State and Local Governments

Appendix A.1: Certification and Participation Data Request OMB #: 0584-xxxx

Expiration Date: xx/xx/20xx

Certification and Participation Data Request

A key component of the DC-M demonstration evaluation is to assess the impact of DC-M on certification and participation in the NSLP and SBP. To that end, we are asking each state to provide district-level data for each district included in the study (in either the demonstration or control group). Two types of data files are requested:

1. Certification data: information on enrolled students by certification status and basis for certification as of the last operating day in October

2. Participation data: monthly information on participation in the NSLP, SBP, Special Milk Program, and Afterschool Snack Program.

Certification Data

Certification data should be provided as of the last operating day in October in each of three years: 2011, 2012, and 2013. Table 1 lists the specific data elements that should be included in the certification data files.¹ Most of these data elements are reported by districts to the state as part of the process for completing FNS Form 742.

Table 1. Data Elements Requested in Certification File

Data Element	Notes
Number of students enrolled	Total number of students enrolled in the district in schools or other facilities that operate the NSLP or SBP, excluding those schools participating in the Community Eligibility Option (CEO), Provision 2, or Provision 3 for lunch
Total number of students certified free
Number of students certified free:
- By application, based on income and household size
- By application, based on categorical eligibility
- By application, then later found on DC-M list - By direct certification	We understand that this category may not be available for all districts. Please provide it for any districts for which it is available.
Number of students directly certified based on (if available):	We would like as much detail on the basis of direct certification as is available. If your data system does not include all of the categories listed here, please provide any that are available. If your data system includes other categories not listed here, please provide that information as well.
- Medicaid
- SNAP
- TANF
- FDPIR
- Other
- Both Medicaid and another program
- More than one other program
Number of students categorically eligible based on (if available):	If your data system does not include all of the categories listed here, please provide any that are available. If your data system includes other categories not listed here, please provide that information as well.
- Medicaid
- SNAP
- TANF
- FDPIR
- Other
Number of students certified reduced-price
Number of applications approved free
- Based on income and household size
- Based on categorical eligibility
Number of applications approved reduced-price
Average daily attendance in the district (if available)
School district name
Unique school district ID number

Note: Schools operating under the Community Eligibility Option (CEO) or Provision 2 or Provision 3 for lunch should not be included in these data.

Participation Data

Certification data should be provided for each operating month in school year (SY) 2011-12, 2012-13, and 2013-14. Table 2 lists the specific data elements that should be included in the monthly participation data files.² Most of these data elements are reported by districts to the state as part of the process for completing FNS Form 10.

Table 2. Data Elements Requested in Monthly Participation Files

Data Element	Notes
Number of schools or other facilities participating in the NSLP	Exclude those schools or other facilities operating under the Community Eligibility Option (CEO), Provision 2, or Provision 3 for lunch.
Number of students enrolled in these facilities
Total number of reimbursable lunches served
Number of reimbursable lunches served, by reimbursement category:
- Free
- Reduced-price
- Paid
Average daily reimbursable lunches served
Number of NSLP operating days
Number of reimbursable lunches served that qualify state for additional payment
Number of reimbursable lunches served in districts certified for performance-based reimbursement
Number of schools or other facilities participating in the SBP	Include severe need. Exclude those participating in Provision 2 or Provision 3 for breakfast.
Number of students enrolled in these facilities
Number of severe need facilities
Number of students enrolled in severe need facilities
Total number of reimbursable breakfasts served	In all schools or other facilities, including severe need. (Exclude those participating in Provision 2 or Provision 3 for breakfast.)
Number of reimbursable breakfasts served, by reimbursement category:
- Free
- Reduced-price
- Paid
Number of severe need reimbursable breakfasts served	Severe need only. (Exclude those participating in Provision 2 or Provision 3 for breakfast.)
Number of severe need reimbursable breakfasts served, by reimbursement category:
- Free
- Reduced-price
- Paid
Average daily reimbursable breakfasts served
Number of SBP operating days
Number of schools or other facilities participating in the Special Milk Program (SMP)	If no schools or other facilities in a given district participate in the Special Milk Program, then this and related data elements will equal zero.
Number of facilities participating in the SMP, by type:
- School
- Residential Child Care Institution
- Non-residential child care institution
- Summer camp
Number of students enrolled in each type of facility participating in the SMP (if available)
Total number of reimbursable milks served
Number of reimbursable milks served, by reimbursement category:
- Free
- Paid
Average daily milks served
Number of operating days for the SMP
Number of schools or other facilities participating in the NSLP Afterschool Snack Program (ASP)	If no schools or other facilities in a given district participate in the NSLP Afterschool Snack Program, then this and related data elements will equal zero.
Number of facilities participating in the ASP, by type:
- School
- Residential Child Care Institution
Number of students enrolled in each type of facility participating in the ASP (if available)
Number of students enrolled in afterschool programs in these facilities (if available)
Total number of reimbursable snacks served
Number of reimbursable snacks served, by reimbursement category:
- Free, in area-eligible sites
- Free, in all sites
- Reduced-price
- Paid
Average daily snacks served
Number of operating days for the ASP
School district name
Unique school district ID number

Note: Schools operating under the Community Eligibility Option (CEO) or Provision 2 or Provision 3 should not be included in these data.

Data Delivery Timeline

Table 3 provides the timeline for the data collection. The data files for SY 2011-2012 and the first few months of SY 2012-2013 should be provided as soon as possible. Data for the remaining months of SY 2012-2013 and for SY 2013-2014 should be provided as they become available.

Table 3: Timing of Data Collection

School Year	Data	Date By Which Data Should Be Delivered
SY 2011–2012	October 2011 Certification Data	December 2012
	August 2011-June 2012 Participation Data	December 2012
SY 2012–2013	October 2012 Certification Data	December 2012
	August-October 2012 Participation Data	December 2012
	November 2012-June 2013 Participation Data	On an ongoing basis, with last file delivered July 12, 2013
SY 2013–2014	October 2013 Certification Data	November 29, 2013
	August 2013-June 2014 Participation Data	On an ongoing basis, with last file delivered July 11, 2014

Data Delivery Methods

Mathematica can accept the requested data in any standard format, but we prefer Microsoft Excel or SAS file formats. Since these files will contain only aggregate data, with no personally identifiable information on individuals, they may be transmitted via email. However, we recommend encrypting the files before sending. If a state prefers, we will provide a secure FTP site for uploading the data files.

1 These data elements are similar to those listed in the first column of Table 4 of the MOU, but with additional detail and notes.

2 These data elements are similar to those listed in the second column of Table 4 of the MOU, but with additional detail and notes.

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-XXXX. The time required to complete this information collection is estimated to average 240 minutes per response.

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