1 SNAP-Agency NDNH Match Results Performance Reporting Too

Supplemental Nutrition Assistance Program State Agency Performance Reporting Tool

Copy of 2015_07_15_SNAP-Agency_NDNH_Match_Results_Performance_Reporting_Tool.xls

SNAP State Agency Performance Reporting Tool

OMB: 0970-0464

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SNAP Agency NDNH Matching Program Performance Reporting Tool








Federal Fiscal Year:
Quarter:
Amended: Y ( ) N ( )

State:














1. 2. 3. 4.
Match Type Quarter Month Unduplicated Individuals Verified as Employed Unduplicated SNAP Cases Closed Due to Earnings Unduplicated SNAP Cases with Benefits Reduced Unduplicated First-Month Avoided SNAP Costs
W-4 Data Match Quarter 1 Oct



Nov



Dec



Quarter 2 Jan



Feb



Mar



Quarter 3 Apr



May



Jun



Quarter 4 Jul



Aug



Sep



QW Data Match Quarter 1 Oct



Quarter 2 Jan



Quarter 3 Apr



Quarter 4 Jul



UI Data Match Quarter 1 Oct



Quarter 2 Jan



Quarter 3 Apr



Quarter 4 Jul



Unduplicated
Annual Total

0 0 0 $-







“Unduplicated” means counting the same person no more than once per federal fiscal year. Individuals should only be counted in one of the three data sources.







Please see instructions below for an explanation of the four performance measures.
For detailed instructions, please see accompanying document: "Explanation and Detailed Instructions on How to Complete and Submit the SNAP Agency NDNH Matching Program Performance Reporting Tool"

General Instructions












Report all outcomes in the month the match was conducted, not the month of state verification or case action. State agencies will report data by December 31, which is 90 days after the end of the federal fiscal year (October 1- September 30).
Previously Unknown Employment












Item 1. Unduplicated Individuals Verified as Employed (receiving SNAP benefits): The number of unduplicated individuals with previously unknown employment that had an NDNH match and were verified as being employed while receiving SNAP benefits in your state.







Actions Taken












Item 2. Unduplicated SNAP Cases Closed Due to Earnings: The number of unduplicated individuals reported in item 1 whose SNAP benefits were terminated as a result of employment verified from an NDNH match.







Item 3. Unduplicated SNAP Cases with Benefits Reduced: The number of unduplicated individuals reported in item 1 whose SNAP benefits were reduced as a result of employment verified from an NDNH match.







Avoided Costs












Item 4. Unduplicated First-Month Avoided SNAP Costs: The total first-month SNAP costs avoided from items 2 and 3.







Unduplicated Annual Total












The unduplicated annual total equals the sum of each column. The total for item 4 represents the annual unduplicated first-month avoided SNAP costs resulting from use of the NDNH.




























The Paperwork Reduction Act of 1995(Pub.L. 104-13)

Public reporting burden for this collection of information is estimated to average 1.625 hours, per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless it displays a currently valid OMB control number.






File Typeapplication/vnd.ms-excel
File TitleSNAP Agency NDNH Match Result Performance Reporting Tool
Authorrmartin
Last Modified ByWindows User
File Modified2015-08-05
File Created2006-01-10

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