Form FNS-834 State Agency (Nslp/Snap) Direct Certification Rate Data

OMB APPROVED NO. 0584-0000
Expiration Date: XX/XX/XXXX

U.S. DEPARTMENT OF AGRICULTURE
FOOD AND NUTRITION SERVICE

STATE AGENCY (NSLP/SNAP)
DIRECT CERTIFICATION RATE DATA ELEMENT REPORT

State

This annual interagency report collects data elements from the State agencies that administer the Supplemental
Nutrition Assistance Program (SNAP) and from the State agencies that administer the National School Lunch
Program (NSLP).
A separate, completed FNS-834 report must be submitted to the Food and Nutrition Service (FNS) no later than
December 1st each school year by:
• the SNAP State agency, providing Data Element #2 below; and
• each State agency that administers the NSLP, providing Data Element #3 below.
These data elements are needed to compute the Direct Certification Rate with SNAP that is required by the
Food, Conservation, and Energy Act of 2008 (Public Law 110-246) and by the Richard B. Russell National
School Lunch Act, as amended by the Healthy, Hunger-Free Kids Act of 2010 (Public Law 111-296) and
promulgated by the regulations published on [insert date], the National School Lunch Program: Direct
Certification Continuous Improvement Plans required by the Healthy, Hunger-Free Kids Act of 2010, which
added a new section 7 CFR 245.12 to NSLP regulations and amended SNAP regulations at 7 CFR 272.5 to
allow for this collection.

School
Year

20 _ _ - 20 _ _

For an understanding of the formula to calculate NSLP direct certification rate with SNAP, and to see how
these data elements come into play, please refer to the reverse side of this form.

State Agency Name and Address:
Contact Information: (Name, Title,
Email, Phone)
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-XXXX. The time required to complete this information collection is 30 minutes per
response, including the time to review instructions, to search existing data resources, to gather the data needed, and to complete and review the
information collection.

SNAP State agency completes this section

NSLP State agency completes this section

Data Element #2 – The number of school-aged children in
SNAP households during the months of July, August, and
September.

Data Element # 3 – The number of SNAP Children in Special
Provision Schools Operating in a Non-Base Year.
Please enter, in the box provided below, the number of children
from households receiving SNAP benefits that attend schools
operating under the provisions of 7 CFR 245.9, if such schools
were reporting in a year other than the base year. See reverse
side for specific instructions.

Please enter, in the box provided below, the unduplicated count
of the number of children ages 5 to 17 years at any time during
the months of July, August, or September of this school year who
were members of households receiving assistance under SNAP
at any time during the months of July, August, or September of
this school year. See reverse side for specific instructions.

Data Element #2

Data Element #3

Optional - The NSLP or SNAP State agency may complete this section, if applicable
Special Circumstances
If there are special circumstances that would affect the direct certification rate calculation for your State that you would like to bring to
our attention, please let us know by marking an "X" in the box to the right. See reverse side for more instruction.

FORM FNS-834 (11-11) Previous Editions Obsolete

SBU

Electronic Form Version Designed in Adobe 9.1 Version

STATE AGENCY (NSLP/SNAP) DIRECT CERTIFICATION RATE DATA ELEMENT REPORT (continued)
PURPOSE - This report collects data elements necessary to compute direct certification rates for comparison with certain benchmarks required by 7 CFR
245.12(b). The benchmark for school year (SY) 2012-13 is 90%, and the benchmark for SY 2013-14 and every school year thereafter is 95%.
To promote transparency and to strengthen the direct certification process so that States can monitor their own performance using the same measures and
methodology that FNS will use, this report identifies each of the data elements and its role in the formula to calculate a State’s NSLP Direct Certification
Rate with SNAP, even if, like Data Element #1, it is not collected on this form.
Direct Certification Rate Formula:
Percent of
SNAP children
directly
certified for
free school
meals
Data
Element

SNAP children
directly certified for
free school meals

+

SNAP children in special
provision schools operating
in a non-base year

=

#1

+

#3

=
School-aged children in SNAP households during
the months of July, August, and September

#2

Instructions and additional information

#1

SNAP CHILDREN DIRECTLY CERTIFIED FOR FREE SCHOOL MEALS: This is the number of children directly certified with SNAP
for free school meals as of the last operating day in October. THIS DATA ELEMENT #1 DOES NOT COME IN ON THIS FORM; it
comes in instead on the FNS-742, line 3-2B. It is due to the NSLP State agency no later than February 1st and to FNS no later
than March 15th each school year.

#2

SCHOOL-AGED CHILDREN IN SNAP HOUSEHOLDS: For our direct certification rate formula, we define “school-aged” as 5 to 17
years old. A query on the database must yield any child in a household receiving assistance under SNAP during the months of July,
August, or September and whose birthdate is between July 1st (of the SY-minus-18) and September 30th (of the SY-minus-5). For
example, for SY 2012-2013, that would be children born between July 1, 1994 (2012 minus 18) and September 30, 2007 (2012 minus
5); and for SY 2013-14, that would be children born between July 1, 1995 (2013 minus 18) and September 30, 2008 (2013 minus 5).
So long as the child’s birthday falls within the birthdate age-range listed for the given school year, include the child in the count. Be
careful, however, that you do not count the same child more than once. We are looking for the unduplicated count, so even if the child
is in a SNAP household for each of the three months, s/he is counted only once. We need only the counts, not the list of names of such
children. THIS DATA ELEMENT #2 IS REPORTED ON THE FRONT OF THIS FORM BY THE SNAP STATE AGENCY in the space
provided. It is due to FNS as soon as possible, but no later than December 1st of each school year. In addition to submitting a
completed report to FNS, you, as the SNAP State agency, must also send a copy of this completed report to the State agency that
administers the NSLP in your State so that they will know the data element you are reporting to FNS. Reporting this data element as
soon as it is available will allow these NSLP State agencies to better monitor their own performance.

#3

SNAP CHILDREN IN SPECIAL PROVISION SCHOOLS OPERATING IN A NON-BASE YEAR - To get this count, NSLP State
agencies must ensure that a match is run between SNAP records and school enrollment records from schools operating under the
provisions of 7 CFR 245.9 (special provision schools) in a year other than the base year. Although you will not actually directly certify
children attending these schools in a non-base year, this process will provide a measure for the count of the number of children who
could have been directly certified with SNAP had it been a base year when direct certification with SNAP is conducted. Such special
provision school matching efforts should occur in or close to October, but must occur no later than the last operating day in October.
(Please refer to the preamble of the final rule cited on the front of this form and to other FNS Guidance regarding special phase-in
allowances and CEO school options.) THIS DATA ELEMENT #3 IS REPORTED ON THE FRONT OF THIS FORM BY THE NSLP
STATE AGENCY in the space provided. It is due by December 1st of each school year. [Note: In a base year, actual SNAP direct
certifications will be reported on the FNS-742, line 3-2B and included in Data Element #1 instead of in Data Element #3. If your State
does not have any special provision schools operating in a non-base year for this school year, enter “0” in the box on the front of this
form.]

If your State has special circumstances that you want us to consider to more closely approximate either of the two data elements
Special
collected on this form, please alert us by putting an "X" in the Special Circumstances box on the front of this form. FNS would then
Circumstances contact any State agency that marks this box, asking the State agency to forward a description of the circumstance they want FNS to
(Optional)
consider, the count of the number of children affected by the circumstance, the methodology for estimating the count, and the source(s)
of published State or Federal data used to support that methodology.
Please note that although this is an interagency form, it is not a shared form. FNS expects separate forms to come in from each State agency. The
SNAP State agency is to fill out the front of this form, completing Data Element #2 and leaving Data Element #3 blank. The State agency that
administers the NSLP in the State is to complete the front of a separate form, completing Data Element #3 and leaving Data Element #2 blank. (If more
than one State agency administers the NSLP in the State, they each are to submit separate forms.) Either State agency may mark the Special
Circumstances (Optional) box.