State, Local, and Tribal Government - State Child Nutrition Agency, SFA, and Schools

APPENDIX B11. SFA DIRECTOR SURVEY (WEB BASED)

OMB Number: 0584-0530

Expiration Date: XX/XX/XXXX

Third Access, Participation, Eligibility and Certification Study Series (APEC III)

SFA DIRECTOR SURVEY (WEB BASED)

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 0584-0530. The time required for the SFA director to complete this information collection is estimated to average 45 minutes per response during each data collection round, including the time to review instructions, search existing data resources, gather and maintain the data needed, and complete and review the collection of information.

NOTES TO REVIEWERS

Overview:

The SFA Director Survey will be a web survey completed by all SFA Directors (or their designee). In addition, a sub-sample of SFAs will be asked to complete an in-depth interview by phone to supplement the survey data.

The following notes to reviewers help to explain the overall flow of the SFA Director survey. Reviewers are encouraged to print this notes page and refer to it while reviewing each section of the SFA Director survey.

________________________________________________________________________________________

General Notes:

1. The SFA will be provided a unique PIN number which will allow them access to only their SFA’s survey online. If the survey is completed by multiple people at the SFA, each person must access the survey using the unique PIN number assigned to the SFA.

2. The user will be able to complete the survey over time, saving the survey for later until the survey is ready for final submission.

3. The web survey will be programmed with automatic skip patterns based on prior responses. In addition, soft and hard logic edits will be built into the survey.

4. The user will be able to print out a copy of the survey as a reference to plan for completing the survey online.

5. For some questions, context specific text will be embedded in the question automatically. This includes information that is derived, calculated, or drawn from pre-loaded data about that SFA. This information will be in <brackets>.

6. At times, boxes are used for instructions and directions. The wording in these boxes has been simplified to increase comprehension for the reviewer. When programmed, these instructions will become considerably more complicated.

7. Some questions will be repeated for each sampled school. The draft survey will only present them once, with a note indicating the questions repeat.

8. For each question, the respondent will have the option to select “Don’t Know”, “Not Applicable”, or “Add Comment”.

9. The survey draws upon the APEC II survey. However, some questions have been re-organized, re-worded, or expanded. Further, some questions are no longer applicable and have been deleted (e.g., CEP questions based on all CEP schools operating in year 1 or year 2), and new questions have been added.

Thank you for participating in the third Access, Participation, Eligibility and Certification Study Series (APEC-III). As you know, the U.S. Department of Agriculture’s (USDA) Food and Nutrition Service (FNS) has contracted with Westat, Inc. to administer APEC III. This SFA Director Survey is one component of data collection that will provide important information about the characteristics of the SFAs participating in the study.

Your responses to this survey will help the study understand your school district’s participation in the National School Lunch Program (NSLP) and/or the School Breakfast Program (SBP), your district’s participation in special provisions (if applicable), how you certify students for free and reduced-price meals, your verification process, how you and your schools record and account for meals served to students, and other relevant information about your district’s processes.

The information you provide will be used for research purposes only. It will not be used to evaluate any single SFA or district and will only be used in aggregate.

Survey Consent Form

PURPOSE: Funded by the United States Department of Food and Agriculture (USDA), Food and Nutrition Service (FNS), the goal of the APEC III study is to provide FNS with reliable, national estimates of erroneous payments in the National School Lunch Program (NSLP) and the School Breakfast Program (SBP) in school year (SY) 2017-2018. The data collected will be used to:

• Generate a national estimate of the annual amount of erroneous payments;

• Provide a robust examination of the student (household), school, and School Food Authorities (SFAs) characteristics that may contribute to or mitigate error;

• Conduct a sub-study on the differences in error rates among SFAs using different implementation strategies in their school meals program; and

• Complete qualitative analyses to better understand the sources of errors and how to potentially address them.

Westat, a research organization, was hired to conduct the APEC III study.

HOW YOU WERE SELECTED: The study team used a scientific method to randomly pick your SFA from a list of SFA’s throughout the entire United States.

INFORMATION TO BE COLLECTED: As the SFA Director, we will ask questions about your district’s participation in the National School Lunch Program (NSLP) and/or the School Breakfast Program (SBP), your district’s participation in special provisions (if applicable), how you certify students for free and reduced-price meals, your verification process, how you and your schools record and account for meals served to students, and other relevant information about your district’s processes.

RISKS AND PRIVACY: There is little risk to being part of this study. We use all data we collect only for the purposes we describe. Many steps are taken to keep your data private to the full extent allowed by law. Any reports we prepare will combine your answers with those from other people in the study to summarize what we found. Your name, district or SFA will never be in the reports we prepare. Nothing you say is shared with the schools in your SFA, other SFAs or any agency that provides benefits to your SFA. Participating in the survey may not help you individually, but it may help us better understand how to reduce error rates in the school breakfast and lunch program.

STUDY COSTS AND COMPENSATION: There is no cost to you to join this study. The interview takes about 45 minutes.

VOLUNTARY PARTICIPATION: This is a research study. While Section 305 of the Healthy, Hunger-Free Kids Act of 2010 requires SFAs to cooperate with FNS research studies, sharing your personal thoughts and opinions during this discussion is completely voluntary. You may skip any question you do not wish to answer and you can stop the interview at any time. Signing this consent form does not waive any of your legal rights. Refusal to participate will not have any impact on your district or position as SFA staff.

QUESTIONS: If you have questions about the study, you may call Roline Milfort, the study project director, toll-free at 1-855-820-6138. If you have questions about your rights as a research participant, please call the Westat Human Subjects Protections office at 1-888-920-7631. Please leave a message with your full name, the name of this study (APEC III), and a phone number including the area code. Someone will return your call as soon as possible.

CONSENT SIGNATURES: I have been given the chance to ask questions about the study and all my questions have been answered to my satisfaction. I have read and understand this entire consent form, and agree to participate in this study.

Participant’s Name (Please type): ______________________________ Date:_______

I agree to participate

I do not agree to participate

General Instructions:

• Report the number of schools, students, meals served, and applications for School Year 2017-2018 AS OF <INSERT DATE> or for the period which you reported to the State Child Education or Nutrition Agency.

• If your SFA is participating in the Community Eligibility Provision (CEP), you will also be asked to reference counts as of <INSERT DATE>.

• When answering questions, select the appropriate response and/or enter all numerical responses in the boxes provided after the question.

• If a given data item is not readily available, please conduct a manual count if possible. If a manual count is not possible, provide your best estimate.

• Click on the “add comment” icon to provide a comment about your response to a question or section.

• You may not need to answer all the questions. The questions you answer will depend on whether your SFA has private schools; Provision 2 or 3 schools; or schools participating in the Community Eligibility Provision. The survey is programmed to move to the next appropriate question based on your responses.

• At the end of the survey, you will be able to print out a copy of your responses. Please keep a copy of your responses as a reference. We may contact you for further clarification.

• After you have printed a copy of your completed survey, select the “Submit” button to complete the survey.

• You can complete the survey over time, by saving your survey and coming back to it at another time.

• You can print a copy of the survey as a reference to help prepare for completion online.

• If you have any questions or inquiries, contact us at [email protected] or 1-855-820-6138.

Q1. Since the focus of this research study is on USDA’s NSLP and SBP, we ask that you calculate and record counts of both schools and students in terms of schools participating in the NSLP and/or SBP and students with an opportunity to participate in the NSLP and SBP.

For example, there may be schools within your SFA that do not provide lunch or breakfast. Students enrolled in these schools would be included in student enrollment counts but they do not have the opportunity to participate in the NSLP or SBP. If it is not possible to provide the counts in terms of students with an opportunity to participate in the NSLP and SBP (i.e., limit to schools participating in these programs), you may provide the counts in terms of total students enrolled (if it is different).

Please indicate whether you will report enrollment in terms of those students with the opportunity to participate in these programs, or only in terms of total students enrolled.

If your district is required to provide at least one meal per school day, select ‘total students enrolled’ and ‘required to offer at least one meal per day’.

STUDENTS WITH AN OPPORTUNITY

TO PARTICIPATE IN THE NSLP AND/OR SBP 1

TOTAL STUDENTS ENROLLED 2

REQUIRED TO OFFER AT LEAST ONE MEAL PER SCHOOL DAY 3

Q2. Will you report the number of schools, students, meals served, and applications for School Year 2017-2018 as of <INSERT DATE> or from another date?

AS OF [INSERT DATE] 1 (GO TO SECTION A)

FROM ANOTHER DATE 2

Q3. Please specify the date other than <INSERT DATE>:

|__|__| / |__|__| / |__|__|__|__|

MONTH DAY YEAR

SECTION A: SFA DISTRICT AND STUDENT CHARACTERISTICS

A1. Please indicate if your SFA includes public schools only, private schools only, or both public and private schools, and the number of each as of <INSERT DATE>. (Publicly funded charter schools should be considered public schools.)

HOW MANY?

PUBLIC SCHOOLS ONLY 1 |__|,|__|__|__| PUBLIC SCHOOLS

PRIVATE SCHOOLS ONLY 2 |__|,|__|__|__| PRIVATE SCHOOLS

BOTH PUBLIC AND PRIVATE SCHOOLS 3 |__|,|__|__|__| PUBLIC SCHOOLS

|__|,|__|__|__| PRIVATE SCHOOLS

A2. Does your SFA administer the NSLP or SBP for more than one school district or other legal entity?

YES 1

NO 0 (GO TO A4)

A3. What is the total number of school districts (public or private) in your SFA?

_____________

NUMBER OF DISTRICTS IN SFA

A4. Do all of the schools in your district start and end on the same date?

Yes, all schools start and end on the
same date 1

No, the start and end date varies 2

A5. What was the date of the first day of your current school year (2017-2018)? If the first day of school varied, record the earliest start date.

|__|__| / |__|__| / |__|__|__|__|

MONTH DAY YEAR

A6. What is the date of the last day of the current school year (2017-2018)? If the last day of school varies, record the last end date.

|__|__| / |__|__| / |__|__|__|__|

MONTH DAY YEAR

A7. Is your SFA food service operation under the direction of a food service management company, or does your SFA use a consulting company, vended meal company, or independent consultant to help plan or manage food service operations?

YES-USES FOOD SERVICE MANAGEMENT COMPANY 1

YES-USES OTHER TYPE OF CONSULTING SERVICE 2

NO, NEITHER 3

A8. Indicate the number of schools, overall and by grade level, that participate in the NSLP, SBP, or both

as of <INSERT DATE>.

Elementary schools are typically grades K-5, middle schools or junior high are typically grades 6-8, and high schools are typically grades 9-12. If your schools don’t align with these categories, please fit them as closely as possible.

		Number of schools operating both NSLP and SBP	Number of schools operating only NSLP	Number of schools operating only SBP
A8a.	TOTAL FOR SFA	_________ # SCHOOLS	_________ # SCHOOLS	_________ # SCHOOLS
A8b.	ELEMENTARY SCHOOLS	_________ # SCHOOLS	_________ # SCHOOLS	_________ # SCHOOLS
A8c.	MIDDLE OR JUNIOR HIGH	_________ # SCHOOLS	_________ # SCHOOLS	_________ # SCHOOLS
A8d.	HIGH SCHOOLS	_________ # SCHOOLS	_________ # SCHOOLS	_________ # SCHOOLS
A8e.	OTHER PROGRAMS (SPECIFY)	_________ # SCHOOLS	_________ # SCHOOLS	_________ # SCHOOLS

A9. Indicate the number of students enrolled, overall and by grade level, enrolled in schools that participate in the NSLP, SBP, or both (i.e. access to NSLP and/or SBP) as of <INSERT DATE>.

		Number of students enrolled in schools operating both NSLP and SBP	Number of students enrolled in schools operating only NSLP	Number of students enrolled in schools operating only SBP
A9a.	TOTAL FOR SFA	_________ # STUDENTS	_________ # STUDENTS	_________ # STUDENTS
A9b.	ELEMENTARY SCHOOLS	_________ # STUDENTS	_________ # STUDENTS	_________ # STUDENTS
A9c.	MIDDLE OR JUNIOR HIGH	_________ # STUDENTS	_________ # STUDENTS	_________ # STUDENTS
A9d.	HIGH SCHOOLS	_________ # STUDENTS	_________ # STUDENTS	_________ # STUDENTS
A9e.	OTHER PROGRAMS (SPECIFY)	_________ # STUDENTS	_________ # STUDENTS	_________ # STUDENTS

A10. As of <INSERT DATE>, record the ethnic, racial, and gender composition of enrolled students with access to the NSLP and/or SBP in your SFA. If there are no enrolled students of a particular ethnic or racial group, enter ‘0’.

		# of Students
a	Hispanic
b	Non-Hispanic
c	Data Not Available
d	White
e	Black or African American
f	Indian or Alaska Native
g	Asian
h	Hawaiian or Pacific Islander
i	Other
j	Data Not Available
k	Male
l	Female
m	Data Not Available

A11. The Healthy Hunger-Free Kids Act provides an additional 6-cents per lunch reimbursement to school districts that are certified to be in compliance with the updated meal patterns. The increased reimbursement is provided to school districts once they meet the new meal patterns published in the final rule on January 26, 2012. Funding became available to school districts starting October 1, 2012.

Does your SFA receive an additional 6-cent reimbursement per lunch for being in compliance with updated meal patterns?

Yes 1

No 0

A12. SFAs where 60 percent or more of the lunches in the second preceding school year were served free or reduced price receive an additional two-cents per meal served. This is referred to as the NSLP 60% subsidy or the “two-cent differential.”

Does your SFA receive a NSLP 60% subsidy?

Yes 1

No 0

A13. Schools are defined as “severe need” for breakfast if they claimed more than 40 percent of their lunches at the free and reduced-price rate in the second preceding school year. Do any schools within your SFA receive this severe need subsidy?

Yes 1

No 0

A14. For the month of <Month, Year> record the number of meals claimed for reimbursement by program for the entire SFA.

PROGRAMMER NOTE: DISPLAY TABLE BELOW FOR SFAS WITH NON-CEP SCHOOLS.

		Total Number of Meals Claimed	Number of Free Meals Claimed	Number of Reduced Price Meals Claimed	Number of Paid Meals Claimed
A14a	NSLP – Lunch	_________ # Meals	_________ # Meals	_________ # Meals	_________ # Meals
A14b	SBP – Breakfast	_________ # Meals	_________ # Meals	_________ # Meals	_________ # Meals

PROGRAMMER NOTE: DISPLAY TABLES FOR SFAS WITH CEP SCHOOLS:

		Total Number of Meals Claimed	Number of Free Meals Claimed	Number of Paid Meals Claimed
A15c	NSLP – Lunch	_________ # Meals	_________ # Meals	_________ # Meals
A14d	SBP – Breakfast	_________ # Meals	_________ # Meals	_________ # Meals

SECTION B: SFA PARTICIPATION IN PROVISION 2 AND 3

B1. Under Provision 2 or 3, schools serve meals free to all students, and, after a base year, do not process applications nor track whether students receiving meals are approved for free or reduced-price meals.

Under Provision 2, the reimbursements received from USDA in a non-base year are based on the total number of meals served and claiming percentages by meal reimbursement type that were established in the base year.

Under Provision 3, the reimbursements are based on the total dollar reimbursement received during the base year and may be adjusted for changes in enrollment and inflation.

Any school participating in the National School Lunch Program or the Breakfast Program may opt for Provision 2 or Provision 3.

Which of the following best describes schools in your SFA?

All schools use Provision 2 (GO TO B3) 1

All schools use Provision 3 (GO TO B3) 2

Some schools use Provision 2 3

Some schools use Provision 3 4

Some schools use Provision 2 and some schools use Provision 3 5

No schools use Provision 2 or 3 6

B2. What is the primary reason (more) schools in your SFA do not participate in Provision 2 or 3?

Process is too complicated or time consuming. 1

Lack technology or resources to change current system. 2

State or local rules require SFA to collect and report individual meal

application data yearly 3

Provision 2 or 3 is not economically beneficial or appropriate for our schools 4

Community Eligibility Provision (CEP) is a better option for our schools 5

Other (SPECIFY) 6

PROGRAMMER NOTE: IF B1=6, SKIP B3 AND GO DIRECTLY TO SECTION C.

B3. As of <INSERT DATE>, record the number of Provision 2 and/or Provision 3 schools and the enrolled students, by category, for your entire SFA.

	NUMBER OF SCHOOLS	NUMBER OF ENROLLED STUDENTS
Total number of provision 2 for NSLP	|__|,|__|__|__|	|__|,|__|__|__|,|__|__|__|
Provision 2 NSLP in base year	|__|,|__|__|__|	|__|,|__|__|__|,|__|__|__|
c. Provision 2 NSLP in non-base year	|__|,|__|__|__|	|__|,|__|__|__|,|__|__|__|
Total number of provision 2 for SBP	|__|,|__|__|__|	|__|,|__|__|__|,|__|__|__|
Provision 2 SBP in base year	|__|,|__|__|__|	|__|,|__|__|__|,|__|__|__|
Provision 2 SBP in non-base year	|__|,|__|__|__|	|__|,|__|__|__|,|__|__|__|
Total number of provision 3 for NSLP	|__|,|__|__|__|	|__|,|__|__|__|,|__|__|__|
Provision 3 NSLP in base year	|__|,|__|__|__|	|__|,|__|__|__|,|__|__|__|
i. Provision 3 NSLP in non-base year	|__|,|__|__|__|	|__|,|__|__|__|,|__|__|__|
Total number of provision 3 for SBP	|__|,|__|__|__|	|__|,|__|__|__|,|__|__|__|
Provision 3 SBP in base year	|__|,|__|__|__|	|__|,|__|__|__|,|__|__|__|
Provision 3 SBP in non-base year	|__|,|__|__|__|	|__|,|__|__|__|,|__|__|__|

SECTION C: SFA PARTICIPATION IN CEP

Under the Community Eligibility Provision (CEP), schools apply claiming percentages to the total number of reimbursable meals in the school(s) that elected CEP (individually or as a group). A school(s) that elects CEP will claim reimbursement based on the percentage of its enrolled students that are “identified students” (e.g., directly certified or other identified students (e.g., homeless, migrants, runaways)). The CEP can be elected for the entire local education agency (LEA), for a group(s) of schools within an LEA, or for an individual school in the LEA.

An LEA is a public board of education or other public authority legally constituted within a State for either administrative control or direction of, or to perform a service function for, public elementary schools or secondary schools in a city, county, township, school district, or other political subdivision of a State, or for a combination of school districts or counties that is recognized in a State as an administrative agency for its public elementary schools or secondary schools.

An SFA is the governing body which is responsible for the administration of one or more schools; and has the legal authority to operate child nutrition programs therein or be otherwise approved by USDA to operate the Program.

C1. In your SFA, was CEP elected by…

No participation in CEP 1 (GO TO C2)

Entire SFAs? 2 (GO TO C3)

Only individual schools? 3 (GO TO C3)

Only groups of schools within SFAs? 4 (GO TO C3)

Combination of individual schools and groups of schools within SFAs? 5 (GO TO C3)

C2. What is the primary reason your SFA did not elect CEP for any school(s)?

Process is too complicated or time consuming 1

Lack technology or resources to change current system 2

State or local rules require SFA to collect and report individual meal application data yearly 3

CEP is not economically beneficial or appropriate in our SFA 4

No schools (or group of schools) were eligible 5

Provision 2 or 3 is a better option for our schools 6

Other (SPECIFY) _________________________________________ 7

C3. Which sources did you use to determine your ISP (Identified Student Percentage) rate?

Supplemental Nutrition Assistance Program (SNAP) 1

Temporary Assistance for Needy Families (TANF) 2

Food Distribution Program on Indian Reservations (FDPIR) 3

Head Start or Early Head Start Participant 4

Migrant child 5

Runaway child 6

Homeless child 7

Foster child certified through means other than an application 8

Non-applicant children certified through means other than an application 9

Medicaid 10

Other (SPECIFY) _________________________________________ 11

With State-level matching, a State agency (usually Child Nutrition) has primary responsibility for developing and maintaining a system that matches lists of children in NSLP schools with a list of children in Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) or Food Distribution Program on Indian Reservations (FDPIR) households using a common identifier or identifiers. This system can be set up in a variety of ways. Some examples include:

• Districts upload enrollment information into a State-maintained computer or web-based system that conducts a match to a list of children in SNAP households. Students are directly certified on the basis of this match.

• A State agency matches State enrollment information with a State list of children in SNAP households. A list of students directly certified on the basis of this match is forwarded to districts.

• An initial match is conducted by a State agency. A list of matched students is sent to districts, which then verify the matches, get further information on students who are “potential” matches, or conduct other types of secondary matching.

C4. Does your SFA use State-level matching to determine the ISP?

YES 1

NO 0

With district-level matching, districts have primary responsibility for matching a list of children enrolled in their schools with a list of children in SNAP households using a common identifier or identifiers. Districts may use manual methods or an automated or electronic system.

C5. Does your SFA use district-level matching to determine the ISP?

YES 1

NO 0 (GO TO SECTION D)

C6. If students are directly certified using district-level matching, is this matching performed manually or electronically, or a combination of both?

Manual matching 1

Electronic matching 2

Combination of both 3

C7. If students are directly certified using both state- and district-level matching, what are the reasons districts perform data matching in addition to that conducted at the State level?

To confirm State-level data matching results (quality control) 1

To confirm direct certification status of students identified
by the State as “potential matches” 2

District preference 3

Statutory requirement 4

Additional check on new enrollments 5

State Agency request 6

Other (SPECIFY) 7

Don’t use both State- and district-level matching 8

SECTION D: CHARACTERISTICS OF EACH SAMPLED SCHOOL (NON-CEP AND CEP)

The next questions ask about the schools that have been selected to participate in this study (referred to as “sampled schools”). Answer the questions below as of <INSERT DATE> for each of the schools sampled. The schools are:

NON CEP SCHOOLS	CEP SCHOOLS
< Non CEP School 1>	< CEP School 1>
< Non CEP School 2>	< CEP School 2>
< Non CEP School 3>	< CEP School 3>
< Non CEP School N>	< CEP School N>

PROGRAMMER NOTE: IF A4=1 (all schools start and end on the same date), START AT D5.

D1. Do all of the sampled schools in your SFA start and end on the same date?

Yes 1 (GO TO D2)

No 2 (GO TO D4)

D2. What is the date of the first day of school for the sampled schools for the current school year?

|__|__| / |__|__| / 2017

MONTH DAY

D3. What is the date of the last day of school for the sampled schools for the current school year? (GO TO D5)

|__|__| / |__|__| / 2018

MONTH DAY

D4. What is the date of the first and last day of school for each of your sampled schools?

	First Day School	Last Day of School
<School 1>	|__|__| / |__|__| / 2017 MONTH DAY	|__|__| / |__|__| / 2018 MONTH DAY
<School 2>	|__|__| / |__|__| / 2017 MONTH DAY	|__|__| / |__|__| / 2018 MONTH DAY
<School 3>	|__|__| / |__|__| / 2017 MONTH DAY	|__|__| / |__|__| / 2018 MONTH DAY
<School N>	|__|__| / |__|__| / 2017 MONTH DAY	|__|__| / |__|__| / 2018 MONTH DAY

D5a. During <Enter Month and Year> how many days was breakfast served for each of your sampled schools?

	a.	b.	c.	d.	e.	f.
	<<SCHOOL 1>>	<<SCHOOL 2>>	<<SCHOOL 3>>	<<SCHOOL 4>>	<<SCHOOL 5>>	<<SCHOOL 6>>
	| | | DAYS	| | | DAYS	| | | DAYS	| | | DAYS	| | | DAYS	| | | DAYS

D5b. During <Enter Month and Year> how many days was lunch served for each of your sampled schools?

	a.	b.	c.	d.	e.	f.
	<<SCHOOL 1>>	<<SCHOOL 2>>	<<SCHOOL 3>>	<<SCHOOL 4>>	<<SCHOOL 5>>	<<SCHOOL 6>>
	| | | DAYS	| | | DAYS	| | | DAYS	| | | DAYS	| | | DAYS	| | | DAYS

The next set of questions will be repeated for each sampled school from your SFA.

D6. What grades does <SCHOOL NAME> serve? (CHOOSE ALL THAT APPLY)

Pre-school P	4th 4	9th 9
Kindergarten K	5th 5	10th 10
1st 1	6th 6	11th 11
2nd 2	7th 7	12th 12
3rd 3	8th 8	Other (SPECIFY) 96

D7. Record the following information about <SCHOOL NAME> as of <INSERT DATE>. “Directly certified” means determining children eligible for free benefits based on documentation obtained directly from appropriate State or local agencies or other authorized individuals and does not involve the household or an application.

Characteristic	Number
Number of enrolled students	_____________
Number of enrolled students by ethnicity	Hispanic _____________________ Non-Hispanic _________________
Number of enrolled students by race	White Black or African American Indian or Alaska Native Asian Hawaiian or Pacific Islander Other
Number of enrolled students by gender	Male Female
Number of enrolled students approved for free meals (Non CEP School)	__________________ (number)
Number of enrolled students approved for reduced price meals (Non CEP School)	__________________ (number)
Number of enrolled students approved for paid meals (Non CEP School)	__________________ (number)
Number of enrolled students directly certified for free meals without an application	__________________ (number)

D8. Does <INSERT SCHOOL NAME> participate in provision 2 or 3 for breakfast? (Select all that apply.)

Yes, Provision 2 1

Yes, Provision 3 2

Neither 0 (GO TO D10)

D9. What is the base school year for this school’s provision 2 or 3 breakfast participation?

_____________ School Year (SY)

D10. Does <INSERT SCHOOL NAME> participate in provision 2 or 3 for lunch? (Select all that apply.)

Yes, Provision 2 1

Yes, Provision 3 2

Neither 0 (GO TO D12)

D11. What is the base school year for this school’s provision 2 or 3 lunch participation?

_____________ School Year (SY)

D12. IF APPLICABLE: Is <INSERT CEP SCHOOL NAME> participating in CEP with the entire SFA, as an individual school or as part of a group of schools?

With entire SFA 1

Individual School 2

Part of Group 3

D13. What is the Identified Student Percentage (ISP) for <INSERT CEP SCHOOL NAME>for the <INSERT RESPONSE FROM D12: SCHOOL, GROUP OR ENTIRE SFA>?

________ ISP %

SECTION E: MEAL APPLICATION PROCESS

The following questions ask about the application that parents/guardians complete to apply for free or reduced priced meals.

E1. How are the applications distributed? (Select all that apply.)

Provided to students to take home on the first day of school 1

Parent request/pick up an application from school 2

Mailed to the household 3

Emailed to the household 4

Available on school website for downloading 5

Available on school website for online completion 6

Distributed prior to the first day of school 7

Some other way (SPECIFY) __________________________ 8

E2. Does your SFA provide assistance to the parent in completing the application?

YES 1

NO 2 (GO TO E5)

E3. What type of assistance is available? (Check all that apply.)

Written instructions 1

Assistance over the phone 2

Assistance in person 3

Group Sessions/classes 4

Some other way (SPECIFY) 5

E4. What are the most common types of assistance/questions that parents need/request? (Check all that apply.)

Language problems 1

Illiteracy/reading comprehension 2

How to complete/answer income questions 3

Determining household composition 4

Determining income sources to include 5

Some other assistance/question (SPECIFY) 6

E5. How are applications submitted?

Paper/Hardcopy 1

Electronic/on-line 2 (GO TO E7)

Both paper and electronic 3

Some other way (SPECIFY) 4

E6. Are paper applications processed electronically (e.g., scanned or processed using a software package) or manually (e.g., manual review of each application)?

Electronically………… 1

Manually………….. 2

A combination of both methods 3

E7. How many staff (at the SFA level) have primary responsibility for reviewing applications and determining certification of free or reduced status?

_________________ (# of Staff)

E8. Does your SFA temporarily extend a student’s certification status of free or reduced price from the prior school year into the current school year?

YES 1

NO 2 (GO TO E10)

E9. For how long is the certification status of free or reduced price extended into the current school year?

Less than 30 days 1

30 days 2

More than 30 days 3

Until a certain date (SPECIFY) 4

Some other time period (SPECIFY) 5

E10. When applications are received, how are they reviewed?

On a “flow basis” as they are received…………………………………………1

Saved and reviewed in batches…………………………………………………2

Other (SPECIFY) ………………………………………………………….3

E11. Is the household contacted if there are any questions in processing the application?

YES 1

NO 2 GO TO E13

E12. Once a household is contacted regarding questions about their applications, how and where are their answers about their application recorded?

<Open Ended Response>

E13. Does your SFA conduct a second review by a person/team before the certification of free or reduced price status is final?

YES………… 1

NO 2 (GO TO E15)

E14. Is this review for all applications, or for a sample of applications?

ALL APPLICATIONS 1

SAMPLE OF APPLICATIONS 2

E15. What are the common omissions or mistakes on applications?

Income amount (s) 1

Income type included/excluded 2

Income frequency (hourly, weekly, bi-weekly, etc.) 3

Household composition/size 4

Leaving sections blank 5

Failing to provide case numbers for categorically eligible 6

Failing to provide a signature 7

Failing to provide last 4 digits of SSN 8

Some other mistake (SPECIFY) 9

E16. Do you offer the application in languages other than English?

YES 1

NO 2 (GO TO SECTION F)

E17. What languages other than English are available for parents? (Select all that apply.)

Spanish 1

Chinese (e.g., Mandarin or Cantonese) 2

French 3

Tagalog 4

Vietnamese 5

Korean 6

Arabic 7

Russian 8

Other (SPECIFY) _______________ 9

SECTION F: DIRECT CERTIFICATION FOR NON CEP SCHOOLS

The next questions are about direct certification, which allows SFAs with non-CEP schools to approve students as eligible for free meals based on information received from other public assistance programs instead of on the basis of an application submitted by the household. Students are generally directly certified by one of three methods: state-level matching, district-level matching, or the letter method.

F1. Does your SFA use direct certification?

YES 1 (GO TO F3)

NO .. 0

F2. Why doesn’t your SFA participate in direct certification?

<Open Ended Response>

F3. In what year did your district begin using direct certification?

|__|__|__|__|

YEAR

With State-level matching, a State agency (usually Child Nutrition) has primary responsibility for developing and maintaining a system that matches lists of children in NSLP schools with a list of children in Supplemental Nutrition Assistance Program SNAP, Temporary Assistance for Needy Families (TANF) or Food Distribution Program on Indian Reservations (FDPIR) households using a common identifier or identifiers. This system can be set up in a variety of ways. Some examples include:

• Districts upload enrollment information into a State-maintained computer or web-based system that conducts a match to a list of children in SNAP households. Students are directly certified on the basis of this match.

• A State agency matches State enrollment information with a State list of children in SNAP households. A list of students directly certified on the basis of this match is forwarded to districts.

• An initial match is conducted by a State agency. A list of matched students is sent to districts, which then verify the matches, get further information on students who are “potential” matches, or conduct other types of secondary matching.

F4. Does your SFA use State-level matching to directly certify students?

YES 1

NO .. 0

With district-level matching, districts have primary responsibility for matching a list of children enrolled in their schools with a list of children in SNAP households using a common identifier or identifiers. Districts may use manual methods or an automated or electronic system.

F5. Does your SFA use district-level matching to directly certify students?

YES 1

NO .. 0 (GO TO F7)

F6. If students are directly certified using district-level matching, is this matching performed manually or electronically, or a combination of both?

Manual matching 1

Electronic matching 2

Combination of both 3

F7. If students are directly certified using both state- and district-level matching, what are the reasons districts perform data matching in addition to that conducted at the State level?

To confirm State-level data matching results (quality control) 1

To confirm direct certification status of students identified
by the State as “potential matches” 2

District preference 3

Statutory requirement 4

Additional check on new enrollments 5

State Agency request 6

Other (SPECIFY) 7

Don’t use both State- and district-level matching 8

With the letter method, the State mails letters to all SNAP households notifying them of their children’s eligibility for free school meals. Households who return the letters to the school district are certified for school meal benefits without having to fill out an application.

F8. Does your SFA use the letter method to directly certify students?

YES 1

NO .. 0

F9. As of [INSERT DATE], what is the number of students in the SFA approved for free meals that were directly certified by SNAP, TANF, or FDPIR without an application?

_______________

(# OF STUDENTS)

SECTION G: VERIFICATION

PROGRAMMER NOTE: FOR SFA’S WITH ALL CEP SCHOOLS, DISPLAY THE MESSAGE BELOW, SKIP SECTION G AND CONTINUE TO SECTION H. OTHERWISE, CONTINUE WITH QUESTION G1.

MESSAGE TO RESPONDENTS WITH ALL CEP SCHOOLS: “Section G: Verification applies to SFAs with non-CEP schools. Your survey will skip Section G because you indicated CEP was elected by your entire SFA”.

The next set of questions asks about the process by which districts verify the information a sample of households reported on applications.

G1. Does your SFA conduct verification on applications?

YES 1

NO 2 (GO TO SECTION H)

G2. When did your SFA begin to verify applications for school year 2017-2018?

|__|__| / |__|__| / |__|__|__|__|

MONTH DAY YEAR

G3. When did your SFA complete verification activities on applications for school year 2017-2018?

COMPLETED (INSERT DATE) 1

|__|__| / |__|__| / |__|__|__|__|

MONTH DAY YEAR

STILL IN PROGRESS 2

G4. Does your SFA conduct verification of applications electronically, manually or a combination of both?

MANUAL/HARDCOPY RECORDS 1

AUTOMATED/ELECTRONIC RECORDS 2

COMBINATION OF BOTH 3

G5. Did your district verify a random sample only; a focused or error prone sample only; a mixture of random and focused or error prone method of selecting applications for verification; or did you verify all applications? Do not include applications verified for a cause in your response.

CIRCLE ONE

MIXTURE OF RANDOM AND ERROR PRONE 1

RANDOM ONLY 2 (GO TO G8)

FOCUSED OR ERROR PRONE ONLY 3 (GO TO G8)

VERIFIED ALL APPLICATIONS 4 (GO TO G8)

OTHER 5 (GO TO G8)

(Please describe the methods used for selecting the applications to be verified and the number of applications verified)

G6. What percentage of your verification sample was random?

|__|__|__|

PERCENTAGE RANDOM

G7. What percentage of your verification sample was focused or error prone?

|__|__|__|

PERCENTAGE FOCUSED OR ERROR PRONE

G8. Did your district identify applications to verify for a cause?

YES 1

NO 2 (GO TO SECTION H)

G9. What method(s) did you use to identify applications to verify for a cause?

<Open Ended Response>

____________

NUMBER OF APPLICATIONS VERIFIED

SECTION H: MEAL COUNTING AND CLAIMING

H1. For each of the following procedures, record whether the SFA uses a manual process and/or hardcopy records, uses an automated process and/or electronic records, or uses a combination of both:

		ALL SCHOOLS MANUAL PROCESS/ HARDCOPY RECORDS	ALL SCHOOLS AUTOMATED PROCESS/ ELECTRONIC RECORDS	SOME SCHOOLS MANUAL PROCESS/ HARDCOPY RECORDS	SOME SCHOOLS AUTOMATED PROCESS/ ELECTRONIC RECORDS	N/A
a.	Point of sale meal counting	1	2	3	4	5
b.	School preparation of meal counts submitted to SFA	1	2	3	4	5
c.	SFA preparation and submission of meal reimbursement claims to state agency	1	2	3	4	5

H2. Describe procedures or processes in place to ensure accuracy of meal counting and claims submitted.

<Open Ended Response>

SECTION I: TRAINING

This section asks about training and technical assistance provided to both SFA and school staff related to processing applications, preparing and serving meals, recording meals as reimbursable, and/or meal counting and claiming.

I1. During the past 12 months, did you require a mandatory training for SFA and/or school staff?

Yes .. 1

No 2 (GO TO QUESTION I6)

I2. What was the format of this training? (Select all that apply.)

Web-based 1

In-person group classes or workshops 2

Self-study 3

One-on-one 4

Hardcopy materials or resource documents 5

Other (SPECIFY) 6

I3. Are there any specific strategies in place to train staff (Select all that apply.)

Pairing less experienced staff with more experienced staff 1

Use of contractors or senior staff 2

100% QC of applications (for Non-CEP schools) 3

Using qualified and experienced staff only 4

None in particular 5

Other (SPECIFY) 6

I4. What topics are covered in trainings? (Select all that apply.)

Reimbursable Meal component 1 Meal/Serving line 2 Administrative requirements 3 Monitoring requirements 4 Direct certification guidelines 5 CEP and ISP requirements 6 Applications for meal benefits 7 Certification for meal benefits 8 Preparing and filing monthly claims 9 Recordkeeping and documentation 10 Maintaining confidentiality 11

USDA civil rights requirements 12 Food purchasing 13 Menu planning 14 Food preparation 15 Food safety/food service operations 16 Food waste 17 Nutrition 18 “Smart Snacks” 19 Staff wellness 20 Parent relations 21 Other (SPECIFY) 22

I5. What types of staff received training? (Select all that apply.)

District-level administrators 1

School-level administrators 2

Food Service Director 3

Cafeteria managers 4

Other cafeteria staff 5

Nutritionists (including RDs and RDNs) 6

Other (SPECIFY) 7

I6. During the past 12 months, has your SFA received any technical assistance from your State Agency?

Technical assistance is defined broadly to mean any form of support from the State agency to correct or prevent problems with program compliance or to improve program operations. Technical assistance can cover any aspect of nutrition program operations, such as meal pattern compliance, menus and food production, procurement, financial management, food safety, meal counting and claiming, eligibility determinations and other. Technical assistance may be provided by the State in a variety of formats, including by telephone, email, web, or onsite.

Yes 1

No 0 (GO TO I8)

I7. On what topics did you receive technical assistance from your State Agency? (Select all that apply.)

New meal pattern requirements 1

Defining reimbursable meals 2

Using computer/software (not certification tool training) 3

Developing menu cycles 4

Using standardized recipes 5

Implementing Offer vs. Serve 6

Controlling portion sizes 7

Documenting use of substitute food 8

Documenting use of left overs 9

Marketing your food program 10

Food purchasing 11

USDA foods 12

Food sanitation/safety 13

Food vendor contracts 14

Budgeting 15

Program Regulations and Procedures 16

Record keeping and reporting 17

Preparing certification materials for additional reimbursement

(including certification tool training) 18

Local school wellness policy development and implementation 19

Local School Wellness Program monitoring, assessment
and evaluation 20

Other (SPECIFY) 21

These next set of questions are about monitoring visits conducted by your SFA.

I8. Does your SFA conduct on-site monitoring visits of schools?

Yes 1

No 0 (GO TO QUESTION I14)

I9. Does your SFA conduct on-site monitoring visits during:

Breakfast only………………………..1

Lunch only……………………………2

Breakfast and Lunch………………..3

I10. Which areas do your visits cover? (Select all that apply.)

a. Meal counting procedures/point of services 1

b. Meal claiming……………………………………………………… 2

c. Cafeteria/food service practices………………………………… 3

d. Other (SPECIFY) 4

I11. How many schools does your SFA visit in a typical year?

_______________

(# OF SCHOOLS)

I12. What percentage of all the schools in the SFA are visited by your SFA in a typical year?

________________

(% OF SCHOOLS)

I13. How do you determine which schools to select for a visit?

<Open Ended Response>

I14. Is there a records review component that is conducted?

Yes 1

No 0 (GO TO SECTION J)

I15. Please describe what this records review entails.

<Open Ended Response>

SECTION J: EDUCATION AND EXPERIENCE

J1. How many years of experience did you have working in the NSLP and SBP prior to your position as SFA director?

___ MONTHS

___ YEARS

J2. How many years of experience do you have as an SFA Director?

___ MONTHS

___ YEARS

J3. What is your highest level of education?

Some high school, no diploma 1

High school graduate, diploma or the equivalent
(for example: GED) 2

Some college credit, no degree 3

Trade/technical/vocational training 4

Associate degree 5

Bachelor’s degree 6

Master’s degree 7

Professional degree 8

Doctorate degree 9

SECTION K: GENERAL COMMENTS

K1. Please share any relevant comments or suggestions that you would like the study to consider that we have not asked about in this survey.

<Open Ended Response>

Thank you for your time and participation. Your feedback is important.

If you have any questions or comments please contact us at 1-855-820-6138 or email us at [email protected].