Form FNS-366A Part A - Program and Budget Summary Statement

FORM APPROVED OMB. NO. 0584-0083
1. STATE AND STATE CODE

U.S. DEPARTMENT OF AGRICULTURE
FOOD AND NUTRITION SERVICE

2. LETTER OF CREDIT NO.

PROGRAM AND BUDGET SUMMARY STATEMENT

3. UNIVERSAL IDENTIFIER NUMBER
4. FEDERAL FISCAL YEAR

PART A - BUDGET PROJECTION

4A.
FROM
MONTH
YEAR

4B.
TO
MONTH
YEAR

FEDERAL FISCAL QUARTER ENDING

FUNCTION

DECEMBER

MARCH

JUNE

SEPTEMBER

PROJECTION
TOTALS

01

CERTIFICATION

0

02

COUPON ISSUANCE

0

03

QUALITY CONTROL

0

04

MANAGEMENT
EVALUATION

0

05

50% FUNDING
FRAUD CONTROL

0

06

75% FUNDING
FRAUD CONTROL

0

07

ADP OPERATIONS

0

08

FAIR HEARINGS

0

09

OTHER ACTIVITIES
(20+ 30)

0

10

TOTAL (1-9)

0

0

0

0

0

5. REMARKS

6. SIGNATURE OF AUTHORIZED OFFICIAL

7. NAME AND TITLE

8. DATE

FORM FNS-366A (7-03) Previous Edition Obsolete
Electronic Form Version Designed in JetForm 5.1 version
According to the Paperw ork 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 is 0584-0083. The time required to
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Clearance Officer, Stop 7602, 1400 Independence Avenue S.W., Washington D.C. 20250-7602.

FORM APPROVED OMB. NO. 0584-0083
1. STATE AND STATE CODE

U.S. DEPARTMENT OF AGRICULTURE
FOOD AND NUTRITION SERVICE

2. LETTER OF CREDIT NO.

PROGRAM AND BUDGET SUMMARY STATEMENT

3. UNIVERSAL IDENTIFIER NUMBER
4. FEDERAL FISCAL YEAR

PART A - BUDGET PROJECTION

4A.
FROM
MONTH
YEAR

FEDERAL FISCAL QUARTER ENDING

FUNCTION

DECEMBER

MARCH

JUNE

SEPTEMBER

4B.
TO
MONTH
YEAR

PROJECTION
TOTALS
0

11 E & T 100% GRANT
12 E & T 50% MATCHING

0

13 E & T DEPENDENT CARE

0

14 E & T TRANSPORTATION
AND OTHER

0

15 OPTIONAL WORKFARE

0

16 OUTREACH

0

17 NUTRITION EDUCATION

0

18 REINVESTMENT

0

19 SAVE

0

20 PAGE 2 SUBTOTAL

0

0

0

0

0

5. REMARKS

6. SIGNATURE OF AUTHORIZED OFFICIAL

FORM FNS-366A (7-03) Previous Edition Obsolete
Electronic Form Version Designed in JetForm 5.1 version

7. NAME AND TITLE

8. DATE

Page 2

FORM APPROVED OMB. NO. 0584-0083
1. STATE AND STATE CODE

U.S. DEPARTMENT OF AGRICULTURE
FOOD AND NUTRITION SERVICE

2. LETTER OF CREDIT NO.

PROGRAM AND BUDGET SUMMARY STATEMENT

3. UNIVERSAL IDENTIFIER NUMBER
4. FEDERAL FISCAL YEAR

PART A - BUDGET PROJECTION

4A.
FROM
MONTH
YEAR

FEDERAL FISCAL QUARTER ENDING

FUNCTION

DECEMBER

MARCH

JUNE

SEPTEMBER

4B.
TO
MONTH
YEAR

PROJECTION
TOTALS

50% FUNDING ADP
DEVELOPMENT

0

22 63% FUNDING ADP
DEVELOPMENT

0

75% FUNDING ADP
DEVELOPMENT

0

21

23

24 EBT ISSUANCE

0

25 ISSUANCE INDIRECT

0

26 EBT STARTUP

0

UNSPECIFIED PORTION
27 OF OTHER

0

28 E & T ABAWD GRANT

0

29

0

30

PAGE 3 SUBTOTAL

0

0

0

0

0

5. REMARKS

6. SIGNATURE OF AUTHORIZED OFFICIAL

FORM FNS-366A (7-03) Previous Edition Obsolete
Electronic Form Version Designed in JetForm 5.1 version

7. NAME AND TITLE

8. DATE

Page 3

PROGRAM AND BUDGET SUMMARY STATEMENT
(Food Stamp Program)
PART A - BUDGET PROJECTION
GENERAL. Part A of the Program and Budget
Summary Statement is used to report projections of
Federal funding needs for the upcoming Federal Fiscal
Year. The quarterly budget projections should be
developed in the same functional categories as those
found on the SF-269 (Financial Status Report). The
budget projections represent the best estimate of
anticipated expenditures to be funded at the
appropriate rate of Federal financial participation for
that category. This report should be updated as
needed. Each update w ill serve to project anticipated
expenditures for the current year. Data for a category
w hich w as previously submitted but has not changed
should be carried forw ard onto the updated report.

A narrative justification should be attached to each
Budget Projection Statement, documenting the
assumptions used to arrive at the figures reported.
The narrative should cover as many of the items listed
above, and any other deemed relevant as having a
significant impact on costs. The State agency is not
required to address every contributing factor in every
submission of a Budget Projection Statement. Rather,
the narrative should concentrate on items that account
for increases or decreases in costs from the
preceding submissions and having greatest impact.
Lengthy explanations are not necessary, but pertinent
figures used in the analysis (for example, the inflation
rate or salary rates and benefits) should be included.

DUE DATE: Part A is to be submitted annually, no
later than August 15 of each year. One copy each
should be retained by the respondent State Program
and Finance Directors and the remaining copies sent to
the appropriate FNS Regional Office for approval.

1. CERTIFICATION - Project salaries and fringe benefits
for full or part-time certification and multifunctional
w orkers for their estimated time actually engaged in
certification of households. Include salaries to be paid
during travel status, estimated travel expenses,
supervisory, clerical, or other support costs, including
related salaries and benefits.

A separate form FNS-366A is required for States to
report any FNS-approved demonstration costs
required to be reported separately. Specify the
project in the Remarks block. Do not include such
separate data in the Statew ide FNS-366A for the
regular (coupon/electronic benefit transfer (EBT))
program unless specifically instructed to do so by
FNS.
PROJECTING FUNDING NEEDS: Those responsible for
the form' s completion w ill evaluate any factors of
program activity that impact on program costs,
determine the projected dollar impact of those factors
and adjust the program budget accordingly.
Such analysis normally w ill take into account, but not
be limited to, the follow ing factors:

2. COUPON ISSUANCE - Project salaries and fringe
benefits for full or part-time issuance and
multifunctional w orkers for their estimated time
actually engaged in coupon issuance transactions.
Include salaries estimated for travel time spent
traveling from w ork site to other issuance locations,
estimated travel expenses, fees estimated to be paid
or accrued under contracts w hich use a transaction
rate, supervisory, clerical, or other support w orker
costs, including salaries and benefits. Include the direct
costs for coupon and non-EBT issuance activities.
Include any indirect costs charged as part of a public
assistance cost allocation plan related to coupon
issuance. Indirect costs assigned by cost rates are
reported in " Issuance Indirect" (Row 25).

The number and salary level of employees
Other factors affecting personnel costs including
(1) Anticipated Increases in pay rates or benefits,
and
(2) Reallocations of staff among units or functions,
insofar as these might result in cost increases or
decreases.

3. PERFORMANCE REPORTING - QUALITY CONTROL:
Project salaries and fringe benefits for full or
part-time Quality Control and multifunctional w orkers
for their estimated time to be actually engaged in
Quality Control activities. Include salaries estimated for
travel, estimated travel expenses, supervisory, clerical,
or other support w orker costs, including salaries and
benefits.

Costs for purchasing, leasing, and maintaining
equipment and space, especially concerning
(1) Any upcoming one-time-only purchases of new
capital assets such as ADP equipment,
(2) Renegotiation of leases,
(3) Changes in depreciation rates or procedures,
(4) Relocation of offices,
(5) Maintenance and renovation w ork, and
(6) Inflation.

4. PERFORMANCE REPORTING - MANAGEMENT
EVALUATION: Project salaries and fringe benefits for
full or part-time Management Evaluation and
multifunctional w orkers for their estimated time to be
actually engaged in Management Evaluation activities.
Include salaries estimated for travel, estimated travel
expense, supervisory, clerical, or other support
w orker costs, including salaries and benefits.

Issuance system costs including:
(1) Renegotiation of issuing agent fee, and
(2) Plans to change issuance systems.
Changes in case load and factors contributing to
increases or decreases in the numbers of
recipients and recertifications, including the
anticipated impact of economic conditions
(and in particular unemployment) and seasonality
Cost implications of corrective action plans
Anticipated changes in program regulations and
operating guides and instructions,
Training needs,
Travel costs, and
Adjustments in insurance premiums.

5. 50% FUNDING - FRAUD CONTROL: Project all
expenses for payroll, equipment, space, and other
support costs of qualified employees that w ill be
engaged specifically in the investigation and
prosecution of Food Stamp Fraud Activity. Include only
costs w hich are to be reimbursed at the 50 percent
Federal Financial Participation rate.
6. 75% FUNDING - FRAUD CONTROL: Project all
expenses for payroll, equipment, space, and other
support costs of qualified employees that w ill be
engaged specifically in the investigation and
prosecution of Food Stamp Fraud Activity. Costs for
fraud hearings w ill also be included, as w ell as costs
generated through formal agreements w ith agencies
other than the State agency. Training costs specifically
related to this job function w ill be reported in this

column. Include only costs w hich are to be
reimbursed at the 75 percent Federal Financial
Participation rate.
7. ADP OPERATIONS: Include funding activity for
operational costs of computer systems w hich are
charged under an approved cost allocation plan.
Also include any special applicable indirect costs.
8. FAIR HEARINGS: Project salaries and fringe
benefits for full or part-time Fair Hearing or
multifunctional w orkers for their estimated time to
be actually engaged in Fair Hearing activities.
Include salaries estimated for travel time, estimated
travel expenses, supervisory, clerical, or other
support costs.
9. OTHER ACTIVITIES (20+ 30): Include funding of
costs for all other activities. Include costs for the
E & T program, w orkfare, SAVE, ADP Development
costs at the 50% , 63% or 75% rates, and outreach
costs and also report these costs in items 11-30
on Pages 2 and 3 of this form. Include costs of
any other activity in item 27 and attach a detailed
listing of these costs. These should include but not
be limited to the follow ing w here applicable: Indian
Administration costs (show reimbursement level),
Wage Matching, etc. The total of items 20 and 30
must be reported in item 9.
10. TOTAL: For each quarter, enter the total cost
projection for items 1-9.

Section 20 of the Food Stamp Act. These are only
programs w hich are not included in Employment
and Training Programs. Include the cost w hen the
participant w ill be reimbursed for w orkfare-related
expenses such as transportation, child care, or the
cost for personal safety items or equipment
required for performance of w ork if these items
are also purchased by regular employees. (Do not
include enhanced reimbursement w hich should be
reported on the SF-270.)
16. OUTREACH: Enter for each quarter of the next
Federal fiscal year the estimated outreach costs.
Include as outreach costs only those costs for
Program informational activities w hich are included
in the State' s outreach plan.
17. NUTRITION EDUCATION: Enter for each
quarter of the next Federal fiscal year the
estimated nutrition education costs. Include as
nutrition education costs only those costs for
nutrition education activities w hich are included in
the State' s nutrition education plan.
18. REINVESTMENT: No entry is required as there
is no Federal share for reinvestment costs.
19. SYSTEMATIC ALIEN VERIFICATION FOR
ENTITLEMENTS (SAVE): Project for each quarter
of the next Federal fiscal year, the administrative
costs of planning, implementing and operating a
SAVE system.

11. EMPLOYMENT AND TRAINING (E&T) PROGRAM
GRANT ALLOCATION (100% GRANT): Project for each
quarter of the next Federal fiscal year the amount of 100%
Federal E&T funding the State expects to spend. The
projected amount may not exceed the State' s annual
E&T grant allocation. NOTE: If applicable, do not include
projections for line 28: E&T ABAWD GRANT in this
category. Do not include participant reimbursements
in this category.

20. PAGE 2 SUBTOTAL: Enter the total of items
11 through 19.

12. E&T ADMINISTRATIVE COSTS (50% MATCHING):
Project for each quarter of the next fiscal year the amount
in excess of the E&T Program grant allocation (line 11) and,
if applicable, the additional E&T grant allocation for " pledge"
States (line 28), needed to operate the E&T program in
accordance w ith FNS-approved State E&T plan. Do not
include participant reimbursements in this category.

22. 63% FUNDING - ADP DEVELOPMENT: Enter
the computer system development costs w hich are
to be reimbursed at the Federal Financial
Participation rate of 63% . On an attachment provide
for each project, the project name, project ceiling,
and amount budgeted.

13. E&T PARTICIPANT REIMBURSEMENT - DEPENDENT
CARE: Project for each quarter of the next Federal fiscal
year the funds needed to reimburse E&T participants
for the costs of dependent care incurred as a result of
E&T participation. NOTE: The Federal contribution may
not exceed one-half of the lesser amount of either the
actual cost of dependent care or the applicable payment
rate for child care established in accordance with the
Child Care and Development Block Grant provisions of
45 CFR 98.43.
14. E&T PARTICIPANT REIMBURSEMENT TRANSPORTATION AND OTHER COSTS: Project
for each quarter of the next Federal fiscal year the
funds needed to reimburse E&T participants
for the costs of transportation and other reasonable
and necessary costs (other than dependent care)
incurred as a result of E&T participation.
15. OPTIONAL WORKFARE: For each quarter of
the next Federal fiscal year, enter the operational
costs for w orkfare programs operated under

21. 50% FUNDING - ADP DEVELOPMENT: Enter
the computer system development costs w hich are
to be reimbursed at the Federal Financial
Participation rate of 50% . On an attachment provide
for each project, the project name, project ceiling,
and amount budgeted.

23. 75% FUNDING - ADP DEVELOPMENT: Enter
the computer system development costs w hich are
to be reimbursed at the Federal Financial
Participation rate of 75% . On an attachment provide
for each project, the project name, project ceiling,
and amount budgeted.
24. EBT ISSUANCE: Enter the salaries and fringe
benefits for full or part time w orkers engaged in
Electronic Benefit Transfer (EBT) issuance. Include
costs to be paid for EBT issuance under contracts.
Enter direct costs and the indirect costs charged
through a public assistance cost allocation plan.
Report indirect EBT issuance costs charged through
an indirect cost rate in " Issuance indirect" .
25. ISSUANCE INDIRECT: Enter the indirect costs
for coupon and EBT issuance that are approved
for cost charging through an indirect cost rate.
Indirect issuance costs charged through a public
assistance cost allocation plan are reported under
" Coupon issuance" or " EBT issuance" as appropriate.

26. EBT STARTUP: Enter the EBT system startup
costs incurred after the implementation APD is
approved and prior to issuance of benefits by the
EBT system. Costs approved for planning an EBT
system are to be included in the appropriate ADP
Development category. Startup costs are design,
development, and implementation costs excluding
system planning approved by FNS. Operational
costs, including equipment costs, are included in
the " EBT issuance" row .
27. UNSPECIFIED PORTION OF OTHER: Enter that

portion of item 9 " Other Activities" not specifically
identified and recorded in items 11-26 and 28. Include
Wage Matching, etc.
28. E&T ABAWD GRANT: If applicable, project for
each quarter of the next Federal fiscal year the amount
of the unmatched additional Federal grant allocated under
section 16(h)(1)(E) of the Food Stamp Act needed to
provide qualifying education/training or w orkfare
opportunities to every able-bodied adult w ithout
dependents (ABAWD) applicant and recipient subject
to the 3-month food stamp time limit. Since the
$20 million E&T ABAWD allocation w ill not be made
before the required due date of this form FNS-366A,
a participating pledge State must submit a revised
FNS-366A w hen its grant is allocated. NOTE: This
projection is separate from - and must not be included
as part of - the EMPLOYMENT AND TRAINING (E&T)
PROGRAM GRANT ALLOCATION (100% GRANT) on
line 11. Do not include participant reimbursements in
this category.
30. PAGE 3 SUBTOTAL: Enter the total of items
21 through 28.
NOTE: The totals from item 30 must be reported
in item 9.