Business- Profit & Not -for- Profit

Appendix F: Memorandum of Understanding between _________

And The

SUMMER ELECTRONIC BENEFIT TRANSFER for Children Evaluation Team

Purpose

This Memorandum of Understanding (MOU) is between __________________ and the Summer Electronic Benefit Transfer for Children Evaluation Team (SEBTC ET) which is comprised of Abt Associates Inc. of 55 Wheeler Street, Cambridge, MA 02138 on behalf of itself and Mathematica Policy Research concerning participation in the Food and Nutrition Service (FNS) of the U.S. Department of Agriculture's (USDA) evaluation and study of the Summer EBT for Children Demonstration Project (SEBTC Demonstration). This MOU describes generally the terms and conditions associated with the participation of _______ in the study. _______ agreed to cooperate with the evaluation study as a condition of receiving a grant to conduct the SEBTC Demonstration. ________ and SEBTC ET are signing this agreement in good faith, and with the expectation of fulfilling their respective obligations as described in this MOU. The sub-grantees and partners participating in the SEBTC Project with ______ include: EBT vendor. The SEBTC Project area consists of _______ School Districts containing ________ contiguous school food authorities spanning _______________Counties.

The SEBTC ET will conduct and collect the following data collection:

1. Interview staff member(s) of ___________ about the implementation and administration of SEBTC during summer 2014.

2. Collect administrative records from _________’s EBT transaction data. Data needs for the evaluation are specified below.

Prior to conducting data collection, the SEBTC ET will obtain necessary initial approvals, continuing approvals or exemptions from the U.S. Office of Management and Budget and the Abt Associates Institutional Review Board (Abt's IRB). Evidence of these approvals will be presented to ______ prior to conducting data collection.

The evaluation team will protect confidential personal information as required by the contract with FNS and applicable Federal laws and regulations. This applies to all data shared by the grantee, sub-grantees, and partners (including the EBT Vendor and all School Food Authorities (SFA) and/or public school districts participating in the demonstration project) with members of the SEBTC ET. No personal identifying information from any interviews conducted by the SEBTC ET will be used in any report or in the public use database. Information collected will not be attributed to a single respondent or a single demographic but will be presented in the aggregate and analyzed across a host of variables. All correspondence between the SEBTC ET and the Grantees’ and partners’ members will remain confidential to the extent required by law.

Roles and Responsibilities of _______

1. Oversee the SEBTC Demonstration and provide access to data from its sub-grantees as specified in the MOU.

2. ______, working with EBT vendor, will facilitate the provision of certain required administrative data from ________'s EBT system, as specified below.

Changes to the Agreement

We anticipate that over the course of the study, some modifications or additions may need to be made to this agreement. It is understood that the terms may be adjusted with written amendments as agreed upon by both parties.

Signatures

The following people have read this Memorandum of Understanding; acknowledge the terms and conditions regarding participation in the USDA Food and Nutrition Service's Evaluation of the Summer EBT for Children Demonstration by ________,its sub-grantees, and its partners; and each individually represents that it has authority and authorization to execute.

_{For Abt Associates, Inc.:}

Ann Collins, Project Director

As Authorized Representative of Abt Associates, Inc., and

Mathematica Policy Research

For Grantee:

Name

Title

Date

_{Contact Information for Designated Liaisons}

Organization	Abt Associates,Inc or Mathmatica	Grantee
Name of Liaison
Title
Office Number
Cell Number
E-mail
Fax Number

Requested data:

1. SEBTC transaction data (from Case/Card and History Files)

Data for each transaction

• Date and time

• Transaction type (debit/credit)

• Transaction mode (regular/manual)

• FNS or Retailer ID number (see note 2 below)

• Dollar amount (for all purchases)

Data for WIC transactions (by food category/subcategory}

Issuance data: food items prescribed, item detail (number of units, size of units}

Purchase data: food items purchased, item detail (number of units, size of units, unit price}

For States with multiple SEBTC sites, SEBTC case/card and transaction data should be provided separately for each site, or else the data should include a site identifier.

Notes:

.. File format for WIC will be identified in each site. Data list includes defined evaluation needs; additional available data will be considered.

FNS retailer number is needed for all reta ilers with SEBTC transactions, in order to link to FNS STARS/REDE data and determine FNS retailer type. WIC States can provide a crosswalk of State WIC retailer number to FNS retailer number in a separate file, if FNS number is not included in the WIC EBT transaction data. This file or the transaction file should also include WIC retailer type.

2. SEBTC Summary Reports

Participation reports (monthly}

• Number of households receiving SEBTC benefits

•Amount of benefits issued (number of children receiving benefits for

WIC sites)

•Number of households by number of transactions (0, 1, 2, 3, 4, 5, 6 or more)

•Amount of benefits redeemed (WIC sites; quantity by food item category and fruit/vegetable$ for WIC sites}

•Amount of benefits remaining in accounts (WIC sites; quantity by food item category and fruit/vegetable $for WIC sites)

Amount of benefits expunged from or expired from SEBTC-WIC accounts ($) (one-time report at close-out of demonstration)

_{Transaction activity reports (monthly reports for debits and credits)}

Number and value of transactions by time of day (hourly preferred)

Number and value of transactions by day of month

Number and value of transactions by type of retailer

Number of denied transactions, by reason

Number of cards by number of transactions (if not always 1card per household)

SEBTC card issuance data (monthly; only count cards issued specifically for SEBTC)

Number issued

Number lost/stolen

Number replaced

Number of PIN locks

GRANTEE AND SEBTC MOU; 2014