Form FNS 878 FNS 878 SLEB SNAP Fraud Investigation Cost Reconciliation

OMB APPROVED NO. 0584-NEW
Expiration Date: XX/XX/XXXX
U.S. DEPARTMENT OF AGRICULTURE FOOD AND NUTRITION SERVICE

SLEB SNAP Fraud Investigation Cost Reconciliation

1. STATE/U.S. TERRITORY
2a. FNS REGION
2b. IAB AREA/WORKCENTER
3. FEDERAL FISCAL YEAR
4a.
FROM
MONTH YEAR

4b.
TO
MONTH YEAR

Fiscal Year
5

Cost Type

01

Compensation (§200.430)

02

Travel/Lodging (§200.474)

03

Training (§200.472)

04

Supplies (§200.453)

05

Other (§200.430 - §200.475)

Previously Reported Costs

Total (1 - 5)
6. EXPLANATION OF COSTS:
Compensation:

Travel:

Training:

Supplies:

Other:

FORM FNS-878 (11/16)

SBU
1

Current Costs

TOTALS

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Summary of Investigative Outcomes:
Case

Number

For each investigation, please provide a detailed explanation of the investigation to include the following:
The name of the business/individual being investigated, the address of the business/individual, names of
other individuals involved, the reason for the investigation, the status of the investigation, any results of
the investigation, and any other pertinent information regarding the investigation.

01

02

03

04

05

2

Contact Information
for SLEB Investigator

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Record of Distribution of EBT Benefits
Case Number

EBT card number

Date card was
issued

Amount of benefits
posted to the card

Unit and individual who was issued the card

Additional amounts
posted

01
02
03
04
05

9

Record of Use of EBT Benefits
Case Number

EBT card number

Date of transaction
(list each separately)

Individual who used the
card

Amount of
benefits used

Amount of cash
exchanged for
EBT benefits

If no cash was exchanged,
description of what was
exchanged

Other individuals involved
in the transaction

01
02
03
04
05

10

EBT Benefits Reconciliation and Summary of Use

Case Number

EBT card number

Benefits on hand at
beginning of reporting
period

Benefits added to card
during reporting period

All EBT benefits used
during reporting period

01
02
03
04
05
11

EBT benefits on hand at
end of reporting period

Approval

Approver Signature

Approver Printed Name

3

Date

Remittance for amount of EBT benefits
not documented as having been used
during reporting period

INSTRUCTIONS
FORM FNS 878
GENERAL. This form is used to provide detailed costs
related to State Law Enforcement Bureau (SLEB)
investigations of Supplemental Nutrition Assistance
Program (SNAP) Electronic Benefits Transfer (EBT)
benefits fraud in accordance with OMB Super-Circular
Vol 78 No. 248, subpart E: Cost Principles. The form
provides a cost breakdown associated with SLEB
investigations of SNAP EBT benefit fraud, a summary
of investigative outcomes, and details on SNAP EBT
benefits used to conduct investigations. In conformity
with OMB Super-Circular Vol 78 No. 248, subpart E:
Cost Principles Section 200.405, allocable costs involve
goods or services designated to conduct investigations
into possible violations of SNAP regulations.

paid currently or accrued, rendered during
the period of performance under the
Federal award, including wages and
salaries directly attributed to investigating
SNAP EBT benefit fraud.
02 Travel/Lodging/Meals (§200.474) –
Include expenses incurred for
transportation, lodging, subsistence, and
related items incurred by employees who
are in travel status on official
business directly attributed to investigating
SNAP EBT benefit fraud.
03 Training (§200.472) – Include costs
incurred for training and education for
employee development directly related to
investigating SNAP EBT benefit fraud.

1 STATE / U.S. Territory. Include the State or U.S.
Territory of the agency completing the form.

04 Supplies (§200.453) – Include costs
incurred for materials and supplies
necessary to carry out SNAP EBT benefit
fraud investigations.

2a FNS REGION. Include the Food and Nutrition
Service (FNS) regional office that covers the State
listed in question 1. See Table A below.

05 Other Costs (§200.430 - §200.475) –
Include other allowable costs incurred as
part of the investigation of SNAP EBT
benefit fraud.

2b IAB AREA / WORKCENTER. Include the
Investigative Analysis (IAB) area/workcenter that
covers the State listed in question 1. See Table B
below.
3 FEDERAL FISCAL YEAR. Include the Federal
fiscal year (FY) for the reporting period. The
Federal FY starts on October 1 and ends on
September 30. For example, FY 2017 begins on
October 1, 2016, and ends on September 30, 2017.
4a FROM (MONTH/YEAR). Include the start month
and year for the reporting period.
4b TO (MONTH/YEAR). Include the end month and
year for the reporting period.
5 COST TYPE. Include allowable costs incurred as
part of the SNAP EBT benefit fraud investigation.
Costs may include compensation, travel, training,
and supplies; however, other allowable costs may
be incurred as part of the investigation. All costs
must be noted on this form and described in detail
in section 6. OMB Super-Circular Vol 78 No. 248,
subpart E: Cost Principles provides guidance on
allowable costs.

6 EXPLANATION OF COSTS. Include a detailed
explanation of all allowable costs and the
calculations listed in section 5, and how it relates to
the investigation.
7 SUMMARY OF INVESTIGATIVE OUTCOMES:
Detail the procedures for and results of SNAP EBT
benefit fraud investigations. Provide detailed
explanations of each investigation to include: the
name of the business/individual being investigated,
the address of the business/individual, names of
other individuals involved, the reason for the
investigation, the status of the investigation, any
results of the investigation, and any other pertinent
information regarding the investigation.

2

8 SNAP EBT BENEFIT VALIDATION: Provide
details for each SNAP EBT card received and
SNAP benefits used during the investigations,
including the original distribution of SNAP EBT
benefits, a record of each individual transaction for
each SNAP EBT card, and a reconciliation of the
usage of SNAP EBT benefits for each card in the
SLEBs possession.

01 Compensation (§200.430) – Include all
remuneration for services of employees,

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Table A. Use this information to complete question 2a.
Food and Nutrition Service (FNS)
Regional Office

States / U.S. Territories

NERO (Northeast Regional Office)

Connecticut
Maine
Massachusetts
New Hampshire

New York
Rhode Island
Vermont

MARO (Mid-Atlantic Regional Office)

Delaware
District of Columbia
Maryland
New Jersey
Pennsylvania

Puerto Rico
Virginia
Virgin Islands
West Virginia

SERO (Southeast Regional Office)

Alabama
Florida
Georgia
Kentucky

Mississippi
North Carolina
South Carolina
Tennessee

MWRO (Midwest Regional Office)

Illinois
Indiana
Michigan

Minnesota
Ohio
Wisconsin

SWRO (Southwest Regional Office)

Arkansas
Louisiana
New Mexico

Oklahoma
Texas

MPRO (Mountain Plains Regional Office)

Colorado
Iowa
Kansas
Missouri
Montana

Nebraska
North Dakota
South Dakota
Utah
Wyoming

WRO (Western Regional Office)

Alaska
American Samoa
Arizona
California
Guam Hawaii

Idaho
Nevada Oregon
Trust Territories
Washington

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Table B. Use this information to complete question 2b.
Investigative Analysis Branch (IAB)
Area/Workcenter

States / U.S. Territories

IAB 1

Connecticut
Delaware
District of Columbia
Maine
Massachusetts

IAB 2

New York *

IAB 3

Indiana
Kentucky
Michigan
North Carolina

Ohio
Tennessee
Virginia
West Virginia

IAB 4

Alabama
Georgia
Florida
Louisiana

Mississippi
Puerto Rico
South Carolina
Virgin Islands

Arkansas
Illinois
Iowa
Kansas
Minnesota
Missouri
Montana
Alaska
Arizona
California
Colorado
Hawaii

Nebraska
North Dakota
Oklahoma
South Dakota
Texas
Wisconsin
Wyoming

New York*

Pennsylvania

IAB 5

IAB 6

IAB 7

Maryland
New Hampshire
New Jersey
Rhode Island
Vermont

Idaho
Nevada
New Mexico
Oregon
Utah

* New York State is covered by both IAB Area 2 and IAB Area 7.

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