State and Local Burden

Attachment T23. Supplemental Afterschool Snacks Administrative Review Form

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.

National School Lunch Program
Supplemental Afterschool Snacks Administrative Review Form

OMB #0584-0006
Expiration Date
xx/xx/20xx

Instructions: Complete this form when conducting Afterschool Snacks Review. This form will
also be used to conduct snack reviews under the Seamless Summer Option.
[ ] DOCUMENTATION REVIEW
[ ] SNACK SERVICE OBSERVATION
SFA Name:

______

Name of Site Reviewed:
Date of Review:

Time Snack Served:

Snack Charges: [ ] All Free
[ ] Reduced $_______ (maximum $0.15)
[ ] Paid $_______
Eligibility (General Area)
[ ] Area Eligible
If area eligible, name of site for which eligibility determined:
___________________________________
1

Is documentation maintained that the site is located at a school,
or in the attendance area of a school, in which 50% or more of
the enrolled students are certified eligible for F/R price meals?
Mark N/A for Seamless Summer Option.

YES

NO

N/A

Comments:

[ ] Non-Area Eligible
2

Is documentation maintained of F/R price eligibility for each
student that receives a free or reduced price snack?

Comments:

SY 18-19

1

YES

NO

National School Lunch Program
Supplemental Afterschool Snacks Administrative Review Form
Accountability (Performance Standard 1)
3

Are point-of-service snack counts by student/benefit category
maintained?

YES

NO

YES

NO

Comments:

4
a) Are snacks being properly counted and claimed?
b) Validate the snack counts claimed for reimbursement for
the review period and day of review (if on-site review is
conducted) record on S-1, line 22.
Review Period
Day of Review (if on-site
review is conducted)

Snacks Counted

Snacks Claimed

Comments:

5

a) If observing snack service, are snack counts by category
for the review period reasonable compared to snack
counts for day of review?

YES

b) Was the meal service operation in compliance with all
program requirements?
Comments:

Meal Pattern/Production Records (Performance Standard 2)
Snack Menu for Day of Review

SY 18-19

Portion Size(s)

2

NO

National School Lunch Program
Supplemental Afterschool Snacks Administrative Review Form
6

Review production records for a minimum of 5 days from the
review period.

YES

NO

a) Production records are completed daily and maintained
for a minimum of 3 years?
b) Do production records list each meal component and
reflect that the planned portion sizes meet the meal
pattern component requirements?
c) Does it appear that each snack claimed for reimbursement
met the 2 component per student requirements?
Comments:

Monitoring (General Area)
YES

7

NO

a) Has the program been monitored within the first 4 weeks of
operation each year?
b) Record the date of last site monitoring visit conducted by SFA.
c) If any deficiencies were noted, determine whether corrective
action was implemented. N/A for Seamless Summer Option.
Comments:

Other Areas (General Area)
8

Does the snack program conduct acceptable education or
enrichment activities before, during or after the snack meal
service? N/A for Seamless Summer Option.

9

Are snacks properly prepared, held, served, and stored within
proper food safety practices?

10

Is the USDA/FNS approved non-discrimination poster prominently
displayed and visible to program participants?

SY 18-19

3

Yes

No

NA

National School Lunch Program
Supplemental Afterschool Snacks Administrative Review Form
Comments:

Record Snacks Missing Meal Components
Use the columns listed below to record the number of snacks
counted and/or claimed for reimbursement from 1) the day of
review and 2) review period that were missing meal components.
Also include any snack consolidation errors. Transfer these totals
by category to the S-1, line 22.

11

Afterschool Snack Errors
F____
1. Day of Review:

R____

Missing Meal Components - Meal Service Line/POS - Consolidation Errors

P____
Total____
F____

2. Review Period:

R____

Missing Meal Components – Production Records – Consolidation Errors

P____
Total____

Comments:

SY 18-19

4

National School Lunch Program
Afterschool Snack Administrative Review Form
Instructions
1.

If the site has been determined area eligible, ensure that documentation is maintained showing the program
is located at a school or in the attendance area of a school where at least 50% of the enrolled children are
eligible for free and reduced price meals.

2.

Ensure that the SFA has maintained documentation showing the current F/R price eligibility for each child
that receives a free or reduced price snack.

3.

Ensure that SFA maintains point-of-service snack counts by student/benefit category.

4.

Ensure that only reimbursable snacks (observe the 2 component per snack requirement) are being counted
and claimed for reimbursement and that only one snack per child is being claimed. Validate the snack counts
claimed for reimbursement for the review period and day of review (if on-site review is conducted) record on
S-1, line 22.

5.

If day of review meal service is observed, compare the day of review counts to 5 days from the review period.
If any inconsistencies are present, the SFA must explain the discrepancy. Also, ensure that all program
requirements were met for the meal service, meal counting and claiming, education/enrichment activities,
food safety, and civil rights.

6.

Enter the snack menu and portion size(s) for the day of review. Review production records for a minimum of
5 days from the review period.
a.
b.
c.

Ensure that production records are completed daily for each meal service and that they are
maintained in accordance with the 3 year record retention requirement.
Ensure that all meal components are listed for each day to include the corresponding portion size.
Reviewer must make certain that the components offered meet the minimum portion size
requirements.
Review each production record and compare the amount of components served to the number of
students claimed. The comparison must demonstrate that each student received a minimum of 2
components. For example if the production record listed that 20 meal components were served and
the claim indicated that 10 students received a reimbursable snack, than this would indicate that
each student received a minimum of 2 components per snack (20 /10 = 2).

7.

Obtain the SFA’s self-monitoring review forms for the current SY. Ensure that the program was monitored in
compliance with 7 CFR Part 210.9 (c).

8.

Evaluate a sample of the enrichment and/or educational activities conducted during the review period and
determine if the activities are acceptable per 7 CFR Part 210.

9.

Evaluate the snack HACCP/food safety plan. Determine if proper food preparation, serving and storing
practices are in place. Reviewer should examine any shared table practices and ensure they are implemented
within proper food safety practices.

10. Ensure that the correct non-discrimination poster is prominently displayed in an area where the snack meal
service is held.

11. Identify and record any non-reimbursable snacks counted and/or claimed for reimbursement. Also include
any snack consolidation errors. Transfer these totals by category to S-1, line 22.

SY 18-19

5