State, Local, and Tribal Government (CN Agency Staff, State Medicaid Agency Staff, Other State Agency Staff, and School District Staff)

Evaluation of the Direct Certification with Medicaid for Free and Reduced-Price (DCM-F/RP) Meals Demonstration

A4 DCM-FRP Site Visit Observation Protocol

State, Local, and Tribal Government (CN Agency Staff, State Medicaid Agency Staff, Other State Agency Staff, and School District Staff)

OMB: 0584-0630

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APPENDIX A-4

SITE VISIT OBSERVATION PROTOCOL

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Site Visit Observation Protocol

Evaluation of Demonstrations of Direct Certification with Medicaid for Free and Reduced-Price Meals (DCM-F/RP)

State:

Date of Observation:

Site Location:

Observer:

Activity Observed:

Time/Duration of Activity:



A. Description of staff completing data process


Observations

Job title of staff member(s) completing the process


Does the same person always complete this data process, or do other people in the [State/district] also complete it?




B. Description of data process


Observations

Objective of data process


Data sources used


How often data process is conducted


Length of time to complete data process


Description of how the data process is conducted


How does the DCM-F/RP process differ from direct certification with other programs?


How does the process for reduced-price meals differ from direct certification for free meals only?


What are the manual steps in the process?


What are the automated steps in the process?


C. Assessments of data process


Assessments

Are any aspects of the data process designed to prevent errors?


Do any aspects of the data process appear vulnerable to errors?


Are any aspects of the process designed to increase efficiency?


Do any aspects of the process seem unnecessary?


Other observations




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