Form FNS 640 (A/B) FNS 640 (A/B) Administrative Review Report

---

Overview

FNS-640A
FNS-640B

---

Sheet 1: FNS-640A

A1. General SFA Information

A2. Certification and Benefit Issuance Review Method

A3. Fiscal Action

A4. Resource Management

A1-1. SFA ID

A1-2. SFA Name

A1.3. Review Period (Month)

A1-4. Review Period (Year)

A1-5. Total # Schools offering SBP

A2-1. Sampling Methodology (Select [x] one)

A2-2. Total # of Students Reviewed (i.e. Sample Size #)

A2-3. SFA Count of Reviewed Students (#)

A2-4. SA Count of Reviewed Students (#)

A2-5. Application Errors by Type (#)

A2-6. Total # of Applications Miscategorized

A2-7. Total # of Benefit Issuance Errors

A3-1. NSLP Total Overclaim/Underclaim ($ +/-)

A3-2. SBP Total Overclaim/Underclaim ($+/-)

A3-3. Afterschool Snacks Total Overclaim/Underclaim ($+/-)

A3-4. Was Overclaim Disregarded (Select [x] if Yes)

A3-5. Were Funds Withheld or Recovered (Select [x] if Yes)

A3-6. Underclaim paid to SFA ($)

A4-1. Risk Flag(s) Triggered (Select [x] all that apply)

A2-1A. 100%

A2-1B. 95% Confidence Level /Electronic Sysytem

A2-1C. 99% Confidence Level / Manual System

A2-3A. Free

A2-3B. Reduced price

A2-4A. Free

A2-4B. Reduced price

A2-5A. Child or Household Name

A2-5B. Case Number

A2-5C. Income Amount or Source

A2-5D. Social Security # (last 4 digits)

A2-5E. Adult Signature

A2-6A. Free -> Reduced Price

A2-6B. Free -> Paid

A2-6C. Reduced price -> Paid

A2-6D. Reduced price -> Free

A2-7A. Free -> Reduced Price

A2-7B. Free -> Paid

A2-7C. Reduced price -> Paid

A2-7D. Reduced price -> Free

A4-1A. SFA Enrollment

A4-1B. NonProfit School Food Service Account

A4-1C. Paid Lunch Equity

A4-1D. Revenue from NonProgram Foods

A4-1E. Indirect Costs

---

Sheet 2: FNS-640B

B1. General SFA Information

B2. General School Information

B3-1. Meal Service Information

B3-2. Day of Review

B3-3. Review Period

B3-4. Recalculation

B4-1. Meal Service Information

B4-2. Day of Review

B4-3. Review Period

B4-4. Recalculation

B5-1. Day of Review

B5-2. Review Period

B1-1. SFA ID #

B1-2. SFA Name

B2-1. School Name

B2-2. Type of School (Select [x] all that apply)

B2-3. Special Provision Options 1, 2 & 3 (Complete Fields as Applicable)

B2-4. Community Eligibility Provision (Complete Fields as Applicable)

B2-5. Food Service System (Select [x] all that apply)

B2-6. CN Programs Offered (Select [x] all that apply)

B2-7. Nonprogram Foods (Select [x] all that apply)

B2-8. OVS (Select [x] if Yes)

B2-9. Targeted Menu Review (DSAT) (Select [x] all that apply)

B3-1A. Location of Meal Service (Select [x] all that apply)

B3-1B. # of points where meal counts are taken

B3-1C. Total # of students with program access

B3-1D. Meal Patterns utilized in the school (Select [x] all that apply)

B3-1E. Review Period: # Serving days

B3-2A. Total # of Meals Served

B3-2B. # of Ineligibles and/or Second Meals Counted

B3-2C. # Meals Served Missing Meal Components

B3-2D. # Incomplete Meals (By Violation Type, leave blank if NA)

B3-2E. Difference (+/-) between SFA and SA Meal Count (#)

B3-3A. Total # of Meals Served

B3-3B. # of Ineligibles and/or Second Meals Counted

B3-3C. # Meals Served Missing Meal Components

B3-3D. # Incomplete Meals (By Violation Type, leave blank if NA)

B3-3E. Difference (+/-) between SFA and SA Meal Count (#)

B3-4A. Was Recalculation necessary? (Select [x] type below if Yes]

B3-4B. In what area was the violation? (Select [x] all that apply)

B4-1A. Location of Meal Service (Check [x] all that apply)

B4-1B. # of points where meal counts are taken

B4-1C. Total # of students with program access

B4-1D. Meal Patterns utilized in the school (Select [x] all that apply)

B4-1E. Review Period: # Serving days

B4-2A. Total # of Meals Served

B4-2B. # of Ineligibles and/or Second Meals Counted

B4-2C. # Meals Served Missing Meal Components

B4-2D. # of Incomplete Meals (By Violation Type, leave blank if NA)

B4-2E. Difference (+/-) between SFA and SA Count (#)

B4-3A. Total # of meals served

B4-3B. # of Ineligibles and/or Second Meals Counted

B4-3C. # Meals Served Missing Meal Components

B4-3D. # Incomplete Meals (By Violation Type, leave blank if NA)

B4-3E. Difference (+/-) between SFA and SA Count (#)

B4-4A. Was Recalculation necessary? (Select [x] type below if Yes]

B4-4B. In what area was the violation? (Select [x] all that apply)

B5-1A. Total # of Snacks Served

B5-1B. Counting and Claiming Consolidation Errors (# +/-)

B5-2A. Total # of Snacks Served

B5-2B. Counting and Claiming Consolidation Errors (# +/-)

B2-2A. Public

B2-2B. Private

B2-2C. charter

B2-2D. Regular

B2-2E. Boarding

B2-2F. RCCI

B2-2G. Pricing

B2-2H. Closed Campus

B2-2I. Traditional Schedule

B2-2J. Single Track

B2-3A. Option Being Used (Enter 1, 2, or 3)

B2-3B. Base Year (Select [x] if in base year)

B2-3C. Non-Base Year ([x] in not in base year)

B2-3D. SFA Calculated Free Claiming % or Funding Level

B2-3E. SA Calculated Free Claiming % or Funding Level

B2-3F. SFA Calculated Reduced Price Claiming % or Funding Level

B2-3G. SA Calculated Reduced Price Claiming % or Funding Level

B2-4A. District-Wide ([x] if CEP district-wide)

B2-4B. SFA Calculated ISP (#)

B2-4C. SA Verified ISP (#)

B2-4D. SFA Calculated Free Claiming %

B2-4E. SA Calculated Free Claiming %

B2-5A. FSMC

B2-5B. Vended

B2-5C. Self Prep (On-Site Prep)

B2-5D. Self Prep (Pre-Packaged Satellite)

B2-5E. Self Prep (Base/Central Kitchen)

B2-5F. Self Pep (Bulk Satellite)

B2-6A. NSLP

B2-6B. SBP

B2-6C. SMP

B2-6D. SSO

B2-6E. Afterschool Snacks

B2-6F. FFVP

B2-7A. Adult Meals

B2-7B. Vending to other CN sites

B2-7C. Catering

B2-7D. A la Carte

B2-7E. Other

B2-9A. Yes

B2-9B. High Risk

B2-9C. Option 1

B2-9D. Option 2

B2-9E. Option 3

B2-9F. Option 4

B3-1A(a). Cafeteria (Traditional Service)

B3-1A(b). Breakfast in the Classroom

B3-1A(c). Grab and Go

B3-1A(d). Other

B3-1D(a). Pre-K Age/Grade Group

B3-1D(a). K-5 Age/Grade Group

B3-1D(b). 6-8 Age/Grade Group

B3-1D(c). 9-12 Age/Grade Group

B3-2D(a). Milk Type

B3-2D(b). Food Quantities

B3-2D(c). Whole Grain Rich Foods

B3-2D(d). Dietary Specifications

B3-2E(a). Free

B3-2E(b). Reduced-Price

B3-2E(c). Paid

B3-3D(a). Milk Type

B3-3D(b). Food Quantities

B3-3D(c). Whole Grain Rich Foods

B3-3D(d). Dietary Specifications

B3-3E(a). Free

B3-3E(b). Reduced-Price

B3-3E(c). Paid

B3-4A(a). Partial

B3-4A(b). Full

B3-4B(a). Performance Standard 1

B3-4B(b). Performance Standard 2

B4-1A(a). Cafeteria

B4-1A(b). Classroom

B4-1A(c). Other

B4-1D(a). Pre-K Age/Grade Group

B4-1D(b). K-5 Age/Grade Group

B4-1D(c). 6-8 Age/Grade Group

B4-1D(d). 9-12 Age/Grade Group

B4-2D(a). Milk Type

B4-2D(b). Vegetable Sub-group

B4-2D(c). Food Quantities

B4-2D(e). Whole Grain Rich Foods

B4-2D(f). Dietary Specifications

B4-2E(a). Free

B4-2E(b). Reduced-Price

B4-2E(c). Paid

B4-3D(a). Milk Type

B4-3D(b). Vegetable Sub-group

B4-3D(c). Food Quantities

B4-3D(d). Whole Grain Rich Foods

B4-3D(e). Dietary Specifications

B4-3E(a). Free

B4-3E(b). Reduced-Price

B4-3E(c). Paid

B4-4A(a). Partial

B4-4A(b). Full

B4-4B(a). Performance Standard 1

B4-4A(b). Performance Standard 2

B5-1B(a). Free

B5-1B(b). Reduced-Price

B5-1B(c). Paid

B5-2B(a). Free

B5-2B(b). Reduced-Price

B5-2B(c). Paid