Appendix 4-HMI Recognition Awards Application (4)

Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities
OMB Control Number: 0584-XX
Expiration Date: 202X-XX-XX

OMB BURDEN STATEMENT: The Food and Nutrition Service (FNS) is collecting this information
to help recognize School Food Authorities (SFA) that meet the criteria of the Healthy Meals
Incentive’s Recognition Award. This is a voluntary collection and FNS will use the information to
recognize SFAs for their significant improvements to the nutritional quality of school meals by
exceeding the transitional school meal pattern requirements for sodium and whole grains and
by taking steps to reduce added sugars. This collection does not request personally identifiable
information that is subject to the privacy requirements outlined at 5 U.S.C. §552a(e)3 of the
Privacy Act of 1974. 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-XXX. The time required to complete this information collection is
estimated to average 900 minutes (15 hours) per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information.

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Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities
Create an online account. You can use your account to:
• Apply for a Healthy Meals Incentives Recognition Award.
• Access your application any time and track the status of your application.
• Access resources to assist you in implementing the award criteria and frequently asked
questions and answers.
First name:________________________
Last name:________________________
Email:____________________________
Password:_________________________
Security questions to recover password:
1. What is the name of your School Food Authority?
2. How many schools in your School Food Authority serve school meals?
3. What is the zip code of the main office for your School Food Authority?
School Food Authority Information:
Name of School Food Authority
Mailing address
City, State, Zip
Phone number
Email address
Number of enrolled students in the
SFA for current school year
Percent of enrolled students that
qualify for free meals
Percent of enrolled students that
qualify for reduced-price meals
Ethnicity of students in the School
Food Authority (by percentage)
Race of students in the School Food
Authority (by percentage)

Ethnicity
Hispanic or Latino:
Not Hispanic or Latino:
Race
American Indian or Alaska Native:
Asian:
Black or African American:
Native Hawaiian or Other Pacific Islander:
White:

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Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities

Are you a recipient of a Healthy Meals
Incentives Sub-Grant? (Yes/No)
Primary Contact Information:
Name (first, last)
Title
Mailing address
City, State, Zip
Phone number
Email address
School Information:
Total number of schools in your School
Food Authority
Number of schools that participate in
the National School Lunch Program
Number of schools that participate in
the School Breakfast Program

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Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities

Eligibility Information
School Food Authorities (SFAs) are eligible to apply for the Recognition Awards if they
participate in the National School Lunch Program (NSLP) and/or School Breakfast Program (SBP)
in the contiguous United States, Hawaii, Alaska, District of Columbia, Puerto Rico, Guam, or the
United States Virgin Islands.
The NSLP and SBP meal programs, as operated within the SFA, must be compliant with all
Program regulations, including meal pattern standards. The NSLP and SBP and the Healthy
Meals Incentives Recognition Awards are administered in a nondiscriminatory manner in
accordance with civil rights laws and regulations.
The information related to race and ethnicity submitted on the application form will not affect
the eligibility for awards. This information is being requested to ensure that program benefits
are distributed without regard to race, color, or national origin.
State Agency Support:
The State agency must confirm that the SFA does not have any outstanding corrective actions
and that any previous findings have been resolved (except as allowed under the USDA FNS
nationwide waivers related to the COVID-19 public health emergency and situations resulting
from damage or disruptions due to natural disasters such as hurricanes, tornadoes, and floods
as well as other exceptional emergency situations or man-made disasters). The State agency
must also confirm that the SFA does not have any findings related to program discrimination
complaints.
The State Agency Confirmation Form must be signed and uploaded before submitting an
application.
[+Upload State Agency Confirmation Form]

4

Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities

5

Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities
Application Directions
Review each award category, the criteria, and the documentation needed before submitting an
application. Complete and review the application, gather and upload documentation, and
submit the completed application. Applications may be submitted through June 30, 2025.
Note the following before applying for an award:
• To qualify for an award, the required number of schools (indicated for each award criteria)
within the SFA must meet all required criteria listed under the award category and submit
all the required documentation.
• There are a total of eight Recognition Awards (see list below). You may apply for any
number of the awards. Remember, an SFA may only receive recognition for each award
once. So, once you receive recognition for an award, you may not reapply for the same
award.
1. Breakfast Trailblazer Award
2. Small or Rural School Food Authority Breakfast Trailblazer Award
3. Lunch Trailblazer Award
4. Small or Rural School Food Authority Lunch Trailblazer Award
5. Innovative School Lunch Makeover Award
6. Innovation in the Cultural Diversity of School Meals
7. Innovation in the Preparation of School Meals
8. Innovation in Nutrition Education
• You may apply for multiple awards at one time, using this application, or you may submit a
separate application each time you apply for an award.
• Applications should be completed by a School Nutrition Director or Foodservice Director.
• Your State agency must sign the State Agency Confirmation Form before you submit your
application but they are not required to review your application.

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Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities
Award Categories, Criteria, and Documentation Required
1. Review the criteria and documentation required for each award category.
2. Check the box near each award for which you plan to apply.
3. Upload the required documentation, review and verify your application, and submit.

 Breakfast Trailblazer Award

The SFA offers school breakfasts with less added sugar and uses more than one meal service
model (e.g., Breakfast in the Classroom, cafeteria, breakfast kiosks).
Check “Yes” in each box below to confirm you have met the criteria.
Criteria
Yes
Documentation Required

School breakfasts for all grades offered demonstrate the
following efforts to lower the added sugars in school
breakfasts:
• Only unflavored milk is offered.
• Breakfast cereals, if offered, meet the Healthy
Meals Incentives added sugars limit.
•

Yogurts, if offered, meet the Healthy Meals
Incentives added sugars limit.

•

No grain-based desserts are offered, as defined by
superscripts 3, 4, or 5 in the Food Buying Guide for
Child Nutrition Program’s Exhibit A: Grain
Requirements for Child Nutrition Programs.
Meals meet all other meal pattern requirements,
including weekly specifications for calories,
sodium, and saturated fat.

•

•

No high-intensity sweeteners (e.g., artificial
sweeteners, non-nutritive sweeteners) are used to
replace added sugars.

Breakfast menus from a sample of one school at
each grade group, for one week.
[+ Add attachments]
See Production records required below.
Documentation of added sugars for cereals and
yogurts including Nutrition Facts labels, product
specification sheets, nutrient analysis of cereal
recipes (using USDA-approved nutrient analysis
software), or other documentation showing the
amount of added sugars in the cereals and
yogurts offered for the qualifying week’s menu.
[+ Add attachments]
See production records required below.

Production records (scanned) from a sample of
one school at each grade group showing the
qualifying week’s menu was served at least
three different times during the 12 months prior
to award application submission (to show the
menu items, crediting information, amount
prepared, amount served for each grade group,
and to show only unflavored milk and no grainbased desserts were offered).
[+ Add attachments]
Ingredient statements for cereals and yogurts.

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Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities
Criteria
At least half (≥50 percent) of the schools within the
SFA* that participate in the SBP must meet the criteria
and at least one of the schools must implement the
breakfast using an alternative meal service delivery
model.
Breakfasts for all grade levels in the schools must meet
the criteria. Both elementary and secondary school
grade levels must be represented in the sample of
schools meeting award criteria.
*If your SFA only has one school site, you may submit
documentation for just that site. If your SFA has three
school sites, you must submit documentation for at
least 2 sites to meet the 50 percent requirement.
The SFA has used student engagement techniques
(taste tests, student surveys, cooking demonstrations,
or advisory groups) and culinary techniques (using
herbs and spices, offering flavor stations, etc.) to
ensure school meals are enjoyed by students

Yes

Documentation Required
A numbered list of all schools in the SFA that
participate in the SBP including school grade
levels (with schools used to qualify for the award
identified).
Also indicate which school implemented the
menu using an alternative meal service delivery
model (e.g., Breakfast in the Classroom,
cafeteria, breakfast kiosks).
[+ Add attachment]

Description of student engagement activities
and culinary techniques including the objectives,
details about the activities, number of
participants, and the outcomes.
[+ Add description: up to four paragraphs, 200
words each]

 Small or Rural SFA Breakfast Trailblazer Award

The small and/or rural SFA has a choice of criteria from which they can choose to demonstrate
that they are offering school breakfasts with less added sugars and sodium.
Check “Yes” in each box below to confirm you have met the criteria.
Criteria
Yes
Documentation Required

The SFA has an enrollment of less than or equal to
5,000 students; OR the majority of students within the
SFA are enrolled in a rural school as defined by a
locality code of 41, 42, or 43 according to the National
Center for Education Statistics (NCES) online tool.
All (100 percent) of the schools within the SFA
participate in the SBP.
Within the past 12 months, the SFA has changed their
school breakfast menus to meet at least four of the
following criteria.

Attendance record or documentation of the
NCES search result for locality.
[+ Add attachment]
A numbered list of all schools in the SFA that
participate in SBP including school grade levels.
[+ Add attachment]
Documentation for criteria 1 through 7 including
one week of school breakfast menus and
production records (scanned), from at least one
school, after changes were made and within the
12 months prior to award application
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Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities

Check “Yes” in each box next to the four criteria below
that you choose to meet.

Criteria

1. All yogurts meet the Healthy Meals Incentives
added sugars limit (only applies if offered).
2. All breakfast cereals meet the Healthy Meals
Incentives added sugars limit (only applies if
offered).
3. No more than 2-ounce equivalents of grain-based
desserts, as defined by superscripts 4 or 5 in the
Food Buying Guide for Child Nutrition Program’s
Exhibit A: Grain Requirements for Child Nutrition
Programs, are offered per week. Grain-based
desserts defined by superscript 3 are not offered.
4. At least ½ cup of dark green and/or ½ cup
red/orange vegetables are offered throughout the
week.
5. All milk offered is unflavored.
6. Breakfast-style sandwiches not on biscuits contain
no more than 500 mg of sodium per 100 grams
(~3.5 ounces) of sandwich. Breakfast-style
sandwiches provided on biscuits contain no more
than 710 mg of sodium per 100 grams (~3.5
ounces) of sandwich (criteria are based on FDA
Food Categories and Voluntary Targets).
7. The SFA and/or a partner organization working in
collaboration with the SFA has conducted at least
two school breakfast nutrition education activities
(e.g., taste-test event, social media campaign) for
students. Activities can be district wide.

Yes

submission (to show the menu items, crediting
information, amount prepared, and amount
served). [+ Add attachments]

Documentation Required

Nutrition Facts labels, product specification
sheets, nutrient analysis of cereal recipes (using
USDA-approved nutrient analysis software), or
other documentation showing the amount of
added sugars in the cereals and yogurts offered
for the qualifying week’s menu.
[+ Add attachments]
See production records required above.

See production records required above.
See production records required above.
Nutrition Facts label with ingredient statements
and recipes, if applicable.
[+ Add attachments]

Description of the nutrition education activities
including the objective, details about the
activity, number of participants, and the results
of the activity demonstrating the value and how
students benefited.
[+ Add description: up to four paragraphs, 200
words each]
• Optional photographs including two or three
clear photos of the activities with release
forms providing USDA with royalty free
unlimited rights to the use and printing of
the photographs, and parental permission
forms, when applicable.
[+ Add attachments]

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Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities

 Lunch Trailblazer Award

The SFA provides reimbursable school lunches that are lower in sodium than current meal
pattern requirements and enjoyed by students.
Check “Yes” in each box below to confirm you have met the criteria.
Criteria
Yes
Documentation Required

At least half (> 50 percent) of the schools within the
SFA* that participate in the NSLP provide school
lunches that meet the Healthy Meals Incentives
weekly sodium limits for the meals.

Meals for all grade levels in the schools must meet the
criteria. Both elementary and secondary school grade
levels must be represented in the sample of schools
meeting award criteria.
*If your SFA only has one school site, you may submit
documentation for just that site. If your SFA has three
school sites, you must submit documentation for at
least 2 sites to meet the 50 percent requirement.

The SFA has used student engagement techniques
(e.g., taste tests, student surveys, cooking
demonstrations, or advisory groups) and culinary
techniques (e.g., using herbs and spices or offering
flavor stations) to ensure school meals are enjoyed by
students.

A numbered list of all schools in the SFA that
participate in the NSLP including school grade
levels (with schools used to qualify for the award
identified).
[+ Add attachment]
Lunch menu from a sample of one school at
each grade group, for one week.
[+ Add attachments]
Production records (scanned) from a sample of
one school at each grade group showing the
qualifying week’s menu was served at least
three different times during the 12 months prior
to award application submission (to show the
menu items, crediting information, amount
prepared, and amount served for each grade
group).
[+ Add attachments]
Documentation of sodium and meal pattern
compliance including weighted nutrient analysis
of meals over the week (using USDA-approved
nutrient analysis software) or recipes and
Nutrition Facts labels with ingredient statements
for the qualifying week’s menu from one school
at each grade group.
[+ Add attachments]
Description of student engagement activities
and culinary techniques including the objectives,
details about the activities, number of
participants, and the outcomes.
[+ Add description: up to four paragraphs, 200
words each]

10

Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities

 Small or Rural SFA Lunch Trailblazer Award

The small and/or rural SFA has a choice of criteria from which they can choose to
demonstrate that they are offering school lunches that are lower in sodium than current
meal pattern requirements and enjoyed by students.
Check “Yes” in each box below to confirm you have met the criteria.
Criteria
Yes
Documentation Required

The SFA has an enrollment of less than or equal to
5,000 students; OR the majority of students within the
SFA are enrolled in a rural school as defined by a
locality code of 41, 42, or 43 according to the National
Center for Education Statistics (NCES) online tool.
All (100 percent) of the schools within the SFA
participate in the NSLP.
Within the past 12 months, the SFA has changed their
school lunch menus to meet at least four of the
following criteria.

Check “Yes” in each box next to the four criteria below
that you choose to meet.
1. Lunch menus include fresh or frozen poultry, fish,
pork, and lean meat (with no saline or salt solution
added), rather than cured, salted, smoked, and
other processed meats.
2. Vegetables must be fresh and/or frozen and
canned vegetables with no salt or sauce added.
3. Fruits must be fresh and/or frozen and canned
fruits with no added sugars.
4. The SFA chooses lower sodium forms of products
from vendors. For tips, check out the Institute of
Child Nutrition’s Sodium Swaps: Utilizing Product
Substitutions available at the Shaking It Up
website.
5. The SFA uses alternatives to replace or reduce the
amount of sodium in main dishes and/or sides,
such as garlic, citrus juice, salt-free seasonings,
herbs, or spices.

Attendance record or documentation of the
NCES search result for locality.
[+ Add attachment]
A numbered list of all schools in the SFA that
participate in NSLP including school grade levels.
[+ Add attachment]
Documentation for criteria 1 through 8 including
one week of school lunch menus and production
records (scanned), from at least one school,
after changes were made and within the 12
months prior to award application submission
(to show the menu items, crediting information,
amount prepared, and amount served).
[+ Add attachments]
Product labels with ingredient statements (for
frozen) and/or supplier order form, fact
sheet/letter, or invoice (for fresh items)
[+ Add attachments]
Product labels with ingredient statements (for
frozen) and/or recipes (for fresh items)
[+ Add attachments]
Product labels with ingredient statements (for
frozen and canned) and/or recipes (for fresh
items)
[+ Add attachments]
Description of how the SFA chose a lower
sodium form of a product, listing what changes
we made.
[+ Add description: up to four paragraphs, 200
words each]
Recipes showing where replacements or
reductions were made.
[+ Add attachments]
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Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities
Criteria

6. All grains are whole grain-rich as defined by the
Grain Requirements for School Meals.

7. No grain-based desserts are offered, as defined by
superscripts 3, 4, or 5 in the Food Buying Guide for
Child Nutrition Program’s Exhibit A: Grain
Requirements for Child Nutrition Programs.
8. The SFA offers only unflavored milk.
9. The SFA engages students in the development of
school lunch menus.

10. The SFA and/or a community partner has
conducted at least two school lunch nutrition
education activities (e.g., taste-test event, farm to
school activities, social media campaign) for
students. Activities can be district wide.

Yes

Documentation Required

Product labels with ingredient statements,
Recipe Analysis Workbook (RAW), Product
Formulation Statements (PFS), or Child Nutrition
(CN) labels of grain items offered for the
qualifying week’s menu.
[+ Add attachments]
See production records required above.

See production records required above.
Description of student engagement activities
including the objectives, details about the
activities, number of participants, and the
outcomes.
[+Add description: up to four paragraphs, 200
words each]
• Optional photographs including two or three
clear photos of the activities with release
forms providing USDA with royalty free
unlimited rights to the use and printing of
the photographs, and parental permission
forms, when applicable.
[+Add attachments]
Description of the nutrition education activities
including the objective, details about the
activity, number of participants, and the results
of the activity demonstrating the value and how
students benefited.
[+ Add description: up to four paragraphs, 200
words each]
Optional photographs including two or three
clear photos of the activities with release
forms providing USDA with royalty free
unlimited rights to the use and printing of
the photographs, and parental permission
forms, when applicable.
[+ Add attachments]

•

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Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities

 Innovative School Lunch Makeover Award

The SFA improves the nutritional quality of a popular school lunch meal for at least one grade
group, while maintaining student acceptance of the meal. The makeover meal meets all meal
pattern requirements.
Check “Yes” in each box below to confirm you have met the criteria.
Criteria
Yes
Documentation Required

The makeover meal meets the Healthy Meals
Incentives sodium limits for the meal.

The makeover meal includes only whole grain-rich
grains, as defined by the Grain Requirements for
School Meals, and no grain-based desserts.

The menu features a local agricultural product* meal
component. When the meal is served, the local
agricultural product is procured locally when available.
See definition for local agricultural product.
The SFA engages students in the development and
marketing of the makeover meal.

The makeover meal is implemented in at least one
school, for at least one grade group, within the SFA
that participates in the NSLP and offered as part of
school meal service at least three different times
during the 12 months prior to award submission.

Documentation of sodium including a Nutrient
analysis (using USDA-approved nutrient analysis
software) or recipes, Nutrition Facts labels, and
nutrition information for the new meal.
[+ Add attachments]
Documentation of whole grain-rich grains
including product labels with ingredient
statements, Recipe Analysis Workbook (RAW),
Product Formulation Statements (PFS), or Child
Nutrition (CN) labels, if applicable, of grain items
offered for the new meal.
[+ Add attachments]
Description of the local agricultural product,
how it was procured through local sources, and
when is normally available.
[+ Add description: up to four paragraphs, 200
words each]
Description of student engagement and actions
taken to improve the school lunch meal and
student acceptance. In addition, include student
acceptability findings including taste-test results
from students at one school for the chosen
grade group(s).
[+ Add description: up to four paragraphs, 200
words each]
Information about the school(s) used to qualify
for the award including name and grade levels.
[+ Add attachment]
Lunch menu for the original meal and new meal.
[+ Add attachments]
Production records (scanned) from at least one
school meal service for the chosen grade
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Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities

Criteria

Yes

group(s), showing the qualifying meal was
served at least three different times during the
12 months prior to award application
submission (to show the menu items, crediting
information, amount prepared, amount served,
and to show no grain-based desserts were
offered).
[+ Add attachments]

Documentation Required

Optional photographs including clear photos of
the original meal and new meal with release
forms providing USDA with royalty free
unlimited rights to the use and printing of the
photographs.
[+ Add attachments]

 Innovation in the Cultural Diversity of School Meals Award

The SFA offers nutritious school meal menu options that reflect the different cultures of
students at the school.
Check “Yes” in each box below to confirm you have met the criteria.
Criteria
Yes
Documentation Required

At least one school within the SFA has collaborated
with students and/or the community to offer
nutritious school meal menu options (at least one
entrée and two sides) that reflect the cultures of
students at the school, while meeting weekly meal
pattern requirements. As part of this collaboration,
the school provides culturally appropriate education
for all students and their families on the new menu
offerings and their cultural significance.

Information about the school(s) used to qualify
for the award including name, grade levels, and
demographics:
• Percent of enrolled students that qualify for
free meals:
• Percent of enrolled students that qualify for
reduced-price meals:
• Ethnicity of students (by percentage):
o Hispanic or Latino:
o Not Hispanic or Latino:
• Race of students (by percentage)
o American Indian or Alaska Native:
o Asian:
o Black or African American:
o Native Hawaiian or Other Pacific
Islander:
o White:
[+ Add attachment]
Description of collaboration including a brief
overview of the culture represented in the new
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Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities

Criteria

Menus must have been used and nutrition education
must have been provided within the past 12 months,
and collaboration must be ongoing in support of these
efforts. However, the menu development and start of
the collaboration could have been earlier.

Yes

menu items, how the school(s) collaborated
with students and/or community members from
that culture to develop the school meal menus,
culturally appropriate education, and the impact
it had on students. Also include how this
information was made available in languages
other than English, as needed.
[+ Add description: up to four paragraphs, 200
words each]

Documentation Required

Support letter from an individual outside of the
school nutrition department that observed the
collaboration between the students and/or
community and school nutrition department on
the development of the new menu items.
[+ Add attachment]
School meal menu(s) (lunch and/or breakfast)
highlighting the culturally-inspired menu items,
including at least one entrée and two sides (with
amounts and crediting information) showing the
items were served at least three different times
during the 12 months prior to award application
submission.
[+ Add attachments]
Recipes/product documentation for culturallyinspired menu items including standardized
recipes and ingredient labels, or Nutrition Facts
labels with ingredient statements, Product
Formulation Statements (PFS), or Child Nutrition
(CN) labels of packaged items.
[+ Add attachments]
Optional photographs including two or three
clear photos of the menu items and any relevant
activities with release forms providing USDA
with royalty free unlimited rights to the use and
printing of the photographs and parental
permission forms, when applicable.
[+ Add attachments]

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Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities

 Innovation in the Preparation of School Meals Award

The SFA implements the meal service of at least three menu items (entrées or sides) prepared
from scratch using a local agricultural product or USDA Food in at least one school.
Check “Yes” in each box below to confirm you have met the criteria.
Criteria
Yes
Documentation Required

Within the past 12 months, the SFA implemented the
meal service of at least three new menu items
(entrées or sides) prepared from scratch using a local
agricultural product* or USDA food. The new menu
items must have been offered as part of school meal
service in at least one school.
See definition for local agricultural product.

Information about the school(s) used to qualify
for the award including name and grade levels.
[+ Add attachment]

The scratch-prepared menu items must be prepared
from recipes developed in accordance with the USDA
recipe standardization process, provide the minimum
creditable amount of at least one meal component,
and fit into weekly meal pattern requirements. The
recipe may be from a source other than the award
applicant (e.g., a USDA Standardized Recipe from the
Child Nutrition Recipe Box).

Description of actions undertaken to provide the
scratch-prepared menu items, how local or
USDA Foods are key ingredients, and outcomes
including plans to permanently include any of
the three new menu items in the school meal
menu.
[+ Add Description: up to four paragraphs, 200
words each]

Semi-homemade or speed-scratch menu items,
condiments, salad dressings, grain-based desserts,
sauces, etc. are not qualifying menu items for
purposes of this award.

Scratch food production incorporates ingredients as
close to their original state as possible. Pre-packaged
tortillas, pizza dough, rolls, buns, and breads, including
proof and bake breads and sandwich bread, dry pasta,
canned beans, fajita chicken meat, beef crumbles,
unseasoned cooked meat, chicken, fish, individually
quick frozen (IQF) fruits/vegetables, and unseasoned
canned fruits/vegetables are acceptable ingredients in
menu items prepared from scratch for this award.

Standardized recipes of each scratch-prepared
menu item, highlighting the creditable meal
component(s) and the source of the recipe.
[+ Add attachments]
School meal menu(s) identifying scratchprepared menu items as part of a reimbursable
school meal.
[+ Add attachments]
Supporting Documentation if using recipes that
are not in the Child Nutrition Recipe Box.
Provide a Recipe Analysis Workbook (RAW),
nutrient analysis (using USDA-approved nutrient
analysis software) or recipes and ingredient
labels or product labels with ingredient lists, and
documentation that the USDA standardization
process was used.
[+ Add attachments]
Production records (scanned) for the meals with
scratch-prepared menu items to show the items,
the amount prepared, and the amount served.
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Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities
[+ Add attachments]

Criteria
If the menu items contain grains, the grains must be
whole grain-rich, as defined by the Grain
Requirements for School Meals.
The SFA engages students in the marketing of the new
menu items.
Photographs (Optional)

Yes

Documentation Required
See production records requirement above.

Description of student engagement activities,
marketing strategies, and their outcomes.
[+ Add description: up to four paragraphs, 200
words each]
Optional photographs including two or three
clear photos of the school meals including the
scratch-prepared menu items and/or the
student engagement activities with release
forms providing USDA with royalty free
unlimited rights to the use and printing of the
photographs and parental permission forms,
when applicable.
[+ Add attachments]

 Innovation in Nutrition Education

The SFA ensures nutrition education is offered at schools.
Check “Yes” in each box below to confirm you have met the criteria.
Criteria
Yes
Documentation Required

The SFA’s Local School Wellness Policy (LWP) includes
specific goals for nutrition education at elementary,
middle, and high school grade levels. The Local School
Wellness Implementation Plan for the school year
includes specific nutrition education activities at
elementary, middle, and high school grade levels.

A numbered list of all schools in the SFA
including school grade levels.
[+ Add attachment]

The SFA’s Local School Wellness Policy Coordinator or
other designated nutrition education coordinator
ensures school nutrition education activities are
coordinated with school nutrition services (school
meals) and any farm to school activities.

Description of how nutrition education is
coordinated within the school and community
and includes a connection to school meals and
farm to school activities.
[+ Add description: up to four paragraphs, 200
words each]
Photographs including two or three clear photos
of nutrition education posters and signage
promoting healthy food and beverage choices
with release forms providing USDA with royalty

All schools within the SFA display nutrition education
posters and signage promoting healthy food and
beverage choices wherever food and drinks are sold to
students on the school campus, during the school day.

Copy of SFA’s Local School Wellness Policy and
implementation plan.
[+ Add attachments]

17

Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities

Criteria

Students are engaged in the development and delivery
of school nutrition promotions and campaigns, such as
through student cafeteria "ambassador"
programs, student-led school meal surveys or advisory
councils, and taste-testing events.

At elementary, middle, and high school levels, the SFA
provides nutrition education to the parents/guardians
of students that includes a discussion of the sodium,
added sugars and whole grain content of school meals.

Local agricultural products* are highlighted on the
school menu and/or in school cafeterias, in all schools
within the SFA, when served.
See definition for local agricultural product.

Yes

free unlimited rights to the use and printing of
the photographs and parental permission forms,
when applicable.
[+ Add attachments]

Documentation Required

Description of student engagement in nutrition
education and promotion activities including the
objective, details about the activity, number of
participants, and the results of the activity,
demonstrating the value of it and how students
benefited.
[+ Add description: up to four paragraphs, 200
words each]
Description of nutrition education activities for
parents including the objective, details about
the activity, number of participants, and the
results of the activity, demonstrating the value
of it and how parents benefited.
[+ Add description: up to four paragraphs, 200
words each]
Copies of menu for each grade group or photos
from cafeteria identifying local agricultural
products.
[+ Add attachments]

*Local Agricultural Product
The definition of “local agricultural products” can depend on geographic, social, governmental,
physical, or economic parameters; seasonality; and/or other factors. Local procurement options
differ greatly across communities depending on district and school size; proximity to
agricultural areas; growing season; and demographics. USDA expects that State agencies will
have varying definitions of “local agricultural products” that align with their particular needs
and goals. The intent of schools utilizing local agricultural products is to serve more locally
produced foods in school cafeterias, improve student nutrition, provide nutrition education
opportunities, and support local and regional farmers, ranchers, and fishers. Local agricultural
products can be meats, seafood, fruits, vegetables, grains, nuts, seeds, dairy foods, or legumes.

18

Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities
Application Verification and Submission
Please read the following statement and sign below if you agree:

 I have reviewed this application and attest to the accuracy of the information provided.
Our School Food Authority agrees to cooperate with USDA and other organizations upon request
to publicize our efforts.
FNS reserves the right to verify all information on the application and reject applications that
are incomplete or otherwise fail to provide factual information.
Name:__________________________________________________________
Signature:_______________________________Date:___________________

Submit Application [Click to submit.]

[Date and time of submission will auto-populate online.]
Thank you for applying for the Healthy Meals Incentives Recognition Awards.
For more information, visit https://www.fns.usda.gov/cnp/healthy-meals-incentives.

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights
regulations and policies, this institution is prohibited from discriminating on the basis of race, color,
national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or
retaliation for prior civil rights activity.
Program information may be made available in languages other than English. Persons with disabilities
who require alternative means of communication to obtain program information (e.g., Braille, large
print, audiotape, American Sign Language), should contact the responsible state or local agency that
administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA
through the Federal Relay Service at (800) 877-8339.
To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA
Program Discrimination Complaint Form which can be obtained online
at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-05080002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter
addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a
written description of the alleged discriminatory action in sufficient detail to inform the Assistant
Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The
completed AD-3027 form or letter must be submitted to USDA by:

19

Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities

1. mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
2. fax:
(833) 256-1665 or (202) 690-7442; or
3. email:
[email protected]
This institution is an equal opportunity provider.

20

Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities
State Agency Confirmation Letter
OMB BURDEN STATEMENT: The Food and Nutrition Service (FNS) is collecting this information
to confirm that the School Food Authority (SFA) applying for the Healthy Meals Incentive
Recognition Award participates in National School Lunch Program and does not have any
unresolved findings. This is a voluntary collection and FNS will use the information to recognize
SFAs for their significant improvements to the nutritional quality of school meals by exceeding
the transitional school meal pattern requirements for sodium and whole grains and by taking
steps to reduce added sugars. This collection does not request personally identifiable
information that is subject to the privacy requirements outlined at 5 U.S.C. §552a(e)3 of the
Privacy Act of 1974. 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-XXX. The time required to complete this information collection is
estimated to average 30 minutes (0.5 hour) per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information.

The State agency must confirm that the School Food Authority (SFA) does not have any outstanding
corrective actions and that any previous findings have been resolved (except as allowed under the USDA
FNS nationwide waivers related to the COVID-19 public health emergency and situations resulting from
damage or disruptions due to natural disasters such as hurricanes, tornadoes, and floods as well as
other exceptional emergency situations or man-made disasters).
The State agency does not need to review the application before the School Food Authority submits.
Check “yes” or “no” for the following questions and use the comment box if additional information is
needed.
1. Does the SFA have an agreement to operate the National School Lunch Program and/or School
Breakfast Program? Yes
No
Comments:

2. Does the SFA have any outstanding corrective actions? Yes

No

Comments:

21

Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities

3. Are there any unresolved findings? Yes

No

Comments:

4. Are there any findings related to program discrimination complaints within the past 3 years?
Yes
No
Comments:

Confirmed by State School Meal Programs Coordinator/Director or Representative:
Name of School Food Authority:_____________________________________
Name: __________________________________________________________
Title: ___________________________________________________________
Phone Number:__________________________________________________
Email Address:___________________________________________________
Signature:_______________________________Date:___________________
In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights
regulations and policies, this institution is prohibited from discriminating on the basis of race, color,
national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or
retaliation for prior civil rights activity.
Program information may be made available in languages other than English. Persons with disabilities
who require alternative means of communication to obtain program information (e.g., Braille, large
print, audiotape, American Sign Language), should contact the responsible state or local agency that
administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA
through the Federal Relay Service at (800) 877-8339.
To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA
Program Discrimination Complaint Form which can be obtained online
at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-050822

Appendix 4_Healthy Meals Incentives Recognition Awards Application

Healthy Meals Incentives Recognition Awards
Application for School Food Authorities

0002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter
addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a
written description of the alleged discriminatory action in sufficient detail to inform the Assistant
Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The
completed AD-3027 form or letter must be submitted to USDA by:
1. mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
2. fax:
(833) 256-1665 or (202) 690-7442; or
3. email:
[email protected]
This institution is an equal opportunity provider.

23