State Agencies (CN and SFA Directors)

APPENDIX D

School Food Authority Director Survey Year 2

OMB Number: 0584-0607

Expiration Date: xx/xx/20xx

Child Nutrition Program Operations Study II

CNOPS

School Food Authority (SFA) Director

Survey 2016-2017

FOR PLANNING PURPOSES ONLY

Please complete the survey at:

http://www.2mresearch.com/cnops2sfa

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 0584-0607. The time required to complete this information collection is estimated to average 2 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.

U.S. Department of Agriculture

Food and Nutrition Service

This survey is being conducted for the Food and Nutrition Service, U.S. Department of Agriculture as part of a study of the National School Lunch Program (NSLP), School Breakfast Program (SBP), and other USDA food programs throughout the country. All responses will be treated in strict privacy; no names will be used in our study reports, and only aggregated results will be reported.

The study is authorized by the Healthy, Hunger-Free Kids Act of 2010 (HHFKA) and participation by selected states, local education agencies, and schools is required under Section 305 of the HHFKA. Section 305 of the Healthy, Hunger-Free Kids Act of 2010 states that “States, State educational agencies, local educational agencies, schools, institutions, facilities, and contractors participating in programs authorized under this Act and the Child Nutrition Act of 1966 (42 U.S.C 1771 et seq.) shall cooperate with officials and contractors acting on behalf of the Secretary, in the conduct of evaluations and studies under those Acts.”

Send comments regarding the burden estimate (2 hours) or any other aspect of this collection of information, including suggestions for reducing this burden, to:

U.S. Department of Agriculture
Food and Nutrition Service
Office of Policy Support
Alexandria, VA 22302
Attn: Dr. Devin Wallace-Williams

If you have any questions about this survey, please email [email protected] or call toll-free at 866.465.7738.

We thank you for your cooperation and participation in this very important study.

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• Depending on the staffing structure of your SFA, you may need input from other colleagues to respond to some questions in the survey. If you need a colleague to complete a section of the survey, you should provide them with the same login credentials. They do not need separate login credentials.

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1. Before starting the survey please fill in the requested contact information below. If the information below is prefilled please review and update the information as necessary.

MONTH DAY YEAR

School District Name

2. Please fill in the contact information for the SFA Director below:

First Name:

Last Name:

Street Address 1:

Street Address 2:

City:

State:

Zip:

Phone Number: Ext.

Email:

3. If you are not the SFA Director please provide your name, title and contact information below:

First Name:

Last Name:

Title:

Street Address 1:

Street Address 2:

City:

State:

Zip:

Phone Number: Ext.

Email:

This section includes questions about schools in your school food authority (SFA) participating in the National School Lunch Program (NSLP), School Breakfast Program (SBP), Child and Adult Care Food Program (CACFP), the Seamless Summer Option (SSO), and the Summer Food Service Program (SFSP). When providing counts of schools, you may group schools together as you would for administrative reporting. For example, you may group two schools with a shared cafeteria.

1.1 What is the total number of schools in your SFA? Please enter your responses by school type.

Elementary schools are schools composed of any span of grades from kindergarten through 6th grade, such as K-4, 4-6, or K-5.

• Middle schools are schools that have no grade lower than 6 and no grade higher than 9, such as 6-8, 6-7, 7-8, or 6-9. These schools may also be known as junior high schools.

• High schools are schools that have no grade lower than 9 and continue through 12th grade, such as grade 9 only, 9-10, or 9-12.

• Other schools are schools that do not meet the elementary, middle, or high school definitions, such as 6-12, K-8, or K-12.

IF NONE, PLEASE ENTER 0.

	a. ELEMENTARY SCHOOLS	b. MIDDLE SCHOOLS	c. HIGH SCHOOLS	d. OTHER SCHOOLS	TOTAL
Total number of schools in your SFA					FILLS WITH SUM

1.2.1 This question is about the number of elementary schools that participated in school meal programs in the 2016-2017 school year (SY).

IF NONE, PLEASE ENTER 0.

	ELEMENTARY SCHOOLS
a. Of the [WEB PREFILL # FROM 1.1a] elementary schools, how many participate in NSLP only
b. Of the [WEB PREFILL # FROM 1.1a] elementary schools, how many schools participate in SBP only
c. Of the [WEB PREFILL # FROM 1.1a] elementary schools, how many schools participate in both SBP and NSLP
d. Of the [WEB PREFILL # FROM 1.1a] elementary schools, how many schools participate in neither SBP nor NSLP

1.2.2 This question is about the number of middle schools that participated in school meal programs in the 2016-2017 school year (SY).

IF NONE, PLEASE ENTER 0.

	MIDDLE SCHOOLS
a. Of the [WEB PREFILL # FROM 1.2a] middle schools, how many participate in NSLP only
b. Of the [WEB PREFILL # FROM 1.2a] middle schools, how many schools participate in SBP only
c. Of the [WEB PREFILL # FROM 1.2a] middle schools, how many schools participate in both SBP and NSLP
d. Of the [WEB PREFILL # FROM 1.2a] middle schools, how many schools participate in neither SBP nor NSLP

1.2.3 This question is about the number of high schools that participated in school meal programs in the 2016-2017 school year (SY).

IF NONE, PLEASE ENTER 0.

	HIGH SCHOOLS
a. Of the [WEB PREFILL # FROM 1.3a] high schools, how many participate in NSLP only
b. Of the [WEB PREFILL # FROM 1.3a] high schools, how many schools participate in SBP only
c. Of the [WEB PREFILL # FROM 1.3a] high schools, how many schools participate in both SBP and NSLP
d. Of the [WEB PREFILL # FROM 1.3a] high schools, how many schools participate in neither SBP nor NSLP

1.2.4 This question is about the number of other schools that participated in school meal programs in the 2016-2017 school year (SY).

IF NONE, PLEASE ENTER 0.

	OTHER SCHOOLS
a. Of the [WEB PREFILL # FROM 1.4a] other schools, how many participate in NSLP only
b. Of the [WEB PREFILL # FROM 1.4a] other schools, how many schools participate in SBP only
c. Of the [WEB PREFILL # FROM 1.4a] other schools, how many schools participate in both SBP and NSLP
d. Of the [WEB PREFILL # FROM 1.4a] other schools, how many schools participate in neither SBP nor NSLP

The following questions deal with participation in the CACFP during SY 2016-2017. For this program, USDA funds afterschool programs to serve a meal or snack to children in low-income areas.

1.3 Do any schools in your SFA participate in the CACFP?

 Yes 1

 No 2 SKIP TO 1.7

1.4 Is your SFA the only CACFP sponsor?

A sponsor is an organization that has entered into an agreement with their administering State agencies to assume administrative and financial responsibilities for CACFP operations. Examples of sponsors include public or private nonprofit schools, private nonprofit organizations, public or private nonprofit camps, and units of local, municipal, county, tribal, or State government, including school food authorities.

 Yes 1 SKIP TO 1.6

 No 2

1.5 How many schools in your SFA currently participate as sponsors in the CACFP ? Please do not count schools that are expected to participate in the future.

A sponsor is an organization that has entered into an agreement with their administering State agencies to assume administrative and financial responsibilities for CACFP operations. Examples of sponsors include public or private nonprofit schools, private nonprofit organizations, public or private nonprofit camps, and units of local, municipal, county, tribal, or State government, including school food authorities.

IF NONE, PLEASE ENTER 0.	NUMBER OF SPONSORS
a. Of the [WEB PREFILL # FROM 1.1a] elementary schools, how many schools participate as sponsors?
b. Of the [WEB PREFILL # FROM 1.1b] middle schools, how many schools participate as sponsors?
c. Of the [WEB PREFILL # FROM 1.1c] high schools, how many schools participate as sponsors?
d. Of the [WEB PREFILL # FROM 1.1d] other schools, how many schools participate as sponsors?

1.6 How many schools in your SFA participate as sites in the CACFP in SY 2016-2017? Please do not count schools that are expected to participate in the future.

A site is a physical location, approved by the State agency, where CACFP meals are served during a supervised time period. Examples of sites include child care centers, afterschool care programs, and schools.

IF NONE, PLEASE ENTER 0.	NUMBER OF SITES
a. Of the [WEB PREFILL # FROM 1.1a] elementary schools, how many schools participate as sites?
b. Of the [WEB PREFILL # FROM 1.1b] middle schools, how many schools participate as sites?
c. Of the [WEB PREFILL # FROM 1.1c] high schools, how many schools participate as sites?
d. Of the [WEB PREFILL # FROM 1.1d] other schools, how many schools participate as sites?

1.7 Do any schools in your SFA not currently participating in the CACFP intend to participate next year (SY 2017-2018)?

SELECT ONLY ONE

 Yes 1

 No 2 SKIP TO 1.9

 Don’t know d SKIP TO 1.9

 Not applicable (All schools participate in the CACFP Afterschool At-risk Supper Program) n SKIP TO 1.9

1.8 Approximately how many additional schools plan to participate in the CACFP next year?

IF NONE, PLEASE ENTER 0.

SCHOOLS

1.9 Is your SFA or are schools in your SFA using strategies to build awareness of the availability of the CACFP among eligible, non-participating students?

 Yes 1

 No 2 SKIP TO 1.11

 Don’t know d SKIP TO 1.11

1.10 What strategies are being used to build awareness of the CACFP among eligible, non-participating students in your schools?

SELECT ALL THAT APPLY

 Mass mailings 1

 Newsletters 2

 Social media (for example, Facebook, Twitter, YouTube) 3

 Public service announcements 4

 Texting campaign 5

 USDA materials (for example, flyers, bookmarks, or postcards) 6

 Advertising at family-friendly events 7

 Presentations to faith-based organizations 8

 Discussion at community meetings 9

 Partnering with local agencies 10

 Other (Specify) 99

Specify (STRING (NUM)

1.11 Is your SFA or are schools in your SFA using strategies to build awareness of the availability of the CACFP to the local community at large?

 Yes 1

 No 2 SKIP TO 1.13

 Don’t know d SKIP TO 1.13

1.12 Please select the strategies used in your SFA to promote the CACFP to the local community at large.

SELECT ALL THAT APPLY

 Social media (for example, Facebook, Twitter, YouTube) 1

 Public service announcements 2

 USDA materials (flyers, bookmarks, and postcards) 3

 Advertising at family-friendly events 4

 Presentations to faith-based organizations 5

 Discussion at community meetings 6

 Partnering with local agencies 7

 Other (Specify) 99

Specify (STRING (NUM))

 Don’t know d

The following questions are about your SFA’s participation in two summer meal programs, the Seamless Summer Option (SSO) and the Summer Food Service Program (SFSP). Both SSO and SFSP provide free meals to children in low-income areas when school is not in session. Only SFAs participating in the NSLP and SBP are eligible to sponsor the SSO.

1.13 Did your SFA sponsor any feeding sites under the SSO in summer of 2016?

 Yes 1

 No 2 SKIP TO 1.15

1.14 How many school and non-school feeding sites in your SFA participated in the SSO during the summer of 2016?

A site is a physical location, approved by the State agency, where meals are served during a supervised time period. Examples of sites include child care centers, afterschool care programs, and schools.

IF NONE, PLEASE ENTER 0.	NUMBER OF SITES
a. School sites
b. Non-school sites

1.15 Did your SFA sponsor the SFSP in summer of 2016?

 Yes 1

 No 2 SKIP TO 1.17

1.16 How many school and non-school feeding sites did your SFA sponsor through the SFSP during the summer of 2016?

IF NONE, PLEASE ENTER 0.	NUMBER OF SITES
a. School sites
b. Non-school sites

1.17 How many schools in your SFA sponsored the SFSP during the summer of 2016? If none enter 0. Please also include school sponsors regardless of whether they also act as a site.

IF NONE, PLEASE ENTER 0.

NUMBER OF SCHOOLS

1.18 Do you anticipate increasing the number of feeding sites operating through the SSO and/or the SFSP during the summer of 2017?

 Yes 1

 No 2 SKIP TO 1.20

 Don’t know d SKIP TO 1.20

1.19 Approximately how many additional school and non-school feeding sites do you anticipate will participate during the summer of 2017? Please respond for each program.

IF NONE, PLEASE ENTER 0.	SEAMLESS SUMMER OPTION	SUMMER FOOD SERVICE PROGRAM
a. School sites
b. Non-school sites

1.20 Is your SFA or are any schools in your SFA using strategies to build awareness of the availability of summer feeding programs among eligible, non-participating students?

 Yes 1

 No 2 SKIP TO 1.22

 Don’t know d SKIP TO 1.22

1.21 What strategies are being used to build awareness of the summer feeding programs among eligible, non-participating students in your schools?

SELECT ALL THAT APPLY

 Mass mailings 1

 Newsletters 2

 Social media (for example, Facebook, Twitter, YouTube) 3

 Public service announcements 4

 Texting campaign 5

 USDA materials (flyers, bookmarks, and postcards) 6

 Advertising at family-friendly events 7

 Presentations to faith-based organizations 8

 Discussion at community meetings 9

 Partnering with local agencies 10

 Other (Specify) 99

Specify (STRING (NUM))

1.22 Is your SFA or are any schools in your SFA using strategies to build awareness of the availability of summer feeding programs to the local community at large?

 Yes 1

 No 2 SKIP TO 2.1

 Don’t know d SKIP TO 2.1

1.23 What strategies are being used to build awareness of the summer feeding programs in the local community at large?

select ALL THAT APPLY

 Promoting the FNS Mapping Tools 1

 Promoting the National Hunger Hotline 2

 Promoting the FNS Summer Meal Site Finder 3

 Social media (for example, Facebook, Twitter, YouTube) 4

 Public service announcements 5

 USDA materials (flyers, bookmarks, and postcards) 6

 Advertising at family-friendly events 7

 Presentations to faith-based organizations 8

 Discussion at community meetings 9

 Partnering with local agencies 10

 Other (Specify) 99

Specify (STRING (NUM))

 Don’t Know d

This section includes questions about student enrollment and National School Lunch Program (NSLP) and School Breakfast Program (SBP) participation at the schools in your SFA during SY 2016-2017.

For this question, please record your responses separately by school type:

• Elementary schools are schools composed of any span of grades from kindergarten through 6th grade, such as K-4, 4-6, or K-5.

• Middle schools are schools that have no grade lower than 6 and no grade higher than 9, such as 6-8, 6-7, 7-8, or 6-9. These schools may also be known as junior high schools.

• High schools are schools that have no grade lower than 9 and continue through 12th grade, such as grade 9 only, 9-10, or 9-12.

• Other schools are schools that do not meet the elementary, middle, or high school definitions, such as 6-12, K-8, or K-12.

2.1 As of October 31, 2016, what was the total number of students enrolled in your SFA?

The total student enrollment should include prekindergarten and kindergarten students who attend school for half a day and may not have access to meals. Children attending a school that does not participate in the NSLP or the SBP should also be included in this count.

IF NONE, PLEASE ENTER 0.

	a. ELEMENTARY SCHOOLS	b. MIDDLE SCHOOLS	c. HIGH SCHOOLS	d. OTHER SCHOOLS
Total number of students enrolled in your SFA.

2.1.1 This question is about the number of elementary school students who participated in school meal programs in SY 2016-2017.

IF NONE, PLEASE ENTER 0.

	ELEMENTARY SCHOOLS
a. Of the [WEB PREFILL # FROM 2.1a] total enrolled elementary school students, how many do not have access to SBP?
b. Of the [WEB PREFILL # FROM 2.1a] total enrolled elementary school students, how many do not have access to NSLP?
c. Of the [WEB PREFILL # FROM 2.1a] total enrolled elementary school students, how many were approved to receive free meals?
d. Of the [WEB PREFILL # FROM 2.1a] total enrolled elementary school students, how many were approved to receive reduced price meals?

2.1.2 This question is about the number of middle school students who participated in school meal programs in SY 2016-2017.

IF NONE, PLEASE ENTER 0.

	MIDDLE SCHOOLS
a. Of the [WEB PREFILL # FROM 2.1b] total enrolled middle school students, how many do not have access to SBP?
b. Of the [WEB PREFILL # FROM 2.1b] total enrolled middle school students, how many do not have access to NSLP?
c. Of the [WEB PREFILL # FROM 2.1b] total enrolled middle school students, how many were approved to receive free meals?
d. Of the [WEB PREFILL # FROM 2.1b] total enrolled middle school students, how many were approved to receive reduced price meals?

2.1.3 This question is about the number of high school students who participated in school meal programs in SY 2016-2017.

IF NONE, PLEASE ENTER 0.

	HIGH SCHOOLS
a. Of the [WEB PREFILL # FROM 2.1c] total enrolled high school students, how many do not have access to SBP?
b. Of the [WEB PREFILL # FROM 2.1c] total enrolled high school students, how many do not have access to NSLP?
c. Of the [WEB PREFILL # FROM 2.1c] total enrolled high school students, how many were approved to receive free meals?
d. Of the [WEB PREFILL # FROM 2.1c] total enrolled high school students, how many were approved to receive reduced price meals?

2.1.4 This question is about the number of other school students who participated in school meal programs in SY 2016-2017.

IF NONE, PLEASE ENTER 0.

	OTHER SCHOOLS
a. Of the [WEB PREFILL # FROM 2.1d] total enrolled other school students, how many do not have access to SBP?
b. Of the [WEB PREFILL # FROM 2.1d] total enrolled other school students, how many do not have access to NSLP?
c. Of the [WEB PREFILL # FROM 2.1d] total enrolled other school students, how many were approved to receive free meals?
d. Of the [WEB PREFILL # FROM 2.1d] total enrolled other school students, how many were approved to receive reduced price meals?

2.2 What was the total number of students in attendance in October 2016? The total is the cumulative sum of the daily attendance counts for October.

For example, 300 students attended elementary schools for 21 days and 250 students attended elementary schools for 20 days. The cumulative sum would be 11,300 students in daily attendance for elementary schools in October 2016.

IF NONE, PLEASE ENTER 0.	ELEMENTARY SCHOOLS	MIDDLE SCHOOLS	HIGH SCHOOLS	OTHER SCHOOLS
Total number of students in attendance in October 2016.

2.3 What was the total number of days that meals were served in October 2016?

If the total number of days that meals were served varies within a school type, please provide the average total number of days for that school type.

IF NONE, PLEASE ENTER 0.	ELEMENTARY SCHOOLS	MIDDLE SCHOOLS	HIGH SCHOOLS	OTHER SCHOOLS
Total number of days that meals were served in October 2016

The following questions ask you to report the number of school meals served or claimed as paid, reduced price, or free during SY 2016-2017. If your SFA operates under Provisions 1, Provision 2, Provision 3, or CEP, you may indicate the number of student lunches and student breakfasts claimed in each appropriate category. Provide counts for October 2016, excluding second meals taken by students.

2.4 For each school type, how many student breakfasts were either served/claimed as paid, reduced price, and free breakfasts during October 2016?

IF NONE, PLEASE ENTER 0.

STUDENT BREAKFASTS	ELEMENTARY SCHOOLS	MIDDLE SCHOOLS	HIGH SCHOOLS	OTHER SCHOOLS
a. What was the total number of paid breakfasts served/claimed?
b. What was the total number of reduced price breakfasts served/claimed?
c. What was the total number of free breakfasts served/claimed?

2.5 For each school type, how many lunches were either served/claimed as paid, reduced price, and free lunches during October 2016?

IF NONE, PLEASE ENTER 0.

STUDENT LUNCHES	ELEMENTARY SCHOOLS	MIDDLE SCHOOLS	HIGH SCHOOLS	OTHER SCHOOLS
a. What was the total number of paid lunches served/claimed?
b. What was the total number of reduced price lunches served/claimed?
c. What was the total number of free lunches served/claimed?

The next questions are about average meal prices charged during SY 2016-2017. For these questions, please record your responses separately for:

• Elementary schools are schools composed of any span of grades from kindergarten through 6th grade, such as K-4, 4-6, or K-5.

• Middle schools are schools that have no grade lower than 6 and no grade higher than 9, such as 6-8, 6-7, 7‑8, or 6-9. These schools may also be known as junior high schools.

• High schools are schools that have no grade lower than 9 and continue through 12th grade, such as grade 9 only, 9-10, or 9-12.

• Other schools are schools that do not meet the elementary, middle or junior high, or high school definition, such as 6-12, K-8, or K-12.

If prices vary within a school type, please provide the average price for that school type.

3.1 What was the average price charged for paid and reduced price breakfasts in your SFA at the beginning of SY 2016-2017? If no students in your SFA are charged for breakfast, please check the appropriate box.

	ELEMENTARY SCHOOLS	MIDDLE SCHOOLS	HIGH SCHOOLS	OTHER SCHOOLS
a. Paid breakfast	$	$	$	$
b. Reduced price breakfast	$	$	$	$
c. Not Applicable – No School Breakfast Program	1 	2 	3 	4 
d. Not Applicable – Breakfast at schools are served free of charge	1 	2 	3 	4 

3.2 What was the average price charged for paid and reduced price lunches in your SFA at the beginning of SY 2016-2017? If no students in your SFA are charged for lunch, please check the “not applicable” box.

LUNCH PRICES	ELEMENTARY SCHOOLS	MIDDLE SCHOOLS	HIGH SCHOOLS	OTHER SCHOOLS
a. Paid lunch	$	$	$	$
b. Reduced price lunch	$	$	$	$
c. Not Applicable – Lunches at schools are served free of charge	1 	2 	3 	4 

3.3 What was the average price charged for paid and reduced price lunches in your SFA at the beginning of SY 2015-2016? If no students in your SFA were charged for lunch, please check the “not applicable” box.

LUNCH PRICES	ELEMENTARY SCHOOLS	MIDDLE OR JUNIOR HIGHS	HIGH SCHOOLS	OTHER SCHOOLS
Paid lunch	$	$	$	$
Reduced price lunch	$	$	$	$
Not Applicable – Lunches at schools were served free of charge	1 	2 	3 	4 

3.4 SFAs participating in the NSLP are required to increase the prices charged for paid meals until their weighted average lunch prices meet the difference between Federal reimbursements for free and paid lunches. This is called the Paid Lunch Equity provision in the Healthy, Hunger-Free Kids Act of 2010.

During SY 2016-2017, what actions did your SFA take in response to the Paid Lunch Equity provision in the Healthy, Hunger-Free Kids Act of 2010?

select ALL THAT APPLY

 Increased paid lunch prices in all schools 1

 Increased paid lunch prices in some schools 2

 Added funds from non-Federal sources to the nonprofit school food services account 3

 Requested an exemption/waiver from the Paid Lunch Equity requirement from the State 4

 No action taken - Paid lunch pricing already complied with new provision 5

 No action taken – Price increase carried over from SY 2015-2016 6

 Other (Specify) 99

Specify (STRING (NUM))

3.5 Did your SFA use non-Federal revenue sources to offset potential price increases in paid meals during SY 2016-2017?

 Yes 1

 No 2 SKIP TO 3.7

3.6 What non-Federal revenue sources did your SFA use?

	Select one response per row
	YES	NO
a. Per-meal State reimbursement for any paid meals	1 	2 
b. Per-meal local reimbursement for any paid meals	1 	2 
c. Funds provided by organizations, such as school-related or community groups, for any paid meals	1 	2 
d. State revenue matching funds that exceed the minimum requirement for paid lunches	1 	2 
e. Share of direct payments made from school district funds to support meal services attributable to any paid meals (for example, pro rata share of general funds used to support meal service)	1 	2 
f. Other (Specify)	1 	2 
(STRING (NUM))

3.7 What was the average weighted price of all paid NSLP lunches charged in your SFA in October 2016?

IF NONE, PLEASE ENTER 0.

$ DOLLARS

The average weighted price for paid lunches can be calculated using the USDA Paid Lunch Equity (PLE) Tool (http://www.fns.usda.gov/sites/default/files/cn/SP09-2016a.xlsx).

The 2016-2017 average weighted price can be found in the SY 2016-17 Non-Federal Calculator or Price Calculator tabs of the Tool.

To calculate an average weighted price of all paid NSLP lunches in October 2016, first determine how many paid lunches were served in October 2016. Multiply the number of paid lunches served by the price paid for each lunch, then divide by the total number of paid lunches.

For example, suppose 300 paid lunches were served in October 2016, with $2.57 paid for 100 lunches and $2.60 paid for 200 lunches. The average weighted price is calculated as: (100 meals * $2.57) + (200 meals *$2.60) / (100+200 meals) = $2.59 per meal.

3.8 Have you increased a la carte prices between SY 2015-2016 and SY 2016-2017?

 Yes 1

 No 2 SKIP TO NEXT SECTION

3.9 What was the average price increase for the following a la carte items? If your SFA did not increase prices for a particular item, please enter $0.00.

	AVERAGE PRICE INCREASE
a. Beverages (water, juice, sports drinks, etc.)	$
b. Milk	$
c. Frozen desserts (ice cream, popsicles, etc.)	$
d. Baked goods – dessert (cookies, cakes, pastries, etc.)	$
e. Bread/grain products (bagels, pretzels, crackers, etc.)	$
f. Snacks (chips, energy bars, jerky, etc.)	$
g. Candy	$
h. Prepared entrées (pizza, hamburgers, burritos, etc.)	$
i. Prepared non-entrée food (French fries, onion rings, etc.)	$
j. Reimbursable meal components	$

In this section of the survey, we want to understand the ways that your SFA procures goods and services for your school meals. Examples of goods and services include food, equipment, and supplies purchased for use in the production of school meals, or personnel hired to serve school meals. By school meals, we mean the meals provided under the School Breakfast Program (SBP), the National School Lunch Program (NSLP), the Child and Adult Care Feeding Program (CACFP) At-Risk Afterschool Meals Component, and summer meals provided in summer through the Seamless Summer Option (SSO) and/or the Summer Food Service Program (SFSP).

Unless otherwise noted, we are interested in learning about your practices and contracts during School Year (SY) 2016-17.

4.1 Did or will your State agency review your SFA’s policies or procedures for procurement of goods and services for school meals during SY 2016-17?

 Yes 1

 No 2

4.2 Are there local policies that your SFA must follow in addition to Federal and State requirements?

 Yes 1

 No 2

4.2a. What is your local simplified acquisition threshold (small purchase threshold)?

IF NONE, PLEASE ENTER 0.

$ DOLLARS

4.2b. What is your local micro-purchase threshold?

IF NONE, PLEASE ENTER 0.

$ DOLLARS

4.3 Who evaluates price quotes and competitive proposals during the procurement process at your SFA?

SELECT ALL THAT APPLY

 SFA foodservice director or manager 1

 SFA head cook or kitchen/cafeteria manager 2

 District business office or purchasing department official 3

 District superintendent 4

 District school board 5

 State agency Child Nutrition Director or staff 6

 Food Service Management Company (FSMC) liaison or agent 7

 Governing or advisory board 8

 Sales broker 9

 Group Buying Organization agent or third party provider 10

 Cooperative Purchasing Group (including, but not limited to, a Consortium) 11

 Other procurement agent 12

 Other (Specify) 99

Specify (STRING (NUM))

4.4 Who makes final procurement contract award decisions for school meals at your SFA?

SELECT ALL THAT APPLY

 SFA foodservice director or manager 1

 SFA head cook or kitchen/cafeteria manager 2

 District business office or purchasing department official 3

 District superintendent 4

 District school board 5

 State agency Child Nutrition Director or staff 6

 Food Service Management Company (FSMC) liaison or agent 7

 Governing or advisory board 8

 Sales broker 9

 Group Buying Organization agent or third party provider 10

 Cooperative Purchasing Group (including, but not limited to, a Consortium) 11

 Other procurement agent 12

 Other (Specify) 99

Specify (STRING (NUM))

4.5 Does your SFA use an FSMC to manage the purchase of any goods and services used for school meals?

 Yes 1

 No 2

Two competitive solicitation methods are used in the formal procurement process for goods and services for school meals. Competitive sealed bids using Invitation for Bids are advertised solicitations where a firm fixed-price contract is awarded to the bidder offering the lowest responsive and responsible price. Competitive proposals using a Request for Proposal may award either a fixed-price or cost-reimbursable contract.

4.6 Does your SFA use the following competitive solicitation methods to procure goods and services for school meals?

	Select one response per row
	YES	NO
a. Competitive sealed bids using Invitation for Bids	1 	2 
b. Competitive proposals using a Request for Proposal	1 	2 

SFAs may use other contracting methods to procure goods and services for school meals. Methods may include small purchases or micro-purchases using Federal, State, or local thresholds. Noncompetitive proposals involve solicitations from only one source. Local produce auctions involve competitive bidding with local producers at a central meeting place.

4.7 Which of the following other contracting methods does your SFA use to procure goods and services for school meals?

SELECT ALL THAT APPLY

 Small Purchases 1

 Micro-purchases 2

 Noncompetitive Proposals 3

 Local Produce Auctions 4

 Other, excluding competitive methods and FSMCs (Specify) 99

Specify (STRING (NUM))

 None 0

To increase purchasing power, SFAs can “band together” within a cooperative and purchase goods and services for school meals at a lower cost. SFAs can also use an agent or a “third-party provider” that purchases goods and services on their behalf.

4.8 Does your SFA belong to a cooperative purchasing group comprised only of SFAs?

SELECT ONLY ONE

 Yes 1

 No 2

4.8a Does your SFA belong to a cooperative purchasing group with a third party that is not an SFA-only cooperative purchasing group (e.g. group purchasing/buying organization, local or State government, or other for-profit or non-profit organizations not participating in Federal Child Nutrition programs)?

 Yes 1

 No 2

4.9 Please estimate the percentage of your SFA’s total purchases of goods and services for school meals that were procured during SY 2016-17 using the following methods.

	PERCENTAGE
a. Food Service Management Company (FSMC)
b. Competitive sealed bids using Invitation for Bids
c. Competitive proposals using a Request for Proposal
d. Small Purchases
e. Micro-purchases
f. Noncompetitive proposals
g. Local Produce Auctions
h. Cooperative purchasing group comprised only of SFAs
i. Cooperative purchasing group with a third party that is not a SFA
j. Other, excluding competitive methods and FSMCs (Specify):
(STRING (NUM))

4.10 From which of the following sources does your SFA procure foods for school meals?

SELECT ALL THAT APPLY

 Manufacturers 1

 Food processors (including, but not limited to, processed end products using USDA Foods - for example, Tyson Foods Inc., Dean Foods Co.) 2

 Distributors (for example, Sysco or US Foods) 3

 Wholesale Clubs (for example, Costco Wholesale, Sam’s Club) 4

 Farmers and/or CSAs that supply at least some purchased foods 5

 Groups of farmers that sell products centrally, such as producer co-ops or food hubs 6

 School gardens 7

 Suppliers contracted by the FSMC, cooperative purchasing group, and/or group buying organization 8

 Other food source supplier 1 (Specify) 9

Specify (STRING (NUM))

 Other food source supplier 2 (Specify) 10

Specify (STRING (NUM))

4.11 Please estimate the percentage of your SFA’s total food purchase value for school meals that was procured from each of the following suppliers or sources in SY 2016-17. For example, if you estimate that a third of the total value of your SFA’s food purchases originates from one supplier or source, then enter the number 33 for that supplier or source.

If categories cannot be reported separately, then provide the percentage value once and list the letter(s) of the other categories included. If a category is not applicable, or you have included its value in a different row, please check the N/A box.

For example, if revenue from manufacturers and food processers cannot be separated, record the total value in row a, write “b” in the last column, and check N/A for row b.

	N/A	PERCENTAGE	LIST OTHER CATEGORIES INCLUDED
a. Manufacturers	n 
b. Food processors	n 
c. Distributors	n 
d. Wholesale clubs	n 
e. Farmers	n 
f. Farmer cooperatives	n 
g. School gardens	n 
h. Suppliers contracted by the FSMC	n 
i. Suppliers contracted by the purchasing cooperative	n 
j. Suppliers contracted by the group buying organization	n 
k. Other (Specify):	n 
(STRING (NUM))

This section is about certification for free or reduced-price school meals, verification, verification for cause, and direct verification practices in your SFA during SY 2016-2017.

5.1 How many students enrolled in your SFA were directly certified as of October 31, 2016?

IF NONE, PLEASE ENTER 0.

STUDENTS

5.2 How many additional students were directly certified after October 31, 2016 up until this point in time?

IF NONE, PLEASE ENTER 0.

STUDENTS

5.3 Is your State or your SFA responsible for matching lists of enrolled students to lists of household participants in SNAP, TANF, or FDPIR to directly certify students?

• SNAP is the Supplemental Nutrition Assistance Program (formerly known as Food Stamps).

• TANF is Temporary Assistance for Needy Families.

• FDPIR is the Food Distribution Program on Indian Reservations.

Note: States may be considered responsible for matching even when SFAs verify information provided by the State, or when an SFA provides student enrollment information to the State. Conversely, SFAs may be considered responsible for matching even when the State provides the SFA with SNAP, TANF, or FDPIR program participation data.

select ALL THAT APPLY

 State 1 SKIP TO 5.5

 SFA 2

 Other (not state or SFA) 3 SKIP TO 5.5

 SFA does not directly certify students 4 SKIP TO 5.5

5.4 What challenges does your SFA face in matching enrolled students to household participation in SNAP, TANF, or FDPIR?

select ALL THAT APPLY

 Lack of staff time and resources to perform data matching 1

 High level of burden (e.g. due to outdated or not user friendly computer systems) 2

 Difficulty reconciling state-generated direct certification lists with local point‑of-sale systems 3

 Difficulty investigating or reconciling partially matched or unmatched children 4

 Need to use a manual matching process 5

 Data insecurity/concerns about personally identifiable information 6

 Lack familiarity with system functions designed for district use 7

 No challenges 8

 Other (Specify) 99

Specify (STRING (NUM))

5.5 Which of the following formats of parent-completed applications for free or reduced-price school meals for their children is used most often for SY 2016-2017?

SELECT ONLY ONE

 Web-based or computer-based application 1

 Computer-read or scannable paper application 2 SKIP TO 5.7

 Manually-entered paper application 3 SKIP TO 5.7

 No parents in the SFA submit applications for school meals 4 SKIP TO 5.7

5.6 Is the web-based or computer-based application integrated with any of the following data systems?

	Select one response per row
	YES	NO
a. Meal claiming system	1 	2 
b. Point-of-sale system	1 	2 
c. Student records	1 	2 
d. Direct certification	1 	2 
e. Other (Specify)	1 	2 
(STRING (NUM))

5.7 What percentage of your free or reduced-price school meal applications are received through the electronic or web-based version? Please provide your best estimate based on applications you received through October 2016.

PERCENTAGE

5.8 For each basis for eligibility listed below, how is the determination of eligibility made when processing applications—manually by the determining official, or automatically (for example, by a computer algorithm, software program, or calculations performed with formulas in a spreadsheet)?

	Select one response per row
	MANUAL DETERMINATION	AUTOMATED DETERMINATION
a. Household income	1 	2 
b. Assistance program case number (for example, SNAP, FDPIR, or TANF)*	1 	2 
c. Child enrolled in Head Start or Even Start	1 	2 
d. Foster child	1 	2 
e. Homeless, migrant, or runaway child	1 	2 

* SNAP is the Supplemental Nutrition Assistance Program (formerly known as Food Stamps). FDPIR is the Food Distribution Program on Indian Reservations. TANF is Temporary Assistance for Needy Families.

5.9 How did you verify applications for SY 2016-2017?

SELECT ONLY ONE

 In a single batch at the beginning of the school year 1

 On a rolling basis as they were approved 2

 In multiple batches 3

 Other (Specify) 99

Specify (STRING (NUM))

 Did not verify applications/exempt 4 SKIP TO 5.19

5.10 What method(s) does your SFA use to first contact households selected for verification?

select ALL THAT APPLY

 Letter 1

 Telephone call 2

 Email 3

 Text 4

 Household's specified communication preference 5

 In person interviews 6

 Other (Specify) 99

Specify (STRING (NUM)

5.11 Does your SFA translate verification notices into the primary language spoken by the recipient household?

 Yes 1

 No 2

5.12 Does your SFA accept emailed submissions of verification documentation from parents?

 Yes 1

 No 2

5.13 Does your SFA follow up with households about verification documentation if they didn’t respond, or if they provided insufficient or unclear documentation??

 Yes 1

 No 2 SKIP TO 5.18

5.14 For households that do not respond to verification requests, how many times does your SFA follow up?

SELECT ONLY ONE

 1 1

 2 2

 3 or more 3

 NA – Our SFA does not follow up with nonresponding households n

5.15 What method(s) does your SFA use to follow up with households that do not respond to verification requests?

Select ALL THAT APPLY

 Mailed letter 1

 Telephone call 2

 Email 3

 Text 4

 Household's specified communication preference 5

 In person interviews 6

 Other (Specify) 99

Specify (STRING (NUM))

5.16 For households that provide insufficient or unclear documentation in response to verification requests, how many times does your SFA follow up?

SELECT ONLY ONE

 1 1

 2 2

 3 or more 3

 NA – Our SFA does not follow up with nonresponding households n

5.17 What method(s) does your SFA use to follow up with households that provide insufficient or unclear documentation in response to verification requests?

Select ALL THAT APPLY

 Mailed letter 1

 Telephone call 2

 Email 3

 Text 4

 Household's specified communication preference 5

 In person interviews 6

 Other (Specify) 99

Specify (STRING (NUM))

5.18 Did your SFA perform verification for cause (that is, verify questionable applications in addition to verifying the sample selected at random) during SY 2016-2017?

 Yes 1

 No 2 SKIP TO 5.21

5.19 How many questionable household applications were verified for cause?

APPLICATIONS

5.19.1 In responding to the next two questions, exclude counts of applications that were directly verified (certification verified without contacting parents). Please provide results by original benefit type and method of approval, as applicable.

How many questionable household applications verified for cause resulted in:

	NUMBER OF QUESTIONABLE HOUSEHOLD APPLICATIONS
	IF NONE, PLEASE ENTER 0.
a. No change to eligibility?
b. A change from free (categorically eligible) to reduced price eligibility?*
c. A change from free (income-eligible) to reduced price eligibility?*

* Categorical eligibility is based on SNAP, TANF, or FDPIR documentation (a case number). Income eligibility is based on household size and income information.

5.19.2 How many questionable household applications verified for cause resulted in changes to paid status? Then, for changes to paid status, indicate how many were a result of NOT responding to requests for verification documentation.

	NUMBER OF QUESTIONABLE HOUSEHOLD APPLICATIONS CHANGED TO PAID STATUS	NUMBER CHANGED FOR NOT RESPONDING TO REQUESTS FOR DOCUMENTATION
	IF NONE, PLEASE ENTER 0.
a. A change from free (categorically eligible) to paid status?
b. A change from free (income-eligible) to paid status?
c. A change from reduced-price to paid status?

5.20 What criteria did your SFA use to identify questionable applications for verification for cause?

	Select one response per row
	YES	NO
a. Non responders from previous school year(s)	1 	2 
b. Applications with zero income listed in current and previous year(s)	1 	2 
c. Error prone (close to income guidelines) applications	1 	2 
d. School district employee application	1 	2 
e. Multiple application submissions with different information in order to qualify for increased benefits	1 	2 
f. Other (Specify)	1 	2 
(STRING (NUM))

5.21 Did your SFA perform direct verification (verified application without contacting parents) on approved household applications?

 Yes 1

 No 2

This section asks about your SFA’s implementation of the updated meal pattern requirements.

6.1 Since which school year (SY) has your SFA received the additional reimbursement of 6 cents per lunch?

SELECT ONLY ONE

 SY 2012-2013 1

 SY 2013-2014 2

 SY 2014-2015 3

 SY 2015-2016 4

• SY 2016-2017 5

 SFA is not certified 6

6.2 Has your SFA used the USDA Best Practices Sharing Center website to assist with menu changes (http://healthymeals.nal.usda.gov/best-practices)?

 Yes 1

 No 2

 Don’t know d

6.3 Has your SFA used any of the following technical assistance resources or opportunities to assist with implementation of the updated meal pattern requirements?

Select ALL THAT APPLY

 Recipes for Healthy Kids cookbook 1

 Nutrition education and technical assistance mailbox 2

 Team Up webinars (not including SA webinars) 3

 Team Up training from the State agency (including SA webinars) 4

6.4 What other steps has your SFA taken to successfully implement the meal pattern requirements?

Select ALL THAT APPLY

 Participating in Farm to School 1

 Participating in DOD Fresh 2

 Ordering different types of USDA foods 2.2

 Ordering different quantities of USDA foods 2.3

 Participating in purchasing cooperatives 3

 Starting school gardens 4

 Updating kitchen equipment 5

 Using Smarter Lunchrooms strategies 6

 Hiring more staff 7

 Training staff 8

 Contracting with a food service management company 9

 Centralizing meal production 10

 Other (Specify): 99

Specify (STRING (NUM))

Following is a list of potential administrative challenges you may continue to experience as you fully implement the meal pattern requirements. How much is each one a challenge to implementing the meal pattern requirements in your SFA?

6.5a How challenging is finding products that meet standards?

SELECT ONLY ONE

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

 Don’t know d

6.5b How challenging is containing the budget?

SELECT ONLY ONE

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

 Don’t know d

6.5c How challenging is containing food costs?

SELECT ONLY ONE

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

 Don’t know d

6.5d How challenging is gaining student acceptance?

SELECT ONLY ONE

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

 Don’t know d

6.5e How challenging is maintaining student participation?

SELECT ONLY ONE

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

 Don’t know d

6.5f How challenging is gaining parent acceptance?

SELECT ONLY ONE

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

 Don’t know d

6.5g How challenging is gaining community acceptance?

SELECT ONLY ONE

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

 Don’t know d

6.5h How challenging is separating portions when age-grade groups overlap?

SELECT ONLY ONE

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

 Not applicable n

 Don’t know d

How much of a challenge is it for your SFA to meet each of the following meal pattern requirements?

6.6a How challenging is it to meet the fluid milk requirement?

SELECT ONLY ONE

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

 Don’t know d

6.6b How challenging is it to meet the minimum average weekly calories requirement?

SELECT ONLY ONE

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

 Don’t know d

6.6c How challenging is it to meet the trans-fat limit requirement?

SELECT ONLY ONE

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

 Don’t know d

6.6d How challenging is it to meet the average weekly saturated fat limit requirement?

SELECT ONLY ONE

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

 Don’t know d

The next set of questions asks how often your SFA uses different types of fruits and vegetables to meet the school meal pattern requirements. Recognizing seasonality differences, please consider use only within the last month.

6.7a How often does your SFA use fresh whole fruit?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.7b How often does your SFA use fresh pre-cut fruit?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.7c How often does your SFA use frozen whole fruit?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.7d How often does your SFA use frozen pre-cut fruit?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.7e How often does your SFA use fruit canned in water?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.7f How often does your SFA use fruit canned in juice?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.7g How often does your SFA use fruit canned in syrup?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.7h How often does your SFA use fruit canned in heavy or regular syrup?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.7i How often does your SFA use 100% fruit juice?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.7j How often does your SFA use dried fruit?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.8a How often does your SFA use fresh whole vegetables?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.8b How often does your SFA use fresh pre cut vegetables?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.8c How often does your SFA use frozen whole vegetables?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.8d How often does your SFA use frozen pre cut vegetables?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.8e How often does your SFA use canned, no salt added vegetables?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.8f How often does your SFA use canned reduced sodium vegetables?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

6.8g How often does your SFA use canned regular sodium vegetables?

SELECT ONLY ONE

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Always 5

The next set of questions is about requirements for whole grains, calories, and sodium.

6.9 What practices has your SFA implemented to meet the whole grain-rich school meals requirement?

Select ALL THAT APPLY

 Purchase whole grain-rich products 1

 Discontinue or change some menu options 2

 Add whole grain-rich items to the menu 3

 Substitute whole grain-rich items for non-whole grain-rich items 4

 Alter recipes 5

 Order whole grain-rich products from USDA Foods more often 6

 Increase portion sizes of some items 7

 No changes—SFA met the 100 percent whole grain-rich requirements prior to the updated standards 8

 Other (Specify) 99

Specify (STRING (NUM))

 Don’t know d

6.10 How challenging has it been to meet the 100 percent whole grain-rich school meals requirement?

SELECT ONLY ONE

 Not challenging 1 SKIP TO 6.12

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

 Don’t know d

6.11 What challenges to the 100 percent whole grain-rich school meals requirement is your SFA experiencing?

Select all that apply

 Lack of student acceptance 1

 Increased food costs 2

 Lack of available products that meet standards 3

 Training of staff 4

 Lack of understanding about the requirements 5

 Other (Specify) 99

Specify (STRING (NUM))

NO RESPONSE M

6.12 Is your SFA having challenges meeting the calorie ranges in the school meals requirements?

 Yes 1

 No 2 SKIP TO 6.13

6.12a For breakfast, what is the biggest challenge for schools with grades K-5 in meeting the calorie requirements?

SELECT ONLY ONE

 Meeting the minimum calorie requirements 1

 Not exceeding the maximum calorie requirements 2

 Meeting the minimum calorie requirements and not exceeding the maximum calorie requirements 3

 No breakfast calorie challenges 4

 Not applicable n

6.12b For breakfast, what is the biggest challenge for schools with grades 6-8 in meeting the calorie requirements?

SELECT ONLY ONE

 Meeting the minimum calorie requirements 1

 Not exceeding the maximum calorie requirements 2

 Meeting the minimum calorie requirements and not exceeding the maximum calorie requirements 3

 No breakfast calorie challenges 4

 Not applicable n

6.12c For breakfast, what is the biggest challenge for schools with grades 9-12 in meeting the calorie requirements?

SELECT ONLY ONE

 Meeting the minimum calorie requirements 1

 Not exceeding the maximum calorie requirements 2

 Meeting the minimum calorie requirements and not exceeding the maximum calorie requirements 3

 No breakfast calorie challenges 4

 Not applicable n

6.12d For breakfast, what is the biggest challenge for schools with other grades (for example, K-8, K-12, or 6-12) in meeting the calorie requirements?

SELECT ONLY ONE

 Meeting the minimum calorie requirements 1

 Not exceeding the maximum calorie requirements 2

 Meeting the minimum calorie requirements and not exceeding the maximum calorie requirements 3

 No breakfast calorie challenges 4

 Not applicable n

6.12e For lunch, what is the biggest challenge for schools with grades K-5 in meeting the calorie requirements?

SELECT ONLY ONE

 Meeting the minimum calorie requirements 1

 Not exceeding the maximum calorie requirements 2

 Meeting the minimum calorie requirements and not exceeding the maximum calorie requirements 3

 No breakfast calorie challenges 4

 Not applicable n

6.12f For lunch, what is the biggest challenge for schools with grades 6-8 in meeting the calorie requirements?

SELECT ONLY ONE

 Meeting the minimum calorie requirements 1

 Not exceeding the maximum calorie requirements 2

 Meeting the minimum calorie requirements and not exceeding the maximum calorie requirements 3

 No breakfast calorie challenges 4

 Not applicable n

6.12g For lunch, what is the biggest challenge for schools with grades 9-12 in meeting the calorie requirements?

SELECT ONLY ONE

 Meeting the minimum calorie requirements 1

 Not exceeding the maximum calorie requirements 2

 Meeting the minimum calorie requirements and not exceeding the maximum calorie requirements 3

 No breakfast calorie challenges 4

 Not applicable n

6.12h For lunch, what is the biggest challenge for schools with other grades (for example, K-8, K-12, or
6-12) in meeting the calorie requirements?

SELECT ONLY ONE

 Meeting the minimum calorie requirements 1

 Not exceeding the maximum calorie requirements 2

 Meeting the minimum calorie requirements and not exceeding the maximum calorie requirements 3

 No breakfast calorie challenges 4

 Not applicable n

6.13 Do you know, by grade level group, average daily sodium content of meals served based in a 5-day week?

 Yes 1

 No 2 SKIP TO 6.14

6.13a For breakfast, what is the current average daily sodium content of meals served at schools with grades K-5?

SODIUM CONTENT

6.13b For breakfast, what is the current average daily sodium content of meals served at schools with grades 6-8?

SODIUM CONTENT

6.13c For breakfast, what is the current average daily sodium content of meals served at schools with grades 9-12?

SODIUM CONTENT

6.13d For breakfast, what is your current average daily sodium content of meals served at schools with other grades (for example, K-8, K-12, or 6-12)?

SODIUM CONTENT

6.13e For lunch, what is the current average daily sodium content of meals served at schools with grades K-5?

SODIUM CONTENT

6.13f For lunch, what is the current average daily sodium content of meals served at schools with grades 6-8?

SODIUM CONTENT

6.13g For lunch, what is the current average daily sodium content of meals served at schools with grades 9-12?

SODIUM CONTENT

6.13h For lunch, what is the current average daily sodium content of meals served at schools with other grades (for example, K-8, K-12, or 6-12)?

SODIUM CONTENT

6.14 What practices does your SFA plan to implement to meet sodium targets during the school year?

Select ALL THAT APPLY or none

 Purchase lower sodium products 1

 Alter recipes (such as limiting salt use, using spices in place of salt) 2

 Discontinue or change some menu options 3

 Increase scratch cooking 4

 Order low sodium USDA Foods more often 5

 Decrease portion sizes 6

 Replacing canned vegetables with fresh or frozen 7

 None 8

 N/A (Current sodium levels already meet the 2^nd Target) 9

 Other (Specify) 99

Specify (STRING (NUM))

 Don’t know d

The next set of questions is about how your SFA addresses student demand for different types of foods, by grade level group.

6.15a Do any of the schools with grades K-5 in your SFA provide any of the following to meet student demand?

select ALL THAT APPLY OR NONE

 Increased fruits and vegetables 1

 A second milk 2

 A second meal 3

 New a la carte offerings 4

 Increased a la carte offerings 5

 None n

 Other (Specify) 99

Specify (STRING (NUM))

6.15b Do any of the schools with grades 6-8 in your SFA provide any of the following to meet student demand?

select ALL THAT APPLY OR NONE

 Increased fruits and vegetables 1

 A second milk 2

 A second meal 3

 New a la carte offerings 4

 Increased a la carte offerings 5

 None n

 Other (Specify) 99

Specify (STRING (NUM))

6.15c Do any of the schools with grades 9-12 in your SFA provide any of the following to meet student demand?

Select ALL THAT APPLY OR NONE

 Increased fruits and vegetables 1

 A second milk 2

 A second meal 3

 New a la carte offerings 4

 Increased a la carte offerings 5

 None n

 Other (Specify) 99

Specify (STRING (NUM))

6.15d Do any of the schools with other grades (for example, K-8, K-12, or 6-12) in your SFA provide any of the following to meet student demand?

Select ALL THAT APPLY or none

 Increased fruits and vegetables 1

 A second milk 2

 A second meal 3

 New a la carte offerings 4

 Increased a la carte offerings 5

 None n

 Other (Specify) 99

Specify (STRING (NUM))

6.16 Does your SFA have difficulty purchasing any of the following vegetable subgroups?

	Select one response per row
	YES	NO
a. Dark green vegetables	1 	2 
b. Red/orange vegetables	1 	2 
c. Beans/peas (legumes)	1 	2 
d. Starchy vegetables	1 	2 
e. Other vegetables	1 	2 

6.16a Why does your SFA have difficulty purchasing these vegetables?

Select ALL THAT APPLY or N/a

 Items are not acceptable to students 1

 Items are too expensive 2

 Not enough variety on the market 3

 Limited availability of items 4

 Items require too much preparation 5

 Limited storage area/refrigeration 6

 Other (Specify) 99

Specify (STRING (NUM))

 N/A—No difficulty purchasing vegetables n

The next set of questions is about how often students waste foods at lunch time based on SFA and/or school staff observations.

6.17 At what school level is the largest proportion of students wasting food served for lunch?

SELECT ONLY ONE

 Elementary schools 1

 Middle schools 2

 High schools 3

 Other schools 4

 Don’t know d SKIP TO 6.18

6.17.1 On average, do students in [FILL SCHOOL TYPE IN 6.17] often, sometimes or rarely consume all of their [FILL A-H] at lunch?

	Often Consume	Sometimes Consume	Rarely Consume	DON’T KNOW
a. Fluid milk	1 □	2 □	3 □	d □
b. Main dish/entrée	1 □	2 □	3 □	d □
c. Bread/grain items	1 □	2 □	3 □	d □
d. Salad/raw vegetables	1 □	2 □	3 □	d □
e. Cooked vegetables	1 □	2 □	3 □	d □
f. Fruit	1 □	2 □	3 □	d □
g. Desserts	1 □	2 □	3 □	d □
h. Other (Specify)	1 □	2 □	3 □	d □
(STRING (NUM))

6.18 What are schools in your SFA doing to prevent or reduce food waste?

Select ALL THAT APPLY

 Allowing more time to eat 1

 Seeking student input for menu planning 2

 Using share tables in the cafeteria 3

 Implementing Offer versus Serve 4

 Improving serving lines 5

 Adding more serving lines 6

 Using Smarter Lunchroom strategies 7

 Other (Specify) 99

Specify (STRING (NUM))

 Schools are not doing anything to prevent or reduce food waste 8

The Smart Snacks in School standards went into effect in SY 2014-2015. The standards apply to all foods and beverages other than reimbursable meals (that is, competitive foods) that are available for sale to students on the school campus during the school day.

7.1 To what extent have the Smart Snacks standards been implemented in your SFA?

SELECT ONE ONLY

 Fully implemented 1

 Partially implemented 2

 Not at all implemented 3

 No competitive foods available in the SFA 4 SKIP TO NEXT SECTION

 Don’t know d

7.2 Do any elementary schools in your SFA have nutrition standards for competitive foods that exceed the Smart Snacks standards?

SELECT ONE ONLY

 Yes 1

 No 2

 No competitive foods in elementary schools 3

 No elementary schools in SFA 4

7.3 Do any middle schools in your SFA have nutrition standards for competitive foods that exceed the Smart Snacks standards?

SELECT ONE ONLY

 Yes 1

 No 2

 No competitive foods in middle schools 3

 No middle schools in SFA 4

7.4 Do any high schools in your SFA have nutrition standards for competitive foods that exceed the Smart Snacks standards?

SELECT ONE ONLY

 Yes 1

 No 2

 No competitive foods in high schools 3

 No high schools in SFA 4

7.5 Do any other schools in your SFA have nutrition standards for competitive foods that exceed the Smart Snacks standards?

SELECT ONE ONLY

 Yes 1

 No 2

 No competitive foods in other schools 3

 No other schools in SFA 4

If you responded “yes” to questions 7.2, 7.3, 7.4 or 7.5 then please answer the question below.

7.6 For which nutrition components has your SFA exceeded the Smart Snacks standards?

Select ALL THAT APPLY

 Have one or more combination food items that contains more than a ¼ cup of fruit and/or vegetable 1

 Food item contains more than 10% of the Daily Value of either calcium, potassium, vitamin D, or dietary fiber 2

 Calorie limits on snack and entrée items 3

 Sodium limits on snack and entrée items 4

 Fat limits on snack and entrée items 5

 Sugar limits on snack and entrée items 6

 Size limits on allowable milks and fruit/vegetable juices 7

 Size limits on “no-calorie” or “low-calorie” beverage options for high schools 8

 Fundraiser exemptions 9

 Other (Specify) 99

Specify (STRING (NUM))

The next set of questions asks about the potential challenges of being able to fully implement the Smart Snacks standards. Using a scale of 1 to 5, where 1=not challenging and 5=extremely challenging, please rate the degree to which each is a challenge in your SFA.

7.7a How challenging is understanding the Smart Snacks standards in your SFA?

SELECT ONE ONLY

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

7.7b How challenging is the availability of competitive foods that meet the Smart Snacks standards in your SFA?

SELECT ONE ONLY

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

7.7c How challenging is the cost of foods that meet the Smart Snacks standards in your SFA?

SELECT ONE ONLY

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

7.7d How challenging is student acceptance of foods that meet the Smart Snacks standards in your SFA?

SELECT ONE ONLY

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

7.7e How challenging is non food-service staff acceptance (“buy-in”) of the Smart Snacks standards in your SFA?

SELECT ONE ONLY

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

7.7f What other important challenge not yet mentioned, if any, has your SFA experienced in meeting the Smart Snacks standards?

Specify

 No other important challenges 1 SKIP TO SECTION 8

7.7g How challenging is that other important challenge to meeting the Smart Snacks standards in your SFA?

SELECT ONE ONLY

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

The following questions are about the design of your SFA’s free and reduced price (F/RP) meal application.

This section begins with questions about your hard copy application form, followed by questions about materials you use to accompany the hard copy form (i.e. instructions, letters, FAQs, and any other information), and then ends with questions about your electronic or web-based version of your F/RP meal application.

8.1 Does your SFA use a hard copy F/RP meal application as your primary application?

 Yes 1

 No 2

8.2 The USDA made available a hard copy F/RP meal application form designed to make it easier for families to complete and submit accurate information, called the USDA Prototype Application for Free and Reduced Price School Meals. Is your SFA’s hard copy F/RP application form identical or closely modeled after the USDA Prototype Application for Free and Reduced Price School Meals?

SELECT ONE ONLY

 Yes, identical to (exactly the same as) the USDA Prototype Application form 1

 Yes, closely modeled after the USDA Prototype Application form 2

 No, completely different from the USDA Prototype Application form 3 SKIP TO 8.6

 Don’t know d SKIP TO 8.6

8.3 Compared to other application forms, how useful has the USDA Prototype Application for Free and Reduced Price School Meals been?

SELECT ONE ONLY

 Not as useful as other forms 1

 Just as useful as other forms 2

 More useful than other forms 3

 Have not used any other forms 4

8.4 How challenging has it been to use the USDA Prototype Application for Free and Reduced Price School Meals?

SELECT ONE ONLY

 Not challenging 1

 A little challenging 2

 Moderately challenging 3

 Very challenging 4

 Extremely challenging 5

 Don’t know d

8.5 How would you rate the quality of information collected from households using the USDA Prototype Household Application for Free and Reduced Price School Meals?

SELECT ONE ONLY

 Low quality 1 SKIP TO 8.8

 Adequate 2 SKIP TO 8.8

 High quality 3 SKIP TO 8.8

8.6 Where did your SFA get your primary hard copy F/RP meal application form?

SELECT ONE ONLY

 We are required to use our State Child Nutrition Office’s hard copy F/RP meal application form, no modifications allowed 1 SKIP TO 8.8

 We are required to use our State Child Nutrition Office’s F/RP meal application form, modifications allowed 2 SKIP TO 8.8

 We choose to use our State Child Nutrition Office’s F/RP meal application form 3 SKIP TO 8.8

 Our SFA has our own hard copy F/RP meal application form 4

 Other (Specify) 99 SKIP TO 8.8

Specify (STRING (NUM))

8.7 Did your SFA (or schools within your SFA) design your own F/RP application form, hire a contractor to design the F/RP application, or use some other approach to designing the F/RP application? Please note, we realize that some parents may choose to submit the USDA prototype application, this question is about your SFA’s primary application.

SELECT ONE ONLY

 SFA’s or schools’ design 1

 SFA contractor’s design 2

 Other (Specify) 99

Specify (STRING (NUM))

 Don’t know d

The next few questions are about the design of any additional materials that may accompany your SFA’s F/RP meal application form. Examples include application instructions, letters, and FAQs, plus other information like charts about family size and income.

8.8 Does your SFA provide households with additional materials to accompany the hard copy F/RP meal application form?

 Yes 1

 No 2 SKIP TO 8.11

8.9 What additional materials does your SFA use to accompany the hard copy F/RP meal application form?

Select ALL THAT APPLY

 Application instructions 1

 Letter or FAQ for households 2

 Other communications provided to households (Specify) 99

Specify (STRING (NUM))

8.10 [If 8.9=1 ASK] Whose materials contributed to the design and content of instructions that accompany your SFA’s F/RP meal application form?

Select ALL THAT APPLY OR NA

 USDA’s prototype materials 1

 State agency issued or endorsed materials 2

 SFA or SFA contractor’s materials 3

 Other (Specify) 99

Specify (STRING (NUM))

 Don’t know d

 NA – Current hard copy SFA FR/P meal application is not accompanied by instructions n

8.11 [If 8.9=2 ASK] Whose materials contributed to the design and content of the letter or FAQ that accompany your SFA’s hard copy F/RP meal application form?

Select all that apply or NA

 USDA’s prototype materials 1

 State agency issued or endorsed materials 2

 SFA or SFA contractor’s materials 3

 Other (Specify) 99

Specify (STRING (NUM))

 Don’t know d

 NA – Current hard copy SFA FR/P meal application is not accompanied by letter or FAQ n

8.12 [If 8.9=99 ASK] Whose materials contributed to the design and content of other communications that accompany your SFA’s F/RP meal application form?

select all that apply or NA

 USDA’s prototype materials 1

 State agency issued or endorsed materials 2

 SFA or SFA contractor’s materials 3

 Other (Specify) 99

Specify (STRING (NUM))

 Don’t know d

 NA – Current hard copy SFA FR/P meal application is not accompanied by other communications n

The following questions are about your SFA’s “electronic” or “web-based” F/RP meal application form and accompanying materials. “Electronic or web-based” refers to applications in which information is entered and submitted electronically. It does not refer to documents accessed electronically and printed out on hard copy for completion.

8.13 Does your SFA use an electronic or web-based F/RP meal application form as your primary application?

 Yes 1

 No 2

8.14 What benefits has your SFA experienced as a result of using the electronic or web-based F/RP meal application form?

select all that apply or No Benefits

 Decreased administrative burden 1

 Decreased costs associated with not using other application types 2

 Decreased application processing time 3

 Decreased household reporting error 4

 Increased school SBP participation 5

 Increased school NSLP participation 6

 Other (Specify) 99

Specify (STRING (NUM))

 No benefits n

8.15 What challenges has your SFA experienced as a result of using the electronic or web-based F/RP meal application form?

select all that apply or No CHALLENGES

 Application is not accessible using mobile devices 1

 Families have limited internet access 2

 Student data is less secure 3

 Difficulty providing technical assistance to parents 4

 Decreased school SBP participation 5

 Decreased school NSLP participation 6

 Other (Specify) 99

Specify (STRING (NUM))

 No challenges n

8.16 Who developed your electronic or web-based version of the F/RP meal application form?

SELECT ONE ONLY

 State agency 1

 SFA staff 2

 A contractor hired by SFA 3

• Software Vendor 4

Specify (STRING (NUM))

 Other (Specify) 99

Specify (STRING (NUM))

 Don’t know d

8.17 Which process does your SFA encourage households to use to complete the F/RP meal applications?

SELECT ONE ONLY

 Electronic or web-based version 1

 Paper applications completed independently 2

 Paper applications completed with in person or phone assistance 3

 Some other method 4

 Not applicable (for example, SFA uses a single process or encourages processes equally) n

The following questions ask about meal counting activities in SY 2016-2017.

9.1 Do schools in your SFA keep track of the number of free, reduced price, and paid meals served to students in the cafeteria and non-cafeteria points of service using any of the following methods?

	FOR EACH ROW, SELECT ONE PER POINT OF SERVICE TYPE
	CAFETERIA		NON-CAFETERIA
	YES	NO	YES	NO
a. Personal Identification Numbers (PINs)	1 	2 	1 	2 
b. Rosters or cashier lists	1 	2 	1 	2 
c. Coded ID cards	1 	2 	1 	2 
d. Biometric technology (for example, fingerprint scanners)	1 	2 	1 	2 
e. Coded tickets or tokens	1 	2 	1 	2 
f. Manual entry	1 	2 	1 	2 
g. Online ordering	1 	2 	1 	2 
h. Hand Held Clicker	1 	2 	1 	2 
i. Other (Specify)	1 	2 	1 	2 
(STRING (NUM))

9.2 Does your SFA provide the following types of training to cashiers?

	TRAINING PROVIDED?
	YES	NO
a. Monitoring student meal selections for reimbursable meals	1 	2 
b. Operating a Point of Service (POS) system	1 	2 
c. Offer versus serve	1 	2 
d. Method of counting meals	1 	2 
e. Acceptable types of payments	1 	2 
f. Managing cash for a la carte and adult meals	1 	2 
g. Meal and food pricing	1 	2 
h. Applications for free or reduced price meals	1 	2 
i. Customer Service	1 	2 
j. Civil rights	1 	2 
k. Maintaining confidential student information	1 	2 
l. Other (Specify)	1 	2 
(STRING (NUM))

9.2.1 How often is each training type provided to cashiers? Please specify if it is when the cashier is hired, once each school year, or more than once each school year. If you selected “No” for a training type in Question 9.2, select “NA-No Training Provided.

	Select all that apply
	HOW OFTEN PROVIDED
	WHEN CASHIER IS HIRED	ONCE EACH SCHOOL YEAR	MORE THAN ONCE EACH SCHOOL YEAR	NA-NO TRAINING PROVIDED
a. Monitoring student meal selections for reimbursable meals	1 	2 	3 	n 
b. Operating a Point of Service (POS) system	1 	2 	3 	n 
c. Offer versus serve	1 	2 	3 	n 
d. Method of counting meals	1 	2 	3 	n 
e. Acceptable types of payments	1 	2 	3 	n 
f. Managing cash for a la carte and adult meals	1 	2 	3 	n 
g. Meal and food pricing	1 	2 	3 	n 
h. Applications for free or reduced price meals	1 	2 	3 	n 
i. Customer service	1 	2 	3 	n 
j. Civil rights	1 	2 	3 	n 
k. Maintaining confidential student information	1 	2 	3 	n 
l. Other (Specify)	1 	2 	3 	n 
(STRING (NUM))

9.2.2 Would these types of cashier training that are not provided be useful to school cashiers given their responsibilities? If you selected “Yes” for a training type in Question 9.2, please select “NA-Training is Provided” in Question 9.2.2 a-l.

	WOULD THIS TYPE OF TRAINING BE USEFUL TO SCHOOL CASHIERS?
	YES	NO	NA-TRAINING IS PROVIDED
a. Monitoring student meal selections for reimbursable meals	1 	2 	n 
b. Operating a Point of Service (POS) system	1 	2 	n 
c. Offer versus serve	1 	2 	n 
d. Method of counting meals	1 	2 	n 
e. Acceptable types of payments	1 	2 	n 
f. Managing cash for a la carte and adult meals	1 	2 	n 
g. Meal and food pricing	1 	2 	n 
h. Applications for free or reduced price meals	1 	2 	n 
i. Customer service	1 	2 	n 
j. Civil rights	1 	2 	n 
k. Maintaining confidential student information	1 	2 	n 
l. Other (Specify)	1 	2 	n 
(STRING (NUM))

9.3 Does your SFA conduct on-site monitoring of cashiers?

 Yes 1

 No 2 SKIP TO 9.5

9.4 How often is on-site monitoring conducted?

SELECT ONE ONLY

 Less than once a year 1

 Once a year 2

 Twice a year 3

 Three or more times a year 4

9.5 Aside from cafeterias, do any schools in your SFA use the following point of service methods for school breakfast?

	Select one per row
	YES	NO
a. Pre-packaged meal (for example, Grab ‘n go, bagged meals)	1 	2 
b. Meal delivery to the classroom	1 	2 
c. Kiosk or cart	1 	2 
d. Vending machine dispensed meal	1 	2 
e. Food truck	1 	2 
f. Other (Specify)	1 	2 
(STRING (NUM))

9.6 Aside from cafeterias, do any schools in your SFA use the following point of service methods for school lunch?

	Select one per row
	YES	NO
a. Pre-packaged meal (for example, Grab ‘n go, bagged meals)	1 	2 
b. Meal delivery to the classroom	1 	2 
c. Kiosk or cart	1 	2 
d. Vending machine dispensed meal	1 	2 
e. Food truck	1 	2 
f. Other (Specify)	1 	2 
(STRING (NUM))

This section asks about revenues and expenditures of your SFA in SY 2015-2016.

10.1 For the SY 2015-2016, please record all revenues that were received by your school district’s foodservice program. Please include revenues from local, State, Federal, and any other sources.

Examples of Federal sources include reimbursements for free, reduced price, and paid meals, reimbursements for other Child Nutrition programs, or adjustments for an underclaim from a Federal or State audit.

Examples of State sources include reimbursements for free or reduced price meals.

Examples of local sources include student payments for reimbursable meals, adult meals, competitive foods sales, school district subsidy, community donations, or catering revenues.

IF NONE, PLEASE ENTER 0.

$ DOLLARS

10.2 How much revenue did your SFA’s foodservice program receive in SY 2015-2016 from each of the following local, State, Federal, and other revenue sources? If your SFA did not receive revenue from a category, please enter a 0 (zero) for that category.

	REVENUE
a. Revenue from local sources	$
b. Revenue from State sources	$
c. Revenue from Federal sources	$
OTHER SOURCES OF REVENUE
(STRING (NUM)) d.	$
(STRING (NUM)) e.	$
(STRING (NUM)) f.	$

10.3 The next set of questions asks about whether your SFA or State provided a subsidy to schools for reimbursable breakfasts or lunches and how that subsidy was provided. NSLP or SBP reimbursements do not count as subsidies.

Did your SFA provide a breakfast subsidy to schools during SY 2015-2016?

 Yes 1

 No 2 SKIP TO 10.5

 N/A – no School Breakfast Program in SFA n SKIP TO 10.5

10.4 How was that SFA breakfast subsidy provided?

SELECT ONE ONLY

 Per meal 1

 Annual lump sum 2

 Supplemental to cover specific costs 3

 Based on a percentage of low-income students 4

 Other (Specify) 99

Specify (STRING (NUM))

10.5 Did your SFA provide a lunch subsidy to schools during SY 2015-2016?

 Yes 1

 No 2 SKIP TO 10.7

10.6 How was that SFA lunch subsidy provided?

SELECT ONE ONLY

 Per meal 1

 Annual lump sum 2

 Supplemental to cover specific costs 3

 Based on a percentage of low-income students 4

 Other (Specify) 99

Specify (STRING (NUM))

10.7 Did your State provide a breakfast subsidy during SY 2015-2016?

 Yes 1

 No 2 SKIP TO 10.9

 N/A – no School Breakfast Program in SFA n SKIP TO 10.9

10.8 How was that State breakfast subsidy provided?

SELECT ONE ONLY

 Per meal 1

 Annual lump sum 2

 Supplemental to cover specific costs 3

 Based on a percentage of low-income students 4

 Other (Specify) 99

Specify (STRING (NUM))

10.9 Did your State provide a lunch subsidy during SY 2015-2016?

 Yes 1

 No 2 SKIP TO 10.11

10.10 How was that State lunch subsidy provided?

SELECT ONE ONLY

 Per meal 1

 Annual lump sum 2

 Supplemental to cover specific costs 3

 Based on a percentage of low-income students 4

 Other (Specify) 99

Specify (STRING (NUM))

10.11 For SY 2015-2016, please record all expenditures made by your school district’s foodservice program.

Examples of expenditure categories include salaries, fringe benefits, total purchased foods (including foods for both reimbursable and non-reimbursable meals), capital expenditures, supplies, storage and transportation, maintenance and repairs, contracted services, payment for an overclaim as a result of a Federal or State audit, overhead or indirect costs, or any other sources.

IF NONE, PLEASE ENTER 0.

$ DOLLARS

These next questions ask about the background of the current SFA director and other key staff working in the SFA. If you are responding on behalf of the SFA director or other key SFA staff, please obtain their information and enter it here.

11.1 When were you hired or promoted into your current position as SFA director?

Please enter the month and year of your start date below.

START DATE

MONTH YEAR

11.2 What is the highest level of education you completed?

SELECT ONE ONLY

 Less than high school 1 SKIP TO 11.4

 High school (or GED) 2 SKIP TO 11.4

 Some college, no degree 3 SKIP TO 11.4

 Associate’s degree 4

 Bachelor’s degree 5

 Master’s degree 6

 Graduate credits beyond a Master’s degree but no degree 7

 Doctorate 8

11.3 Is your degree in food and nutrition, family and consumer sciences, nutrition education, foodservice management, dietetics, culinary arts, business or a related field?

 Yes 1

 No 2

11.4 Does the SFA director share leadership or other key responsibilities with other staff at the SFA, such as an assistant director?

 Yes 1

 No 2 SKIP TO NEXT SECTION

11.5 Please enter the job titles of up to two key SFA staff below.

SFA Staff 1

SFA Staff 2

SFA Staff 3

SFA Staff 4

SFA Staff 5

11.6 The following questions are about the key SFA staff you named in the previous question. If you only named one key staff person then only fill in the answers for the first column.

	SFA STAFF 1	SFA STAFF 2
a. When was the SFA staff person hired or promoted into his or her current position? Please enter the month and year of start date.	Month YEAR	Month YEAR
b. What is the highest level of education the SFA staff person completed?	1  Less than high school SKIP TO 12.1 2  High school (or GED) SKIP TO 12.1 3  Some college, no degree SKIP TO 12.1 4  Associate’s degree 5  Bachelor’s degree 6  Master’s degree 7  Graduate credits beyond a Master’s degree but no degree 8  Doctorate	1  Less than high school SKIP TO 12.1 2  High school (or GED) SKIP TO 12.1 3  Some college, no degree SKIP TO 12.1 4  Associate’s degree 5  Bachelor’s degree 6  Master’s degree 7  Graduate credits beyond a Master’s degree but no degree 8  Doctorate
c. Is the degree of the SFA staff person in food and nutrition, family and consumer sciences, nutrition education, food service management, dietetics, culinary arts, business or a related field?	1  Yes 2  No	1  Yes 2  No

11.6 The following questions are about the key SFA staff you named in the previous question. If you only named one key staff person then only fill in the answers for the first column.

	SFA STAFF 3	SFA STAFF 4
a. When was the SFA staff person hired or promoted into his or her current position? Please enter the month and year of start date.	Month YEAR	Month YEAR
b. What is the highest level of education the SFA staff person completed?	1  Less than high school SKIP TO 12.1 2  High school (or GED) SKIP TO 12.1 3  Some college, no degree SKIP TO 12.1 4  Associate’s degree 5  Bachelor’s degree 6  Master’s degree 7  Graduate credits beyond a Master’s degree but no degree 8  Doctorate	1  Less than high school SKIP TO 12.1 2  High school (or GED) SKIP TO 12.1 3  Some college, no degree SKIP TO 12.1 4  Associate’s degree 5  Bachelor’s degree 6  Master’s degree 7  Graduate credits beyond a Master’s degree but no degree 8  Doctorate
c. Is the degree of the SFA staff person in food and nutrition, family and consumer sciences, nutrition education, food service management, dietetics, culinary arts, business or a related field?	1  Yes 2  No	1  Yes 2  No

11.6 The following questions are about the key SFA staff you named in the previous question. If you only named one key staff person then only fill in the answers for the first column.

	SFA STAFF 5
a. When was the SFA staff person hired or promoted into his or her current position? Please enter the month and year of start date.	Month YEAR
b. What is the highest level of education the SFA staff person completed?	1  Less than high school SKIP TO 12.1 2  High school (or GED) SKIP TO 12.1 3  Some college, no degree SKIP TO 12.1 4  Associate’s degree 5  Bachelor’s degree 6  Master’s degree 7  Graduate credits beyond a Master’s degree but no degree 8  Doctorate
c. Is the degree of the SFA staff person in food and nutrition, family and consumer sciences, nutrition education, food service management, dietetics, culinary arts, business or a related field?	1  Yes 2  No

12. FINAL REMARKS

12.1 Before you submit your survey, do you have any other comments that you would like to share with the Food and Nutrition Service of U.S. Department of Agriculture? These comments can be related to the survey topics or any other topic.

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