Obtaining Feedback from LEAs that Participated in the USDA's Verification Improvement Project

Attachment B - Participant feedback survey - NSLP verification project

OMB Number:
0503-0021
Expiration Date:
02/28/2018

Participant feedback survey – school year 2015-2016 verification project

1. Please attach the final version of our modified initial verification notice that you sent this
year.
2. How many households:
_____ received an initial verification notice, by letter, from your office
submitted paper documents by mail
emailed pictures of documents
personally dropped off documents at your office (or at the school)
other methods
_____ did not respond and received benefit termination letters from your office
3. How many households received one or more follow-up verification requests from your
office (including letters, phone calls, email or text messages, etc.)?
(Please list the number of households contacted at least once after the initial letter, not
the number of separate contacts made to each household.)

4. Did your office send stamped return envelopes with your initial verification letters?
 Y
 N
5. If any households responded with emailed pictures of documents, please comment on the
general quality (readability, etc.) or completeness of those images.

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 0503-0021. The time required to
complete this information collection is estimated to average 10 minutes 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.

6. Please comment on the general quality or completeness of documents delivered by other
means (mailed photocopies, mailed originals, documents delivered in person).

What is the name of the software products and the name of the software vendors (ex.,
“Heartland”, “Horizon”) that your office uses to process applications, determine the
verification sample, and print and/or send your verification letters?
For processing applications: Product _____________ Vendor _________________
For determining verification sample: Product __________ Vendor ______________
For printing/sending verification letters: Product __________ Vendor _____________
7. Please provide us with any additional feedback on your experience in this year’s
verification project.