools which are not operating a base year. These are reported
in item 4-4 below.
4-2. In Column A, enter the TOTAL NUMBER OF STUDENTS approved as FREE ELIGIBLE based on a FS/TANF/
FDPIR case number which was submitted on an application (Categorically Eligible Applications). In Column B, enter
the TOTAL NUMBER OF APPROVED CATEGORICALLY ELIGIBLE APPLICATIONS on file.
4-3. In Column A, enter the TOTAL NUMBER OF STUDENTS approved as FREE ELIGIBLE based on household
size and income information submitted on an application (Income Eligible - Free Applications). In Column B, enter
the TOTAL NUMBER OF APPROVED INCOME ELIGIBLE - FREE APPLICATIONS on file.
4-4. Enter the TOTAL NUMBER OF FREE ELIGIBLES reported for Provision 2/3 schools which are not operating a
base year in Column A. (This number is determined by adjusting the number of free eligibles in the base year for
these schools to reflect current total enrollment.)
5. In Column A, enter the TOTAL NUMBER OF STUDENTS approved as REDUCED PRICE ELIGIBLE. In Column B, enter the TOTAL
NUMBER OF APPROVED REDUCED PRICE ELIGIBLE APPLICATIONS on file.
5-1. Enter the TOTAL NUMBER OF REDUCED PRICE ELIGIBLES reported for Provision 2/3 schools which are not
operating a base year in Column A. (This number is determined by adjusting the number of reduced price eligibles in
the base year for these schools to reflect current total enrollment.)

II. RESULTS OF VERIFICATION
6. Indicate the type of verification process the SFA uses to comply with the requirements of 7 CFR 245.6a.
7 though 12. Enter the results of the verification process BY TYPE OF APPLICATION APPROVAL. Items 7 through 11 are required,
and are reported as of the date of completion of verification. For the purposes of this report verification is complete:
-

for households whose eligibility does not change: as of the date of the confirmation of eligibility by a
reviewing official;
for households which do not appeal a change in eligibility: as of the first operating day following the last date
for filing an appeal in response to a notice of change in eligibility;
for households which appeal a change in eligibility: as of the first operating day following a decision by the
hearing official.

7. Enter the number of applications with no change in eligibility and the number of students on these applications, for each application
type.
8. Enter the number of applications for which the eligibility was changed to FREE BASED ON DOCUMENTATION PROVIDED BY THE
HOUSEHOLD, and the number of students on these applications, for each application type.
9. Enter the number of applications for which the eligibility was changed to REDUCED PRICE BASED ON DOCUMENTATION
PROVIDED BY THE HOUSEHOLD, and the number of students on these applications, for each application type.
10. Enter the number of applications for which the eligibility was changed to PAID BASED ON DOCUMENTATION PROVIDED BY THE
HOUSEHOLD, and the number of students on these applications, for each application type.
11. Enter the number of applications for which the eligibility was changed to PAID BECAUSE THE HOUSEHOLD DID NOT RESPOND,
and the number of students on these applications, for each application type. NOTE: Report ALL applications for which the household
did not respond, even if the students on the application continued to receive free or reduced price meals while being claimed as paid.
12. Enter the number of applications for households whose eligibility was changed to PAID as a result of verification that resubmitted
applications and were re-approved for either free or reduced-price meal benefits, and
the number of students on these applications, for each application type.