Attachment D FNS-828 School Food Authority Paid Lunch Price Report

OMB APPROVED NO. 0584-0594
Expiration Date: XX/XX/XXXX

UNITED STATES DEPARTMENT OF AGRICULTURE - Food and Nutrition Service

SCHOOL FOOD AUTHORITY PAID LUNCH PRICE REPORT
This form is for reporting SFA paid reimbursable lunch price data by each group of students.
STATE AGENCY NAME:

Enter the State Agency total number of SFAs:
Enter the school year (20XX-20XX):

Instructions: Please enter the most frequently charged price for each group of students. Students should be
grouped into the Elementary, Middle/Junior High, and High school categories as used within each SFA.
*For SFAs with no students in one of the above groups, please enter "N/A".
**For SFAs that do not charge a paid price for student lunches please enter "$0.00".
***State agencies must consolidate paid lunch prices reported by SFAs for the current school year and submit the
FNS-828 to FNS by the last operating day of November each year.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 0584-0594. The time required to
complete this information collection is estimated to average 10 hours per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information.

Column 1
SFA Name

Enter the name of the
SFA

Column 2
SFA ID

Enter the SFA ID

FORM FNS-828 (05-11) Previous Editions Obsolete

Column 3

Column 4

Elementary

Middle/Junior High

Enter the most
frequently charged
paid price for
elementary school
d
($X XX)

Enter the most
frequently charged paid
lunch price for middle/jr
high school students
($X XX)

SBU

Column 5
High
Enter the most
frequently charged
paid lunch price for
high school students
($X XX)

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