State and Local Governments

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

Appendix F.2 (5-10-13)

State and Local Governments

OMB: 0584-0586

Document [docx]
Download: docx | pdf

A


ppendix F.2: District Cost Survey – SY 2013-2014 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. It is set up 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 the 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.

Does your State conduct matching at the State level for direct certification?

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. Does your district conduct matching at the district level for direct certification?

Var


Yes 1

No 0

NO RESPONSE M


a1 = 1 and a2 = 1

A3. Which entity performs 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 is direct certification conducted in your district?

Var


Select one only

Direct certification is not used 1

Other (specify) 2 GO TO B1

SShape1 pecify (STRING (NUM))

NO RESPONSE M GO TO B1


a4 = 1

A5. Why is 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 are 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 is responsible for overseeing the direct certification process in your district?

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 is [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 is [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] each month? Please include management time. (Your best estimate is fine.)



HOURS

a. Hours in [MONTH 1]

Shape10

b. Hours in [MONTH 2]

Shape11

C. CERTIFICATION BY APPLICATION



all

Next, we ask about the certification by application process in your district.

C1. Who is responsible for overseeing the certification by application process in your district?

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 are 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. Is 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. Does 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 is received through the web-based process?

Var

Shape16

%

(RANGE NUMBER RANGE)

Don’t know yet (first year of use) D

NO RESPONSE M



c4 = 1

C7. Who manages 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 month for managing the web-based application site? (Your best estimate is fine.)

Var


DOLLARS

a. Cost in [MONTH 1]

$Shape18

b. Cost in [MONTH 2]

$Shape19



NO RESPONSE M



c7=1 or c7=3

C9. Who at the district works 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 month? Please include management time, as well as time spent developing and testing the site. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

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 2013-2014 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 2013-2014 school year?

Var


Yes 1

No 0

NO RESPONSE M



c11=1

IF C12=1, FILL and translations

C13. Who coordinates or works 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 month? Please include management time. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

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 coordinates or works 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 month? Please include management time as well as time spent printing forms. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

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 this year? Your best estimate is fine.

Var



(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?


Shape100 $ (FIELD DESCRIPTION)

(RANGE NUMBER RANGE)

NO RESPONSE M



c15 ne 1

C

Var

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


Shape101 $ (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 does 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 (Shape102 STRING (NUM))

NO RESPONSE M


ALL

C22. Who works 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 (Shape103 STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape104 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape105 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 month? Please include management time. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

a. District food service director

Shape106

Shape107

b. Superintendent

Shape108

Shape109

c. Business manager

Shape110

Shape111

d. Student database administrator

Shape112

Shape113

e. Database or programming staff

Shape114

Shape115

f. District-level food service clerical or administrative staff

Shape116

Shape117

g. District-level communications department

Shape118

Shape119

h. Other district-level clerical or administrative staff

Shape120

Shape121

i. Principals

Shape122

Shape123

j. School secretaries or administrative staff

Shape124

Shape125

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

Shape126

Shape127

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

Shape128

Shape129

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

Shape130

Shape131



all

C24. How are 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

SShape132 pecify (STRING (NUM))

NO RESPONSE M



all

C25. Who works 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 (Shape133 STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape134 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape135 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 month? Please include management time. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

a. District food service director

Shape136

Shape137

b. Superintendent

Shape138

Shape139

c. Business manager

Shape140

Shape141

d. Student database administrator

Shape142

Shape143

e. Database or programming staff

Shape144

Shape145

f. District-level food service clerical or administrative staff

Shape146

Shape147

g. District-level communications department

Shape148

Shape149

h. Other district-level clerical or administrative staff

Shape150

Shape151

i. Principals

Shape152

Shape153

j. School secretaries or administrative staff

Shape154

Shape155

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

Shape156

Shape157

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

Shape158

Shape159

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

Shape160

Shape161



ALL

C27. Who answers 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 Shape162 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape163 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape164 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 month? Please include management time. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

a. District food service director

Shape165

Shape166

b. Superintendent

Shape167

Shape168

c. Business manager

Shape169

Shape170

d. Student database administrator

Shape171

Shape172

e. Database or programming staff

Shape173

Shape174

f. District-level food service clerical or administrative staff

Shape175

Shape176

g. District-level communications department

Shape177

Shape178

h. Other district-level clerical or administrative staff

Shape179

Shape180

i. Principals

Shape181

Shape182

j. School secretaries or administrative staff

Shape183

Shape184

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

Shape185

Shape186

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

Shape187

Shape188

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

Shape189

Shape190




c4 = 1

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

C29. How often are 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

SShape191 pecify (STRING (NUM))

NO RESPONSE M



all

C30. Are 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. Is 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 collects 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 Shape192 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape193 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape194 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 month? Please include management time. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

a. Principals

Shape195

Shape196

b. School secretaries or administrative staff

Shape197

Shape198

c. School-level food service staff

Shape199

Shape200

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

Shape201

Shape202

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

Shape203

Shape204

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

Shape205

Shape206


C30 NE 2

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

Var


Yes 1

No 0

NO RESPONSE M



C30 NE 2

C35. Does each school keep originals or copies of the hardcopy applications it receives?

Var


Yes 1

No 0

NO RESPONSE M



C30 NE 2

C36. Who logs or copies forms (as applicable) and then sends 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 Shape207 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape208 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape209 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 month? Please include management time. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

a. Principals

Shape210

Shape211

b. School secretaries or administrative staff

Shape212

Shape213

c. School-level food service staff

Shape214

Shape215

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

Shape216

Shape217

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

Shape218

Shape219

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

Shape220

Shape221



C30 ne 2

C38. How often are 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

SShape222 pecify (STRING (NUM))

NO RESPONSE M



all

C39. Who works 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 (Shape223 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape224 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 month? Please include management time. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

a. District food service director

Shape225

Shape226

b. Superintendent

Shape227

Shape228

c. Business manager

Shape229

Shape230

d. Student database administrator

Shape231

Shape232

e. Database or programming staff

Shape233

Shape234

f. District-level food service clerical or administrative staff

Shape235

Shape236

g. District-level communications department

Shape237

Shape238

h. Other district-level clerical or administrative staff

Shape239

Shape240

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

Shape241

Shape242

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

Shape243

Shape244



C30 ne 2

C41. Are 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 works 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 Shape245 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape246 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape247 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 month? Please include management time. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

a. District food service director

Shape248

Shape249

b. Superintendent

Shape250

Shape251

c. Business manager

Shape252

Shape253

d. Student database administrator

Shape254

Shape255

e. Database or programming staff

Shape256

Shape257

f. District-level food service clerical or administrative staff

Shape258

Shape259

g. District-level communications department

Shape260

Shape261

h. Other district-level clerical or administrative staff

Shape262

Shape263

i. Principals

Shape264

Shape265

j. School secretaries or administrative staff

Shape266

Shape267

k. School-level food service staff

Shape268

Shape269

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

Shape270

Shape271

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

Shape272

Shape273

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

Shape274

Shape275



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 (Shape276 STRING (NUM))

NO RESPONSE M



all

C45. For “complete” applications, is 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 reviews “complete” applications to determine certification status? Please include internal review 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 Shape277 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape278 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape279 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 month? Please include management time and time spent on internal reviews of initial determination. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

a. District food service director

Shape280

Shape281

b. Superintendent

Shape282

Shape283

c. Business manager

Shape284

Shape285

d. Student database administrator

Shape286

Shape287

e. Database or programming staff

Shape288

Shape289

f. District-level food service clerical or administrative staff

Shape290

Shape291

g. District-level communications department

Shape292

Shape293

h. Other district-level clerical or administrative staff

Shape294

Shape295

i. Principals

Shape296

Shape297

j. School secretaries or administrative staff

Shape298

Shape299

k. [Fill from C46oth_specify/ The other school-level staff member you mentioned]

Shape300

Shape301

l. [Fill from C46oth_specify /The other staff member you mentioned]

Shape302

Shape303

m. [Fill from C46oth_specify /The other staff member you mentioned]

Shape304

Shape305





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

SShape306 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 are directly certified.

D1. Who works 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 Shape307 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape308 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape309 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 month? Please include management time. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

a. District food service director

Shape310

Shape311

b. Superintendent

Shape312

Shape313

c. Business manager

Shape314

Shape315

d. Student database administrator

Shape316

Shape317

e. Database or programming staff

Shape318

Shape319

f. District-level food service clerical or administrative staff

Shape320

Shape321

g. District-level communications department

Shape322

Shape323

h. Other district-level clerical or administrative staff

Shape324

Shape325

i. Principals

Shape326

Shape327

j. School secretaries or administrative staff

Shape328

Shape329

k. School-level food service staff

Shape330

Shape331

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

Shape332

Shape333

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

Shape334

Shape335

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

Shape336

Shape337



all

D3. Who works 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 Shape338 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape339 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape340 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 month? Please include management time. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

a. District food service director

Shape341

Shape342

b. Superintendent

Shape343

Shape344

c. Business manager

Shape345

Shape346

d. Student database administrator

Shape347

Shape348

e. Database or programming staff

Shape349

Shape350

f. District-level food service clerical or administrative staff

Shape351

Shape352

g. District-level communications department

Shape353

Shape354

h. Other district-level clerical or administrative staff

Shape355

Shape356

i. Principals

Shape357

Shape358

j. School secretaries or administrative staff

Shape359

Shape360

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

Shape361

Shape362

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

Shape363

Shape364

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

Shape365

Shape366



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 Shape367 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape368 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape369 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 month? Please include management time. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

a. District food service director

Shape370

Shape371

b. Superintendent

Shape372

Shape373

c. Business manager

Shape374

Shape375

d. Student database administrator

Shape376

Shape377

e. Database or programming staff

Shape378

Shape379

f. District-level food service clerical or administrative staff

Shape380

Shape381

g. District-level communications department

Shape382

Shape383

h. Other district-level clerical or administrative staff

Shape384

Shape385

i. Principals

Shape386

Shape387

j. School secretaries or administrative staff

Shape388

Shape389

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

Shape390

Shape391

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

Shape392

Shape393

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

Shape394

Shape395



all

D7. In the past two 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 [MONTH 1]

$ Shape396

b. Costs in [MONTH 2]

$ Shape397



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 Shape398 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape399 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape400 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 month? Please include management time. (Your best estimate is fine.)

Hours in [MONTH 1]

Hours in [MONTH 2]

a. District food service director

Shape401

Shape402

b. Superintendent

Shape403

Shape404

c. Business manager

Shape405

Shape406

d. Student database administrator

Shape407

Shape408

e. Database or programming staff

Shape409

Shape410

f. District-level food service clerical or administrative staff

Shape411

Shape412

g. District-level communications department

Shape413

Shape414

h. Other district-level clerical or administrative staff

Shape415

Shape416

i. Principals

Shape417

Shape418

j. School secretaries or administrative staff

Shape419

Shape420

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

Shape421

Shape422

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

Shape423

Shape424

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

Shape425

Shape426



all

D10. How are 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

SShape427 pecify (STRING (NUM))

NO RESPONSE M



all

D11. Who coordinates or works 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 Shape428 (STRING (NUM))

Response Option Other (SPECIFY) 98

Specify (Shape429 STRING (NUM))

Response Option Other (SPECIFY) 99

Specify (Shape430 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 month? 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 [MONTH 1]

Hours in [MONTH 2]

a. District food service director

Shape431

Shape432

b. Superintendent

Shape433

Shape434

c. Business manager

Shape435

Shape436

d. Student database administrator

Shape437

Shape438

e. Database or programming staff

Shape439

Shape440

f. District-level food service clerical or administrative staff

Shape441

Shape442

g. District-level communications department

Shape443

Shape444

h. Other district-level clerical or administrative staff

Shape445

Shape446

i. Principals

Shape447

Shape448

j. School secretaries or administrative staff

Shape449

Shape450

k. School-level food service staff

Shape451

Shape452

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

Shape453

Shape454

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

Shape455

Shape456

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

Shape457

Shape458


E. STAFF SALARIES

E1. Each of the staff categories that you indicated are 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 are paid.

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)

1Shape459

(STRING (NUM))

1Shape460

(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):

1Shape461

(STRING (NUM))

1

1 Percentage (GO TO E2a)

2 Some other way (GO TO E2b)

1Shape462

PERCENTAGE

OShape463 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 45 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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File Created2021-01-29

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