State and Local Burden

Attachment T3. Site Selection Worksheet

This information is being collected from State agencies, school food authorities, schools. This is a
revision of a currently approved information collection. The Richard B. Russell National School
Lunch Act (NSLA) 42 U.S.C. § 1758, as amended, authorizes the National School Lunch Program
(NSLP). This information is required to administer and operate this program in accordance with the
NSLA. Under the Privacy Act of 1974, any personally identifying information obtained will be kept
private to the extent of the law. 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 0584-0006. The time required to complete this information collection is estimated to
average 47.5 hours of reporting burden per response. The burden consists of the time it takes for the
State agency to conduct the off-site portion of the review which includes scheduling of the review
and the completion of the Off-site Assessment, Resource Management Risk Indicator, and Site
Selection Tools. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to: U.S. Department of
Agriculture, Food and Nutrition Services, Office of Policy Support, 3101 Park Center Drive, Room
1014, Alexandria, VA 22302, ATTN: PRA (0584-0006). Do not return the completed form to this
address.

OMB #0584-0006
Expiration Date
ADMINISTRATIVE REVIEW SITE SELECTION WORKSHEET SY 2018-2019
SFA:
A.
Type
(E,C,S)

xx/xx/20xx

Month:
B.

C.

LEA Name (if more than one LEA
makes up the SFA)

School Name

D. Special Provisions
only
Provision
Type
1,2, 3, or
CEP

SBP

NSLP

E.*

F.*

G.*

H.

I.

J.

Number
Serving
Days

Number
Free
Eligible

Number
Free
Claimed

Free
ADP
(F) ÷ (D)

ADP
%

Reason for Selection

ADMINISTRATIVE REVIEW SITE SELECTION WORKSHEET - Instructions
Last updated School Year 2017-2018

Enter the name of SFA and record the month used in collecting date for school selection
COLUMN A . Indicate the type of school, E – Elementary (serving lunches to any grade pre-school through 8), S – Secondary (serving lunches to any grade 9 through 12) or C –
Combination (serving lunches to any combination of elementary and secondary grades).
COLUMN B. List the name of the LEA for each school if more than one LEA is in the SFA.
COLUMN C. List the name of all of the schools in the SFA participating in the NSLP.
COLUMN D. Is for Provision 1, 2, or 3 or CEP schools only.
Check
if for breakfast (SBP) only;
Check
if for lunch (NSLP) only; or
Check both
if for NSLP and SBP if the provision is used for both meal services
COLUMN E. Record the number of serving days for each school for the month selected.
COLUMN F. Enter the highest number of free eligible for each school. For CEP schools this is determined by multiplying the Identified Student Population by 1.6 and then multiplying that
percentage by total enrollment. For example if a site has 100 students with an ISP of 45.00 multiplied by 1.6 equals 72. To figure out column F you would then multiply the enrollment
(100) by .72, resulting in 72.
COLUMN G. Enter the number of free lunches claimed for the month selected.
COLUMN H. Calculate free ADP by dividing the number free claimed (G) by the number of serving days (E). Round the ADP to the nearest whole number.
COLUMN I. Calculate the percent of free participation by dividing the free ADP (H) by the number free eligible (F). Round to three (3) decimal places and multiply the result by 100 to
convert to a percentage.
COLUMN J. Indicate the reason for selecting the schools for review.
Determine the minimum number of schools to review using the table below.
Number of Schools
in the SFA

Minimum Number
of Schools
to Review for NSLP
1 to 5 .................................................1

Number of Schools
in the SFA

Minimum Number
of Schools
to Review for NSLP
41 to 60............................................6

6 to 10................................................2

61 to 80............................................8

11 to 20..............................................3

81 to 100........................................10

21 to 40..............................................4

101 or More...................................12*

* 12 plus 5 percent of the number of schools over 100. Fractions must be rounded to the nearest whole number.

All schools with a free average daily participation (ADP) of 100 or more and a free participation factor of 100 percent or more must be reviewed, with the exception of Residential Child Care
Institutions (RCCI) (without day students). For SFAs that consist of more than one LEA, the SA must select at least one school from each LEA so that at minimum one school from each LEA is
reviewed. Selection of additional schools to meet the minimum number of schools to review must be based on the following criteria:

Last updated School Year 2017-2018

•

Elementary schools with a free ADP of 100 or more and percent free participation of 97 percent or more

•

Combination schools with a free ADP of 100 or more and a percent free participation of 87 percent or more

•

Secondary schools with a free ADP of 100 or more and a percent free participation of 77 percent or more

When the number of schools selected using the criteria described above does not meet the required number of schools to review or one school from at least each LEA is not selected, the SA must
select additional schools using SA criteria. The SA must document the reason(s) for selecting the schools for review. SA criteria may include:
•

Low participation schools

•

High participation schools

•

Schools that have less than 100 free ADP but greater than 100 percent free participation

•

Recommendations from a food service director

•

Findings from the on-site visits or the claims review process

•

Any school in which the daily meal counts appear questionable

•

Identical or very similar claiming patterns (i.e., identical breakfast/lunch meal counts for each day of the week)

•

Large changes in the free meal counts (i.e., a significant increase/decrease in the amount of free meals reported without reason)

•

Schools with a new manager

•

Manager or school never reviewed by SA

•

New or unusual accountability system

•

Proportional mix of the different counting systems employed by the SFA

•

Schools with a significant number of Office of Inspector General Hotline and/or parent complaints

•

Schools with alternate points of service

•

Schools with a mix of age/grade groups (i.e., K-12 schools)

•

Schools participating in Fresh Fruit and Vegetable Program, Afterschool Snacks, Seamless Summer Option, and Special Milk Program

Other Site Selection Criteria
SBP Site Selection Procedures
SAs must review the SBP at 50 percent of the schools that were selected for a NSLP review, with a minimum of one (1) school receiving an SBP review. SBP review sites are based on the
number of schools selected for NSLP review operating the SBP. If 10 NSLP schools are selected for review and all 10 operate SBP, then 5 SBP schools are required to be reviewed. If SBP is
only in operation in 5 schools, then 3 would be required (round up). As long as a minimum of 1 school operates SBP from the schools selected for review, no additional action is needed.

Last updated School Year 2017-2018