State and Local Governments

The Evaluation of Demonstrations of NSLP/SBP Direct Certification of Children Receiving Medicaid Benefits

Appendix F.1 (5-6-13)

State and Local Governments

OMB: 0584-0586

Document [docx]
Download: docx | pdf

Appendix F.1: District Cost Survey - Summer 2013 (Retrospective) OMB #: 0584-xxxx

Expiration Date: xx/xx/20xx

I. INTRODUCTION


All


This survey is designed to help us estimate the cost of certifying students for free or reduced price meals in both districts that are part of the Direct Certification with Medicaid (DC-M) demonstration and those that are serving as the control group for the evaluation. For this round of the survey, we are asking you to respond for the entire 2012-2013 school year, as best you can; the timing of the demonstration was such that we could not collect the data earlier. We divide the year into two periods: (1) July-September 2012, and (2) October 2012-June 2013. For the first period, we will ask you to estimate time or dollars spent on various tasks for the entire period (three months); for the second period, we will ask you to estimate time spent during a typical month. We make this distinction because certification activities tend to be focused during the July to September period in many districts. During the 2013-2014 school year, we will collect data bimonthly, in order to improve data quality.


This survey is to be completed by the food service program director or a designated member of staff who has knowledge of certification procedures. One or more staff in your district may complete the survey; please circulate the survey among appropriate staff, if necessary, to obtain all responses. In some districts, one staff member may be able to complete the entire survey. In other districts, multiple staff may complete sections. During the survey, we will ask about the following key topics:

  • The matching method, steps and individuals involved in conducting direct certification in your district, including the number of hours spent on different tasks

  • The steps and individuals involved in the certification by application process in your district, including the number of hours spent on different tasks

  • Salary and benefit levels for relevant categories of staff

Click here to print this survey. You may find it helpful to gather this information before starting the survey, but you will be able to save your progress and return at a later time if you need to. At the end of the survey, you will also be able to return to specific sections and provide responses to missing questions.


A. DIRECT CERTIFICATION


All

Direct certification is the process whereby school officials determine a child’s eligibility for free school meals in the National School Lunch Program (NSLP) based on data provided by the State or local public assistance office about participation in the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Food Distribution Program on Indian Reservations (FDPIR), or Medicaid (for districts participating in the Direct Certification – Medicaid demonstration). Direct certification can be implemented at the State or district level.


A1. With State-level matching, a State agency (usually Child Nutrition) is responsible for a system that matches a list of children in NSLP schools with a list of children in SNAP households (and/or a list of children in other qualifying programs) using a common identifier or identifiers.

Did your State conduct matching at the State level for direct certification in 2012-2013?

Var


Yes 1

No 0

NO RESPONSE M

all

A2. With district-level matching, districts are responsible for matching a list of children enrolled in their schools with a list of children in SNAP households (and/or in other qualifying programs) using a common identifier or identifiers. Districts may use manual methods or their own computer systems. Did your district conduct matching at the district level for direct certification in 2012-2013?

Var


Yes 1

No 0

NO RESPONSE M

a1 = 1 and a2 = 1

A3. Which entity performed matching for direct certification first?

Var


Select one only

State 1

District 2

NO RESPONSE M




a1 ne 1 and a2 ne 1

A4. How was direct certification conducted in your district?

Var

Select one only

Direct certification was not used 1

Other (specify) 2 GO TO B1

SShape1 pecify (STRING (NUM))

NO RESPONSE M GO TO B1



a4 = 1

A5. Why was direct certification not conducted in your district?

Var


Shape2 (FIELD DESCRIPTION) GO TO C1

(STRING (NUM))

NO RESPONSE M GO TO C1




B. DIRECT CERTIFICATION PROCESS


ALL

The next questions are about the direct certification process in your district.

B1. Which levels of staff were involved with the direct certification process?

Var


Select all that apply

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Database or programming staff 5

District-level food service clerical or administrative staff 6

Other district-level clerical or administrative staff 7

Response Option Other (SPECIFY) 98

Specify (Shape3 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape4 STRING (NUM))

NO RESPONSE M



ALL

B2. Who was responsible for overseeing the direct certification process in your district during the 2012-2013 school year?

Var


Select one only

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Response Option Other (SPECIFY) 99

SShape5 pecify (STRING (NUM))

NO RESPONSE M





PROGRAMMER BOX b2

ask B3 or b3a for first response selected at B1, then ask follow up question b4 if applicable. then ask B3 or b3a for second response selected at B1, then ask follow up question B4 if applicable. continue loop until B3 or b3a (and follow up) has been asked for each response selected at B1, then go to C1.


a2 = 1 and (a1 = 0 or a3 = 2) and B1 NE M


B3. In which steps was [JOB TITLE FROM B1] involved?

Var


Select all that apply

Receiving or downloading files from the State Agency of children receiving SNAP, TANF, FDPIR, and/or Medicaid 1

Updating match specifications, developing programming to implement them, and testing and refining programs 2

Extracting relevant student data from district files 3

Updating database to include new fields or change previous fields 4

Running district-level matching of student data and SNAP, TANF, FDPIR, and/or Medicaid data and identifying matches 5

Researching close or partial matches 6

Reviewing remaining lists of SNAP, TANF, FDPIR and other Medicaid eligibles manually to identify additional matches, including siblings of matched students 7

Merging direct certification results to point-of-sale and/or main student databases or other approaches to making information available to cashiers 8

Making sure all state and federal regulations are followed 9

Response Option Other (SPECIFY) 98

Specify (Shape6 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape7 STRING (NUM))

NO RESPONSE M


PROGRAMMER BOX B3

ask b4 for each response selected at b3.



a1 = 1 and (a2 = 0 or a3 = 1) and B1 NE M


B3A. In which steps was [JOB TITLE FROM B1] involved?

Var


Select all that apply

Uploading student enrollment files to the state system for matching 1

Receiving file of matches from the state and reviewing 2

Researching close or partial matches 3

Reviewing remaining lists of SNAP, TANF, FDPIR and other Medicaid eligibles manually to identify additional matches, including siblings of matched students 4

Merging direct certification results to point-of-sale and/or main student databases or other approaches to making information available to cashiers 5

Communications with State Agency 6

Making sure all state and federal regulations are followed 7

Response Option Other (SPECIFY) 98

Specify (Shape8 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape9 STRING (NUM))

NO RESPONSE M


PROGRAMMER BOX B3A

ask b4 for each response selected at b3A.



(B3 NE 0 or b3a ne 0) AND (B3 ne m or b3a ne m)

B4. How many hours did the [JOB TITLE FROM B1] spend on [TASK FROM B3 AND/OR B3A] during July to September? How many hours in a typical month during the rest of the year? Please include management time. (Your best estimate is fine.)



HOURS

a. Total hours in July-September period

Shape10

b. Typical Monthly Hours After October 1

Shape11

C. CERTIFICATION BY APPLICATION


all

Next, we ask about the certification by application process in your district during school year 2012-2013.

C1. Who was responsible for overseeing the certification by application process in your district during the 2012-2013 school year?

Select one only

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Response Option Other (SPECIFY) 99

SShape12 pecify (STRING (NUM))

NO RESPONSE M GO TO C3


c1 ne m

C2. What were the main duties of the [RESPONSE FROM C1] in overseeing the certification by application process?

Var


Select all that apply

Supervising district-level steps 1

Working with principals who supervise school-level steps 2

Supervising school-level steps directly 3

Making sure all state and federal regulations are followed 4

Response Option Other (SPECIFY) 99

Specify (Shape13 STRING (NUM))

NO RESPONSE M



all

C3. Was most of the work involved with certification by application done at the school level or at the district level?

Var


Select one only

Primarily school level 1

Primarily district level 2

School level and district level equally 3

NO RESPONSE M

all

C4. Did your district have a web-based application process?

Var


Yes 1

No 0 GO TO C11

NO RESPONSE M GO TO C11



c4 = 1

C5. How long has the web-based application process been in place?

Var


Shape15 Shape14 YEARS AND/OR [SKIP] MONTHS

(RANGE NUMBER RANGE) (RANGE NUMBER RANGE)

NO RESPONSE M


c4 = 1

C6. What percentage of applications was received through the web-based process?

Var

Shape16

%

(RANGE NUMBER RANGE)

Don’t know D

NO RESPONSE M



c4 = 1

C7. Who managed the web-based application site? Please include work on developing and testing the site.

Var


Select one only

District staff manages 1

Contractor manages 2

District and contractor manage jointly 3

Response Option Other (SPECIFY) 99

SShape17 pecify (STRING (NUM))

NO RESPONSE M



c7 = 2 or c7 = 3

C8. How much money was paid to the contractor each period for managing the web-based application site? (Your best estimate is fine.)

Var


DOLLARS

a. Cost in July-September 2012

$Shape18

b. Average Monthly Cost After October 1, 2012

$Shape19



NO RESPONSE M



c7=1 or c7=3

C9. Who at the district worked on managing the web-based application site? Please include work on developing and testing the site.

S

Var

elect all that apply

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Database or programming staff 5

District-level food service clerical or administrative staff 6

District-level communications department 7

Other district-level clerical or administrative staff 8

Response Option Other (SPECIFY) 98

Specify (Shape20 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape21 STRING (NUM))

Not applicable N GO TO C11

NO RESPONSE M GO TO C11



c9 ne m

FILL response options (a-h) from responses selected at c9

FILL RESPONSE options i and j FROM C9oth_specify;

IF C9oth_specify IS EMPTY, FILL The other staff member you mentioned

C10. How many hours did the following people spend managing the web-based application site each period? Please include management time, as well as time spent developing and testing the site. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. District food service director

Shape22

Shape23

b. Superintendent

Shape24

Shape25

c. Business manager

Shape26

Shape27

d. Student database administrator

Shape28

Shape29

e. Database or programming staff

Shape30

Shape31

f. District-level food service clerical or administrative staff

Shape32

Shape33

g. District-level communications department

Shape34

Shape35

h. Other district-level clerical or administrative staff

Shape36

Shape37

i. [Fill from C9oth_specify /The other staff member you mentioned]

Shape38

Shape39

j. [Fill from C9oth_specify /The other staff member you mentioned]

Shape40

Shape41




all

C11. Was there need to update the content of the application forms for the 2012-2013 school year?

Var


Yes 1

No 0

NO RESPONSE M



ALL

C12. Was there need for any new translation of the application forms for the 2012-2013 school year?

Var


Yes 1

No 0

NO RESPONSE M



c11=1

IF C12=1, FILL and translations

C13. Who coordinated or worked on revising the content of the application form [and translations]?

Var


Select all that apply

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Database or programming staff 5

District-level food service clerical or administrative staff 6

District-level communications department 7

Other district-level clerical or administrative staff 8

Principals 9

School secretaries or administrative staff 10

Other school-level staff 11

Specify (Shape42 STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape43 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape44 STRING (NUM))

Not applicable N GO TO C15

NO RESPONSE M GO TO C15



c11=1 and c13 ne m and c13 ne n

IF C12=1, FILL and translations

FILL response options (a-j) from responses selected at c13

fill response option k from c13oth_specify;

if c13oth_specify is empty, fill The other school-level staff member you mentioned

FILL RESPONSE options l and m FROM C13oth_specify;

IF C13oth_specify IS EMPTY, FILL The other staff member you mentioned

C14. How many hours did the following people spend revising the content of the application form [and translations] each period? Please include management time. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. District food service director

Shape45

Shape46

b. Superintendent

Shape47

Shape48

c. Business manager

Shape49

Shape50

d. Student database administrator

Shape51

Shape52

e. Database or programming staff

Shape53

Shape54

f. District-level food service clerical or administrative staff

Shape55

Shape56

g. District-level communications department

Shape57

Shape58

h. Other district-level clerical or administrative staff

Shape59

Shape60

i. Principals

Shape61

Shape62

j. School secretaries or administrative staff

Shape63

Shape64

k. [Fill from C13oth_specify/ The other school-level staff member you mentioned]

Shape65

Shape66

l. [Fill from C13oth_specify /The other staff member you mentioned]

Shape67

Shape68

m. [Fill from C13oth_specify /The other staff member you mentioned]

Shape69

Shape70



all

C15. Are hardcopy application forms printed by district or school staff each year?

Var


Yes 1

No 0 GO TO C18

NO RESPONSE M GO TO C18


c15 = 1

C16. Who coordinated or worked on printing hardcopy application forms?

Var


Select all that apply

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Database or programming staff 5

District-level food service clerical or administrative staff 6

District-level communications department 7

Other district-level clerical or administrative staff 8

Principals 9

School secretaries or administrative staff 10

Other school-level staff 11

Specify (Shape71 STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape72 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape73 STRING (NUM))

Not applicable N GO TO C18

NO RESPONSE M GO TO C18



c16 ne m and c16 ne n

FILL response options (a-j) from responses selected at c16

fill response option k from c16oth_specify;

if c16oth_specify is empty, fill The other school-level staff member you mentioned

FILL RESPONSE options l and m FROM C16oth_specify;

IF C16oth_specify IS EMPTY, FILL The other staff member you mentioned

C17. How many hours did the following people spend having hardcopy applications printed each period? Please include management time as well as time spent printing forms. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. District food service director

Shape74

Shape75

b. Superintendent

Shape76

Shape77

c. Business manager

Shape78

Shape79

d. Student database administrator

Shape80

Shape81

e. Database or programming staff

Shape82

Shape83

f. District-level food service clerical or administrative staff

Shape84

Shape85

g. District-level communications department

Shape86

Shape87

h. Other district-level clerical or administrative staff

Shape88

Shape89

i. Principals

Shape90

Shape91

j. School secretaries or administrative staff

Shape92

Shape93

k. [Fill from C16oth_specify/ The other school-level staff member you mentioned]

Shape94

Shape95

l. [Fill from C16oth_specify /The other staff member you mentioned]

Shape96

Shape97

m. [Fill from C16oth_specify /The other staff member you mentioned]

Shape98

Shape99





all

C18. How many hardcopy application forms were printed last year (SY 2012-2013)? Your best estimate is fine.

Var


Shape100 (FIELD DESCRIPTION)

(RANGE NUMBER RANGE)

NO RESPONSE M



c15 = 1

C

Var

19. What was the cost of the supplies used to print hardcopy application forms last year?


Shape101 $ (FIELD DESCRIPTION)

(RANGE NUMBER RANGE)

NO RESPONSE M




c15 ne 1

C

Var

20. If forms were printed by a vendor, what was the cost of printing hardcopy application forms last year?


Shape102 $ (FIELD DESCRIPTION)

(RANGE NUMBER RANGE)

Not printed by a vendor N

NO RESPONSE M




c4 = 1

The next questions are about parent outreach regarding applications.

C21. How did your district let parents or guardians know about the online application process?

Var


Select all that apply

Letters mailed to parents or guardians 1

Emails to parents or guardians 2

School district website 3

Public service announcements 4

At school registration 5

Response Option Other (SPECIFY) 99

Specify (Shape103 STRING (NUM))

NO RESPONSE M


ALL

C22. Who worked on letting parents or guardians know about the application process for free or reduced-price school meals (online or on paper)?

Var


Select all that apply

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Database or programming staff 5

District-level food service clerical or administrative staff 6

District-level communications department 7

Other district-level clerical or administrative staff 8

Principals 9

School secretaries or administrative staff 10

Other school-level staff 11

Specify (Shape104 STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape105 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape106 STRING (NUM))

Not applicable N GO TO C24

NO RESPONSE M GO TO C24


c22 ne m and c22 ne n

FILL response options (a-j) from responses selected at c22

fill response option k from c22oth_specify;

if c22oth_specify is empty, fill The other school-level staff member you mentioned

FILL RESPONSE options l and m FROM C22oth_specify;

IF C22oth_specify IS EMPTY, FILL The other staff member you mentioned

C23. How many hours did the following people spend letting parents or guardians know about the application process each period? Please include management time. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. District food service director

Shape107

Shape108

b. Superintendent

Shape109

Shape110

c. Business manager

Shape111

Shape112

d. Student database administrator

Shape113

Shape114

e. Database or programming staff

Shape115

Shape116

f. District-level food service clerical or administrative staff

Shape117

Shape118

g. District-level communications department

Shape119

Shape120

h. Other district-level clerical or administrative staff

Shape121

Shape122

i. Principals

Shape123

Shape124

j. School secretaries or administrative staff

Shape125

Shape126

k. [Fill from C22oth_specify/ The other school-level staff member you mentioned]

Shape127

Shape128

l. [Fill from C22oth_specify /The other staff member you mentioned]

Shape129

Shape130

m. [Fill from C22oth_specify /The other staff member you mentioned]

Shape131

Shape132



all

C24. How were hardcopy application forms distributed?

Var


Select all that apply

Picked up at school registration and/or school offices 1

Available to print from district website 2

Mailed to parents or guardians 3

Sent home with students 4

Response Option Other (SPECIFY) 99

SShape133 pecify (STRING (NUM))

NO RESPONSE M



all

C25. Who worked on mailing application forms to parents or guardians and/or distributing application forms to schools to send home with students?

Var


Select all that apply

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Database or programming staff 5

District-level food service clerical or administrative staff 6

District-level communications department 7

Other district-level clerical or administrative staff 8

Principals 9

School secretaries or administrative staff 11

Other school-level staff 12

Specify (Shape134 STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape135 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape136 STRING (NUM))

Not applicable N GO TO C27

NO RESPONSE M GO TO C27


c25 ne m and c25 ne n

FILL response options (a-j) from responses selected at c25

fill response option k from c25oth_specify;

if c25oth_specify is empty, fill The other school-level staff member you mentioned

FILL RESPONSE options l and m FROM C25oth_specify;

IF C25oth_specify IS EMPTY, FILL The other staff member you mentioned

C26. How many hours did the following people spend mailing application forms to parents or guardians and/or distributing application forms to schools to send home with students each period? Please include management time. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. District food service director

Shape137

Shape138

b. Superintendent

Shape139

Shape140

c. Business manager

Shape141

Shape142

d. Student database administrator

Shape143

Shape144

e. Database or programming staff

Shape145

Shape146

f. District-level food service clerical or administrative staff

Shape147

Shape148

g. District-level communications department

Shape149

Shape150

h. Other district-level clerical or administrative staff

Shape151

Shape152

i. Principals

Shape153

Shape154

j. School secretaries or administrative staff

Shape155

Shape156

k. [Fill from C25oth_specify/The other school-level staff member you mentioned]

Shape157

Shape158

l. [Fill from C25oth_specify/The other staff member you mentioned]

Shape159

Shape160

m. [Fill from C25oth_specify/The other staff member you mentioned]

Shape161

Shape162



ALL

C27. Who answered calls with questions about the application process?

Var


Select all that apply

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Database or programming staff 5

District-level food service clerical or administrative staff 6

District-level communications department 7

Other district-level clerical or administrative staff 8

Principals 9

School secretaries or administrative staff 10

Other school-level staff 11

Specify Shape163 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape164 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape165 STRING (NUM))

Not applicable N GO TO C29

NO RESPONSE M GO TO C29



c27 ne m and c27 ne n

FILL response options (a-j) from responses selected at c27

fill response option k from c27oth_specify;

if c27oth_specify is empty, fill The other school-level staff member you mentioned

FILL RESPONSE options l and m FROM C27oth_specify;

IF C27oth_specify IS EMPTY, FILL The other staff member you mentioned

C28. How many hours did the following people spend answering calls about the application process each period? Please include management time. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. District food service director

Shape166

Shape167

b. Superintendent

Shape168

Shape169

c. Business manager

Shape170

Shape171

d. Student database administrator

Shape172

Shape173

e. Database or programming staff

Shape174

Shape175

f. District-level food service clerical or administrative staff

Shape176

Shape177

g. District-level communications department

Shape178

Shape179

h. Other district-level clerical or administrative staff

Shape180

Shape181

i. Principals

Shape182

Shape183

j. School secretaries or administrative staff

Shape184

Shape185

k. [Fill from C27oth_specify/ The other school-level staff member you mentioned]

Shape186

Shape187

l. [Fill from C27oth_specify /The other staff member you mentioned]

Shape188

Shape189

m. [Fill from C27oth_specify /The other staff member you mentioned]

Shape190

Shape191





c4 = 1

The next questions are about the submission and processing of applications in your district.

C29. How often were applications submitted online processed?

Var


Select one only

On a rolling basis as they are submitted 1

Daily 2

More than once a week 3

Once a week 4

Once every two weeks 5

Response Option Other (SPECIFY) 99

SShape192 pecify (STRING (NUM))

NO RESPONSE M


all

C30. Were paper forms returned to the child’s school or to a central office?

Var


Select one only

Child’s school 1

Central office 2

Both child’s school and central office 3

NO RESPONSE M


all

C31. Was a business reply envelope provided for parents or guardians to return applications?

Var


Yes 1

No 0

NO RESPONSE M



C30 ne 2

C32. Who collected the hardcopy application forms at the school level?

Var


Select all that apply

Principals 1

School secretaries or administrative staff 2

School-level food service staff 3

Other school-level staff 4

Specify Shape193 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape194 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape195 STRING (NUM))

Not applicable N GO TO C34

NO RESPONSE M GO TO C34


C30 NE 2 AND C32 NE M and c32 ne n

FILL response options a and b from responses selected at C32

fill response option c from c32oth_specify;

if c32oth_specify is empty, fill The other school-level staff member you mentioned

FILL RESPONSE options d and e FROM C32oth_specify;

IF C32oth_specify IS EMPTY, FILL The other staff member you mentioned

C33. How many hours did the following people spend collecting hardcopy application forms each period? Please include management time. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. Principals

Shape196

Shape197

b. School secretaries or administrative staff

Shape198

Shape199

c. School-level food service staff

Shape200

Shape201

d. [Fill from C32oth_specify/The other school-level staff member you mentioned]

Shape202

Shape203

e. [Fill from C32oth_specify/The other staff member you mentioned]

Shape204

Shape205

f. [Fill from C32oth_specify/The other staff member you mentioned]

Shape206

Shape207


C30 NE 2

C34. Were hardcopy applications logged in or processed at the school level?

Var


Yes 1

No 0

NO RESPONSE M



C30 NE 2

C35. Did each school keep originals or copies of the hardcopy applications it received?

Var


Yes 1

No 0

NO RESPONSE M



C30 NE 2

C36. Who logged or copied forms (as applicable) and then sent the hardcopy application forms to the district office?

Var


Select all that apply

Principals 1

School secretaries or administrative staff 2

School-level food service staff 3

Other school-level staff 4

Specify Shape208 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape209 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape210 STRING (NUM))

Not applicable N GO TO C38

NO RESPONSE M GO TO C38



C30 ne 2 and C36 ne m and c36 ne n

FILL response options a and b from responses selected at C36

fill response option c from c36oth_specify;

if c36oth_specify is empty, fill The other school-level staff member you mentioned

FILL RESPONSE options d and e FROM C36oth_specify;

IF C36oth_specify IS EMPTY, FILL The other staff member you mentioned

C37. How many hours did the following people spend at the school level logging, tracking, or sending hardcopy application forms to the district office each period? Please include management time. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. Principals

Shape211

Shape212

b. School secretaries or administrative staff

Shape213

Shape214

c. School-level food service staff

Shape215

Shape216

d. [Fill from C36oth_specify/The other school-level staff member you mentioned]

Shape217

Shape218

e. [Fill from C36oth_specify/The other staff member you mentioned]

Shape219

Shape220

f. [Fill from C36oth_specify/The other staff member you mentioned]

Shape221

Shape222



C30 ne 2

C38. How often were hardcopy application forms sent to the district office?

Var


Select one only

Daily 1

2 -4 times a week 2

Once a week 3

Once every two weeks 4

Kept at school level 5


Response Option Other (SPECIFY) 99

SShape223 pecify (STRING (NUM))

NO RESPONSE M



all

C39. Who worked on logging and tracking hardcopy application forms at the district level?

Var


Select all that apply

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Database or programming staff 5

District-level food service clerical or administrative staff 6

District-level communications department 7

Other district-level clerical or administrative staff 8

Response Option Other (SPECIFY) 98

Specify (Shape224 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape225 STRING (NUM))

Not applicable N GO TO C41

NO RESPONSE M GO TO C41



C39 ne m

FILL response options (a-h) from responses selected at C39

FILL RESPONSE options i and j FROM C39oth_specify;

IF C39oth_specify IS EMPTY, FILL The other staff member you mentioned

C40. How many hours did the following people spend logging and tracking application forms at the district level each period? Please include management time. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. District food service director

Shape226

Shape227

b. Superintendent

Shape228

Shape229

c. Business manager

Shape230

Shape231

d. Student database administrator

Shape232

Shape233

e. Database or programming staff

Shape234

Shape235

f. District-level food service clerical or administrative staff

Shape236

Shape237

g. District-level communications department

Shape238

Shape239

h. Other district-level clerical or administrative staff

Shape240

Shape241

i. [Fill from C39oth_specify/The other staff member you mentioned]

Shape242

Shape243

j. [Fill from C39oth_specify/The other staff member you mentioned]

Shape244

Shape245



C30 ne 2

C41. Were hardcopy application forms checked for completeness at the school level or at the district level?

Var


Select one only

School level 1

District level 2

Both school level and district level 3

NO RESPONSE M



all

C42. Who worked on checking hardcopy application forms for completeness and collecting critical missing information?

Var


Select all that apply

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Database or programming staff 5

District-level food service clerical or administrative staff 6

District-level communications department 7

Other district-level clerical or administrative staff 8

Principals 9

School secretaries or administrative staff 10

School-level food service staff 11

Other school-level staff 12

Specify Shape246 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape247 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape248 STRING (NUM))

Not applicable N GO TO C44

NO RESPONSE M GO TO C44



C42 ne m and c42 ne n

FILL response options (a-j) from responses selected at C42

fill response option k from c42oth_specify;

if c42oth_specify is empty, fill The other school-level staff member you mentioned

FILL RESPONSE options l and m FROM C42oth_specify;

IF C42oth_specify IS EMPTY, FILL The other staff member you mentioned

C43. How many hours did the following people spend checking hardcopy application forms for completeness and/or collecting critical missing information each period? Please include management time. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. District food service director

Shape249

Shape250

b. Superintendent

Shape251

Shape252

c. Business manager

Shape253

Shape254

d. Student database administrator

Shape255

Shape256

e. Database or programming staff

Shape257

Shape258

f. District-level food service clerical/administrative staff

Shape259

Shape260

g. District-level communications department

Shape261

Shape262

h. Other district-level clerical or administrative staff

Shape263

Shape264

i. Principals

Shape265

Shape266

j. School secretaries or administrative staff

Shape267

Shape268

k. School-level food service staff

Shape269

Shape270

l. [Fill from C42oth_specify/The other school-level staff member you mentioned]

Shape271

Shape272

m. [Fill from C42oth_specify/The other staff member you mentioned]

Shape273

Shape274

n. [Fill from C42oth_specify/The other staff member you mentioned]

Shape275

Shape276



all

C44. How is critical missing information from a hardcopy application (such as a signature) obtained?

Var


Select all that apply

Letters mailed to parents or guardians 1

Letters sent home with students 2

Telephone calls or text messages to parents or guardians 3

E-mail to parents or guardians 4

Visits to students’ homes 5

Response Option Other (SPECIFY) 99

Specify (Shape277 STRING (NUM))

NO RESPONSE M


all

C45. For “complete” applications, was there an automated process in place to determine students’ certification status?

?

Var

Yes, fully automated process in place 1

Yes, partly automated process in place with some manual steps 2

No automated process in place 0

NO RESPONSE M



all

C46. Who reviewed “complete” applications to determine certification status? Please include internal reviews of initial determination.

Var


Select all that apply

Automated review process 1

District food service director 2

Superintendent 3

Business manager 4

Student database administrator 5

Database or programming staff 6

District-level food service clerical or administrative staff 7

District-level communications department 8

Other district-level clerical or administrative staff 9

Principals 10

School secretaries or administrative staff 11

Other school-level staff 12

Specify Shape278 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape279 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape280 STRING (NUM))

Not applicable N GO TO C48

NO RESPONSE M GO TO C48



C46 ne m and c46 ne n

FILL response options (a-j) from responses selected at C46

fill response option k from c46oth_specify;

if c46oth_specify is empty, fill The other school-level staff member you mentioned

FILL RESPONSE options l and m FROM C46oth_specify;

IF C46oth_specify IS EMPTY, FILL The other staff member you mentioned

C47. How many hours did the following people spend reviewing completed applications to determine certification status each period? Please include management time and time spent on internal reviews of initial determination.. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. District food service director

Shape281

Shape282

b. Superintendent

Shape283

Shape284

c. Business manager

Shape285

Shape286

d. Student database administrator

Shape287

Shape288

e. Database or programming staff

Shape289

Shape290

f. District-level food service clerical or administrative staff

Shape291

Shape292

g. District-level communications department

Shape293

Shape294

h. Other district-level clerical or administrative staff

Shape295

Shape296

i. Principals

Shape297

Shape298

j. School secretaries or administrative staff

Shape299

Shape300

k. [Fill from C45oth_specify/The other school-level staff member you mentioned]

Shape301

Shape302

l. [Fill from C45oth_specify/The other staff member you mentioned]

Shape303

Shape304

m. [Fill from C45oth_specify/The other staff member you mentioned]

Shape305

Shape306






all

C48. For how long are hardcopy application forms stored?

Var


Select all that apply

Stored electronically 1

Less than one year 2

Between one year and three years 3

Between three years and five years 4

Longer than five years 5

Response Option Other (SPECIFY) 99

SShape307 pecify (STRING (NUM))

NO RESPONSE M



all

C49. Are hardcopy application forms stored at the school level or the district level?

Var


Select one only

Stored at the school level only 1

Stored at the district level only 2

Stored at both the school level and the district level 3

NO RESPONSE M



*D. NOTIFICATION OF CERTIFICATION STATUS


all

The remaining questions are about students certified through the application process, as well as those who were directly certified.

D1. Who worked on maintaining required documentation of certification status?

Var


Select all that apply

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Database or programming staff 5

District-level food service clerical or administrative staff 6

District-level communications department 7

Other district-level clerical or administrative staff 8

Principals 9

School secretaries or administrative staff 10

School-level food service staff 11

Other school-level staff 12

Specify Shape308 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape309 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape310 STRING (NUM))

Not applicable N GO TO D3

NO RESPONSE M GO TO D3



d1 ne m and d1 ne n

FILL response options (a-j) from responses selected at d1

fill response option k from D1oth_specify;

if D1oth_specify is empty, fill The other school-level staff member you mentioned

FILL RESPONSE options l and m FROM d1oth_specify;

IF D1oth_specify IS EMPTY, FILL The other staff member you mentioned

D2. How many hours did the following people spend maintaining required documentation of certification status each period? Please include management time. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. District food service director

Shape311

Shape312

b. Superintendent

Shape313

Shape314

c. Business manager

Shape315

Shape316

d. Student database administrator

Shape317

Shape318

e. Database or programming staff

Shape319

Shape320

f. District-level food service clerical or administrative staff

Shape321

Shape322

g. District-level communications department

Shape323

Shape324

h. Other district-level clerical or administrative staff

Shape325

Shape326

i. Principals

Shape327

Shape328

j. School secretaries or administrative staff

Shape329

Shape330

k. School-level food service staff

Shape331

Shape332

l. [Fill from D1oth_specify/The other school-level staff member you mentioned]

Shape333

Shape334

m. [Fill from D1oth_specify/The other staff member you mentioned]

Shape335

Shape336

n. [Fill from D1oth_specify/The other staff member you mentioned]

Shape337

Shape338



all

D3. Who worked on drafting or updating the letters sent to notify parents or guardians of their children’s certification status?

Var


Select all that apply

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Database or programming staff 5

District-level food service clerical or administrative staff 6

District-level communications department 7

Other district-level clerical or administrative staff 8

Principals 9

School secretaries or administrative staff 10

Other school-level staff 11

Specify Shape339 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape340 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape341 STRING (NUM))

Not applicable N GO TO D5

NO RESPONSE M GO TO D5



D3 ne m and d3 ne n

FILL response options (a-j) from responses selected at d3

fill response option k from D3oth_specify;

if D3oth_specify is empty, fill The other school-level staff member you mentioned

FILL RESPONSE options l and m FROM d3oth_specify;

IF D3oth_specify IS EMPTY, FILL The other staff member you mentioned

D4. How many hours did the following people spend drafting or updating notification letters each period? Please include management time. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. District food service director

Shape342

Shape343

b. Superintendent

Shape344

Shape345

c. Business manager

Shape346

Shape347

d. Student database administrator

Shape348

Shape349

e. Database or programming staff

Shape350

Shape351

f. District-level food service clerical or administrative staff

Shape352

Shape353

g. District-level communications department

Shape354

Shape355

h. Other district-level clerical or administrative staff

Shape356

Shape357

i. Principals

Shape358

Shape359

j. School secretaries or administrative staff

Shape360

Shape361

k. [Fill from D3oth_specify/ The other school-level staff member you mentioned]

Shape362

Shape363

l. [Fill from D3oth_specify /The other staff member you mentioned]

Shape364

Shape365

m. [Fill from D3oth_specify /The other staff member you mentioned]

Shape366

Shape367



all

D5. Who works on printing or copying the letters sent to notify parents or guardians of certification status?

Var


Select all that apply

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Database or programming staff 5

District-level food service clerical or administrative staff 6

District-level communications department 7

Other district-level clerical or administrative staff 8

Principals 9

School secretaries or administrative staff 10

Other school-level staff 11

Specify Shape368 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape369 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape370 STRING (NUM))

Not applicable N GO TO D7

NO RESPONSE M GO TO D7



d5 ne m and d5 ne n

FILL response options (a-j) from responses selected at d5

fill response option k from D5oth_specify;

if D5oth_specify is empty, fill The other school-level staff member you mentioned

FILL RESPONSE options l and m FROM d5oth_specify;

IF D5oth_specify IS EMPTY, FILL The other staff member you mentioned

D6. How many hours did the following people spend printing or copying notification letters each period? Please include management time. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. District food service director

Shape371

Shape372

b. Superintendent

Shape373

Shape374

c. Business manager

Shape375

Shape376

d. Student database administrator

Shape377

Shape378

e. Database or programming staff

Shape379

Shape380

f. District-level food service clerical or administrative staff

Shape381

Shape382

g. District-level communications department

Shape383

Shape384

h. Other district-level clerical or administrative staff

Shape385

Shape386

i. Principals

Shape387

Shape388

j. School secretaries or administrative staff

Shape389

Shape390

k. [Fill from D5oth_specify/ The other school-level staff member you mentioned]

Shape391

Shape392

l. [Fill from D5oth_specify /The other staff member you mentioned]

Shape393

Shape394

m. [Fill from D5oth_specify /The other staff member you mentioned]

Shape395

Shape396



all

D7. In the past three months, how much money was spent on postage or other delivery costs for certification-related activities? Please include costs of mailing applications to parents or guardians, business reply envelopes, letters to parents or guardians notifying them of certification status, and any other postage or delivery costs.

Var


AMOUNT

a. Costs in July-September 2012

$ Shape397

b. Average Monthly Cost After October, 2012 1

$ Shape398

NO RESPONSE M


all

D8. Who responds to questions about certification decisions?

Var


Select all that apply

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Database or programming staff 5

District-level food service clerical or administrative staff 6

District-level communications department 7

Other district-level clerical or administrative staff 8

Principals 9

School secretaries or administrative staff 10

Other school-level staff 11

Specify Shape399 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape400 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape401 STRING (NUM))

Not applicable N GO TO D10

NO RESPONSE M GO TO D10



d8 ne m and d8 ne n

FILL response options (a-j) from responses selected at d8

fill response option k from D8oth_specify;

if D8oth_specify is empty, fill The other school-level staff member you mentioned

FILL RESPONSE options l and m FROM d8oth_specify;

IF D8oth_specify IS EMPTY, FILL The other staff member you mentioned

D9. How many hours did the following people spend responding to questions about certification decisions each period? Please include management time. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. District food service director

Shape402

Shape403

b. Superintendent

Shape404

Shape405

c. Business manager

Shape406

Shape407

d. Student database administrator

Shape408

Shape409

e. Database or programming staff

Shape410

Shape411

f. District-level food service clerical or administrative staff

Shape412

Shape413

g. District-level communications department

Shape414

Shape415

h. Other district-level clerical or administrative staff

Shape416

Shape417

i. Principals

Shape418

Shape419

j. School secretaries or administrative staff

Shape420

Shape421

k. [Fill from D8oth_specify/ The other school-level staff member you mentioned]

Shape422

Shape423

l. [Fill from D8oth_specify /The other staff member you mentioned]

Shape424

Shape425

m. [Fill from D8oth_specify /The other staff member you mentioned]

Shape426

Shape427



all

D10. How were certification results made available to school food service cashiers?

Var


Select one only

Transmitted through an automated process 1

Lists printed and distributed 2

Response Option Other (SPECIFY) 99

SShape428 pecify (STRING (NUM))

NO RESPONSE M


all

D11. Who coordinated or worked on making certification results available to school food service cashiers? Please include entering certification status into electronic systems as well as creating printed lists.

Var


Select all that apply

District food service director 1

Superintendent 2

Business manager 3

Student database administrator 4

Database or programming staff 5

District-level food service clerical or administrative staff 6

District-level communications department 7

Other district-level clerical or administrative staff 8

Principals 9

School secretaries or administrative staff 10

School-level food service staff 11

Other school-level staff 12

Specify Shape429 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape430 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape431 STRING (NUM))

Not applicable N GO TO D13

NO RESPONSE M GO TO D13



d11 ne m and d11 ne n

FILL response options (a-j) from responses selected at d11

fill response option k from D11oth_specify;

if D11oth_specify is empty, fill The other school-level staff member you mentioned

FILL RESPONSE options l and m FROM d11oth_specify;

IF D11oth_specify IS EMPTY, FILL The other staff member you mentioned

D12. How many hours did the following people spend making certification results available to school food service cashiers each period? Please include management time and time spent entering certification status into electronic systems, as well as time spent creating printed lists.. (Your best estimate is fine.)

Hours in July-September

Hours in Typical Month post October 1

a. District food service director

Shape432

Shape433

b. Superintendent

Shape434

Shape435

c. Business manager

Shape436

Shape437

d. Student database administrator

Shape438

Shape439

e. Database or programming staff

Shape440

Shape441

f. District-level food service clerical or administrative staff

Shape442

Shape443

g. District-level communications department

Shape444

Shape445

h. Other district-level clerical or administrative staff

Shape446

Shape447

i. Principals

Shape448

Shape449

j. School secretaries or administrative staff

Shape450

Shape451

k. School-level food service staff

Shape452

Shape453

l. [Fill from D11oth_specify/ The other school-level staff member you mentioned]

Shape454

Shape455

m. [Fill from D11oth_specify /The other staff member you mentioned]

Shape456

Shape457

n. [Fill from D11oth_specify /The other staff member you mentioned]

Shape458

Shape459



E. STAFF SALARIES

E1. Each of the staff categories that you have indicated were involved in certification activities are listed below.

E1a. Please enter the average salary or hourly rate (do not include fringe benefit costs) that employees in each category were paid in SY 2012-2013.

E1b. (For each response at E1) Is that per hour, per week, biweekly, bimonthly, per month or per year?

E1.

Staffing Position

(Fill with staff categories at Q…)

E1a.

Pay Rate
(dollars)

E1b.

Basis Paid
(select from list)

1Shape460

(STRING (NUM))

1Shape461

(STRING (NUM))

1

1 per hour

2 per week

3 biweekly

4 bimonthly

5 per month

6 per year

2

2

2

3

3

3

4

4

4

5

5

5

6

6

6

7

7

7

8

8

8

9

9

9

10

10

10



E2. [For each response at E1] Are fringe benefits calculated as a percentage (such as 50 percent of salary), or some other way?

If as a percentage, go to E2a. If some other way, go to E2b.

E2a. Please enter the rate.

E2b. If fringe benefits are not calculated as a percentage, but as an amount or some other way, please enter the dollar amount.

E1.

Staffing Position

(Fill with staff categories at Q…)

E2.

Fringe Benefit

E2a.

Fringe Benefit Percentage

E2b.

Calculated another way (Enter dollar amount):

1Shape462

(STRING (NUM))

1

1 Percentage (GO TO E2a)

2 Some other way (GO TO E2b)

1Shape463

PERCENTAGE

OShape464 THER SPECIFY


2

2



3

3



4

4



5

5



6

6



7

7



8

8



9

9



10

10




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 48 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

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