State, Local & Tribal LEA Schools

CEO C_10 Meal Count Verification Form _Non-CEO

OMB Clearance # 0584-XXXX

Expiration Date: XX/XX/20XX

Community Eligibility Option Evaluation

Meal Count Verification Form—Non-CEO Schools

LEA Name: __________________________________________LEA ID: ________________

School Name: ________________________________________School ID: ______________

Target Day: ___ / ___ / _______ Number of Registers: _______

Month Day Year

INTERVIEWER NOTE: Introduce yourself to the respondent. Remind them of the reason for your visit (refer to advance letter if needed). Review informed consent paragraph from the advance letter; and give them a copy of this letter.

Target day is the before your visit with the School Food Service Manager. Confirm that the meal counts from the target day will be submitted to the LEA at the end of the week. If the meal counts will not be submitted to the LEA at the end of the week, in time for your LEA visit the following week, find out when meal counts were last submitted, and what the most recent day in the submission was. This is your adjusted target day.

 No breakfast served  No lunch served

1	2	3		4	5
	Breakfast		Lunch
	School Recorded Counts	Interviewer Verification Counts		School Recorded Counts	Interviewer Verification Counts
Daily Total for All Registers	Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________		Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________
If available, enter the separate totals for each register below.
Register 1	Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________		Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________
Register 2	Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________		Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________
Register 3	Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________		Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________
Register 4	Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________		Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________
Register 5	Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________		Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________
Register 6	Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________		Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________
Register 7	Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________		Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________
Register 8	Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________		Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________
Register 9	Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________		Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________
Register 10	Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________		Free: __________ Reduced:______ Paid: __________ Total: __________	Free: __________ Reduced:______ Paid: __________ Total: __________

Instructions for Completing Meal Count Verification Form

This form collects data on the number and types of reimbursable meals served to students on the target day in sampled non-CEO schools. The information is first collected from the school’s records from the source where the initial counting of the meal was documented. The information is then verified by the data collector, using the same method the school uses. This information will allow us to study the accuracy of schools’ meal counting and reporting.

Notes:

• This form is filled out for all schools scheduled for a site visit/menu survey.

• This form will be completed by the data collector, with records provided by the school’s Cafeteria Manager. This form will be completed during the first visit to the school, preferably on the Friday before the target week at the time of Menu Survey instruction.

• Collect and verify meal counts for the Target Day. The Target Day is the day before your visit, or, if meal counts are not submitted at least weekly, the last day’s meal counts that were submitted to the LEA.

Step by Step Instructions

• Before your visit, fill in the LEA Name and ID number, the School Name and ID Number, and Target Day date.

Entering the School’s Recorded Meal Counts

• If the school did not serve breakfast or lunch on the Target Day, check the box to the left of the meal.

• Using the school’s records provided to you by the Cafeteria Manager (typically a Cash Report, Cash & Sales Report, or Meal Report), enter the school’s meal counts in column 2, “School Recorded Counts.”

  • If the school records only the sum of meals across all registers, complete the first row of the table “Daily Total for All Registers.” Record the number Of Free, Reduced Price, and Paid lunches here, along with the total.

  • If the school keeps records for each individual cash register, record the information on the form in the same way, with the number of free, reduced price, and paid meals for that register (1 through 10, or as many as needed), along with the total number of meals at that register.

• Enter this information exactly as entered in the school’s records. Do not make any corrections. Data on the “Meal Count Verification Form” should be exactly the same as the school’s records.

Entering the Verified Meal Counts

• You will verify the school’s meal counts by following the same procedure the school uses to generate its own count for recordkeeping. The method used will be obtained during the pre-visit interview.

• Different schools use different systems or methods to count the number of Free, Reduced Price, and Paid lunches. Some example are:

• Manual cash register system: counts are recorded on paper tapes or receipts. You will collect the tape for each register, count the number of each meal type served, and record the meal counts in column 3 for breakfast and column 5 for lunch.

• Manual ticket system: a ticket that indicates whether a lunch is free, reduced price, or full price is collected for each reimbursable lunch. Tickets may be color coded, or have an actual code. You will count the number of tickets for each meal type at each register, and record this in column 3 for breakfast and column 5 for lunch.

• Roster check off system: Cashiers record whether a reimbursable lunch is free, reduced price, or full price using pen and paper and a simple chart. You will count the number of checkmarks recorded at each register for each type of meal, and record this in column 3 for breakfast and column 5 for lunch.

• Electronic point of sale system: These systems include automated functions to produce counts of different meal types. Work with the person identified as being responsible for generating daily meal counts at the school. This may be the Cashier, Cafeteria Manager, or Food Service Director. Ask this person if they can generate the meal counts for the target day, and ask for a print out. Use this print out to enter the verified meal counts on the form.

• If possible, verify meal counts at each individual register and record the data for each register in column 3 for breakfast and column 5 for lunch, “Interviewer Verification Counts.”

• If the school does not generate separate counts for each register, use the first row of the table, “Daily Total for All Registers,” to record the daily total for Free, Reduced Price, and Paid lunches, along with the Total.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB number. The valid OMB control number for this information collection is 0584-XXXX. The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Food and Nutrition Service, Office of Research and Analysis, 3101 Park Center Drive, Alexandria, Virginia 22302.

Meal Count Verification Form—Non-CEO Schools 1