Form FNS 418 FNS 418 Report of the Summer Food Service Program for Children

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FORM APPROVED OMB. NO. 0584-0280
Expiration Date: XX/XX/XXXX
U.S. DEPARTMENT OF AGRICULTURE
FOOD AND NUTRITION SERVICE

REPORT OF THE
SUMMER FOOD SERVICE
PROGRAM FOR CHILDREN

1. STATE

2. CALENDAR
YEAR

4A. TYPE OF SUBMISSION
("X" ONE)

FOR FNS USE ONLY

A.

30 - Day

B.

60 - Day (Optional)

C.

90 - Day

D.

90 - Day

STATE CODE

CAL. YEAR

Revision No.

MONTH TYPE

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

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

3. MONTH

E.

Closeout

F.

Other

FNS REGIONAL OFFICE USE
REVEIWED

4B. LAST REPORTING MONTH OF
FISCAL YEAR?
YES
NO

DATE
SIGNATURE OF FNS OFFICIAL

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 information collection is 0584-0280. The time required to complete this information collection
is estimated to average 2 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and
complete and review the information collection.
PART A - MEALS SERVED
TOTAL MEALS - ALL SPONSORS
Report every month
MEAL TYPE

BREAKFASTS

LUNCHES

SUPPERS

SUPPLEMENTS

TOTAL

SELF-PREP/RURAL SITES
(A)
ACTUAL

5.

ESTIMATED

6.

TOTAL

7.

ACTUAL

8.

ESTIMATED

9.

TOTAL

10.

ACTUAL

11.

ESTIMATED

12.

TOTAL

13.

ACTUAL

14.

ESTIMATED

15.

TOTAL

16.

ACTUAL

17.

ESTIMATED

18.

TOTAL

19.

OHTER SITES
(B)

I CERTIFY that this report is true and correct to the best of my knowledge and belief.
20. SIGNATURE

21. TITLE

22. DATE SIGNED

23. ADMINISTERING AGENCY
FORM FNS-418 (07-12) Previous Editions Obsolete

SBU

Electronic Form Version Designed in Adobe 9.1 Version

NO FURTHER MONIES OR OTHER BENEFITS MAY BE PAID OUT UNDER THESE PROGRAMS UNLESS THIS
REPORT IS COMPLETE AND FILED AS REQUESTED BY EXISTING REGULATIONS (7 C.F.R. 225)

PART B - COMMODITIES
(Complete for 90-Day report for last reporting month of the fiscal year.)
24. CUMULATIVE MEALS (All Types) ACTUALLY SERVED BY SPONSORS ELIGIBLE TO RECEIVE USDA DONATED COMMODITIES.
(If no sponsors are eligible to receive commodities, enter "X".)
PART C - MEALS SERVED
(Complete according to instructions for July 90-Day Report Only)
MEAL TYPE
(Actual Meals Served)

BREAKFASTS

25.

LUNCHES

26.

SUPPERS

27.

SUPPLEMENTS

28.

TOTAL

29.

SCHOOL
SPONSORS
(A)

GOVERNMENT
SPONSORS
(B)

RESIDENTIAL
CAMPS
(C)

NATIONAL
YOUTH SPORTS
PROGRAM
(D)

PART D - PARTICIPATION - JULY 90-DAY REPORT ONLY

NO. OF SPONSORS

30.

NO. OF SITES

31.

NO. OF RURAL SITES 32.
(Include in 31 above)

ADA OF SPONSORS
REPORTED LINE 30
34. REMARKS

33.

NON-PROFIT
PRIVATE
SPONSORS
(E)

TOTAL
(F)

INSTRUCTIONS
(All items self-explanatory unless noted below)
DEFINITIONS

PART B - (Line 24)

1.

"Actual" - Meals for which claims have been approved for
reimbursement for the month.

Complete for 90-Day Report for the Last Operating Month of the
Fiscal Year

2.

"Estimated" - Projection of the number of meals that were served
and are expected to be approved for reimbursement for which
claims have not seem received or approved by the reporting due
date.

3.

"Total" - The sum of ACTUAL and ESTIMATED data.

Sponsors eligible to receive commodities in the Summer Food Service
Program are self-preparation sponsors and those sponsors which contract
with a school or with a school district for the preparation of meals, and
school food authority sponsors procuring meals from a food service
management company as provided by Program regulations.

4.

"ADA" - SFSP average daily attendance rate (ADA) is calculated
by taking the total number of meals served in a sponsor's primary
meal service (usually lunch) during the claim period and dividing
that number by the number of operating or meal service days
for that claim period. This results in the ADA for a sponsor on an
average day during the claim period.

TYPE OF SUBMISSION

Report the total number of ACTUAL meals served by all sponsors eligible
to receive USDA donated commodities whether or not those sponsors
actually received commodities. This is a cumulative number of meals (all
types) for the entire Summer Food Service Program. For summer camps,
this would include both the reimbursable meals served to needy children
and at the State's option, actual counts of non-reimbursable meals served
to non-needy children. Submit this information on the 90-Day Report for
the last operating month.
(EXAMPLE: If all meal service concluded in the month of August,
then line 24 would be completed on the August 90-Day Report.)

4A. "30-Day Report" - Due in FNS Regional Offices on the last day
of the month following the month being reported. This report may
contain ACTUAL and ESTIMATED data.

PART C - (Lines 25-29)
Complete for July 90-Day Report ONLY

4B. "60-Day Report" - A 60-Day Report is not required.
4C. "90-Day Report" - The 90-Day Report must be submitted to the
FNS Regional Office within ninety days following the month being
reported. This is a "final" report and must consist of ACTUAL data
only.

COLUMNS A-E

4D. "Revised 90-Day Report" - Submit revisions to the latest 90-Day
Report in accordance with FNS instructions.

COLUMN F

4E.

"Closeout Report" - Submit the Annual Financial
Reconciliation (Closeout) of Program Grants Report in accordance
with FNS instructions.

4F.

"Other Reports" - Submit other reports in accordance with FNS
instructions. Use the "Remarks" section if necessary to describe
the purpose of the report.
PART A - (Lines 5-19)

Note: For each reporting month, complete Columns A and B.
COLUMN A
Enter the ACTUAL, ESTIMATED, AND TOTAL number of BREAKFASTS,
LUNCHES, SUPPERS, and SUPPLEMENTS served in self-prep and/or
rural sites operating under all sponsor types.
COLUMN B
Enter the ACTUAL, ESTIMATED, and TOTAL number of BREAKFASTS,
LUNCHES, SUPPERS, and SUPPLEMENTS served in all other sites
operating under all sponsor types.

Enter the ACTUAL number of BREAKFASTS, LUNCHES, SUPPERS,
AND SUPPLEMENTS served by each of the indicated sponsor types.

Enter the total number of BREAKFASTS, LUNCHES, SUPPERS, and
SUPPLEMENTS served by all sponsors.
PART D - (Lines 30-33)
Complete for July 90-Day Report ONLY
Line 30 - Enter the number of sponsors by type that operated during the
month of July.
Line 31 - Enter the number of sites that operated under each sponsor type
during the month of July.
Line 32 - Enter the number of sites from Line 31 which are rural sites.
Include these sites on Line 31 above.
Line 33 - Enter the Average Daily Attendance (ADA) for each type of
sponsor entered on Line 30 for the month of July. This is the sum of the
average daily attendance figures reported by each type of sponsor.