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APEC-II SFA REIMBURSEMENT CLAIM VERIFICATION FORM TARGET MONTH FOR SAMPLED SCHOOL
ICR 201208-0584-008 · OMB 0584-0530 · Object 34359501.
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Document Metadata
| File Type | application/msword |
|---|---|
| File Title | APEC-II SFA REIMBURSEMENT CLAIM VERIFICATION FORM TARGET MONTH FOR SAMPLED SCHOOL |
| Subject | Form |
| Keywords | APEC-II SFA REIMBURSEMENT CLAIM VERIFICATION FORM TARGET MONTH FOR SAMPLED SCHOOL |
| Author | Alicia Leonard |
| Last Modified By | Writer |
| File Modified | 2012-06-27 |
| File Created | 2026-11-13 |
| Conversion State | complete |
Extracted Text
OMB Approval No.: 0584-0530 Approval Expires: NSLP AND SBP ACCESS, PARTICIPATION, ELIGIBILITY, AND CERTIFICATION STUDY (APEC-II) SFA REIMBURSEMENT CLAIM VERIFICATION FORM TARGET MONTH FOR SAMPLED SCHOOL 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 control number. The valid OMB control number for this collection is 0584-0530. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, searching existing data resources, gather the data needed, and complete and review the information collected. NSLP AND SBP ACCESS, PARTICIPATION, ELIGIBILITY, AND CERTIFICATION STUDY (APEC-II) SFA REIMBURSEMENT CLAIM VERIFICATION FORM TARGET MONTH FOR SAMPLED SCHOOL SFA Name: SFA ID: |___|___|___|___|___|___|___|___| School Name: School ID: |___|___|___|___|___|___|___|___| Date: | | | / | | | / | | | MONTH DAY YEAR Target Month From: | | | / | | | / | | | TO | | | / | | | / | | | MONTH DAY YEAR MONTH DAY YEAR IF CEO SCHOOL, ENTER REPORTED MEALS FOR FREE, PAID AND TOTAL ONLY PART A: BREAKFAST REPORTED TO SFA BY SCHOOL REPORTED TO STATE AGENCY BY SFA Free: | | | |,| | | | Reduced: | | | |,| | | | Paid: | | | |,| | | | Total: | | | |,| | | | Free: | | | |,| | | | Reduced: | | | |,| | | | Paid: | | | |,| | | | Total: | | | |,| | | | COMPLETE FOR PROVISION 2 OR PROVISION 3 SCHOOL IN NON-BASE YEAR ENTER THE CLAIMING PERCENTAGES USED: BASE YEAR PERIOD USED: | | | | % FREE | | | | % REDUCED | | | | % PAID YEARLY PERCENTAGES 1 MONTHLY PERCENTAGES 2 SPECIFY MONTH USED: COMPLETE FOR CEO SCHOOL ENTER THE CLAIMING PERCENTAGES USED: | | | | % FREE | | | | % PAID PART B: LUNCH REPORTED TO SFA BY SCHOOL REPORTED TO STATE AGENCY BY SFA Free: | | | |,| | | | Reduced: | | | |,| | | | Paid: | | | |,| | | | Total: | | | |,| | | | Free: | | | |,| | | | Reduced: | | | |,| | | | Paid: | | | |,| | | | Total: | | | |,| | | | COMPLETE FOR PROVISION 2 OR PROVISION 3 SCHOOL IN NON-BASE YEAR ENTER THE CLAIMING PERCENTAGES USED: BASE YEAR PERIOD USED: | | | | % FREE | | | | % REDUCED | | | | % PAID YEARLY PERCENTAGES 1 MONTHLY PERCENTAGES 2 SPECIFY MONTH USED: COMPLETE FOR CEO SCHOOL ENTER THE CLAIMING PERCENTAGES USED: | | | | % FREE | | | | % PAID PART C: INTERVIEWER: The number of meals an SFA claims for a school may differ from what the schools report to the SFA because the SFA makes an error or because the SFA is correcting an error in the school’s meal counts. 1. COMPARE BREAKFAST COUNTS AND CLAIMS. First for breakfast, compare the SFA claims against the school reports for each meal type (free, reduced-price, paid, and total) for the target month. [Or for CEO schools, free, paid and total for the target month]. If they differ, then check the SFA records to see if there are any notes in the file indicating that the SFA corrected the school breakfast counts and document in the space provided below under “COMMENTS.” COMMENTS: 2. COMPARE LUNCH COUNTS AND CLAIMS. Next for lunch, compare the SFA claims against the school reports for each meal type (free, reduced-price, paid, and total) for the target month. [Or for CEO schools, free, paid and total for the target month]. If they differ, then check the SFA records to see if there are any notes in the file indicating that the SFA corrected the school lunch counts and document in the space provided below under “COMMENTS.” COMMENTS: