Worksheet FNS 10 OMB# 0002

U.S. DEPARTMENT OF AGRICULTURE

FOOD AND NUTRITION SERVICE

REPORT OF SEAMLESS SUMMER OPERATIONS

STATE AGENCY: Submit report according to the instructions 30 and 90 days following the month being reported. Send original to the Regional Administrator, Food & Nutrition Service.

1. STATE

4. TYPE OF SUBMISSION

   1. ☐ 30 – DAY

   2. ☐ 90 – DAY

   3. ☐ 90 – DAY

REVISION NO:

4. ☐ CLOSEOUT

5. ☐ OTHER (DESCRIBE)

FOR FNS USE ONLY

CALENDAR YEAR

MONTH

TYPE

STATE CODE

2. CALENDAR YEAR

3. MONTH

PART A – Seamless Summer Option (SSO) Reporting (Complete Monthly)

			CONGREGATE (A)	NON-CONGREGATE (B)	AVERAGE DAILY MEALS (C)
5. SSO LUNCHES		ACTUAL
		ESTIMATED
		TOTAL
6. SSO SNACKS		ACTUAL
		ESTIMATED
		TOTAL
7. SSO BREAKFASTS		ACTUAL
		ESTIMATED
		TOTAL

		CONGREGATE (A)	NON-CONGREGATE (B)		TOTAL (C)
8. SCHOOLS OPERATING SSO
S8. SSO SITES
S9. SSO OPERATING DAYS
10. REMARKS

I CERTIFY THAT THIS REPORT IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.		19. AGENCY
20. SIGNATURE	21. TITLE		22. DATE SIGNED

According to the Paperwork Reduction Act of 1995, no persons are 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 0584-0594. The time required to complete this information collection is 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

FORM FNS-10 SSO (07-23) Electronic Form Version Designed in Adobe 10.0 Version

NO FURTHER MONIES OR OTHER BENEFITS MAY BE PAID OUT UNDER THESE PROGRAMS UNLESS THIS REPORT IS COMPLETED AND FILED AS REQUESTED BY EXISTING REGULATIONS (7 C.F.R. 210 & 220)

INSTRUCTIONS

(ALL ITEMS SELF-EXPLANATORY UNLESS NOTED BELOW)

For each applicable month, all schools approved to operate the NSLP Seamless Summer Option during the month being reported should be accounted for on this report. The 30-day report should include "actual" data from valid claims received, and "estimated" data for those claims which have not been validated or received by the reporting due date.

Data reported which is not based on valid claim data should represent the best estimate of the State agency of the actual level of operation.

The 30-day report is due in the Food Program Reporting System 30 days following the month being reported.

The 90-day report must contain only valid final claim data and must be submitted in the Food Program Reporting System within 90 days following the month being reported. The 90-day report must not contain "estimated" data for any item.

DEFINITIONS (for the purpose of this report):

1. "Average Daily Meals" - The number of meals served on an average day during the month being reported. It may be determined in accordance with the following example: School A served for 20 days a total of 2,000 meals; 2,000 divided by 20 equals an average of 100 meals served daily. School B served for 16 days a total of 2,400 meals; 2,400 divided by 16 equals an average of 150 meals served daily. School C served for 30 days a total of 1,800 meals; 1,800 divided by 30 equals an average of 60 meals served daily. One hundred (Average daily meals served for School A) plus 150 (Average daily meals served for School B) plus 60 (Average daily meals served for School C) equals 310, total aggregate average daily meals for the three schools.

The State agency may use any valid method to determine the number of average daily meals; however, it should provide a result like the result obtained in the calculation method cited above. Under normal circumstances, the number of average daily meals should not vary appreciably from one month to the next. If there is any significant monthly change in the number of average daily meals served, it should be explained in the "Remarks" section of the report.

“Actual – Meals for which claims have been approved for the reimbursement for the month.

2. “Estimated” – Projection of the number of meals that were served and are expected to be approved for reimbursement for which claims have not been received or approved by the reporting due date.

3. “Total” – The sum of ACTUAL and ESTIMATED data.

4. “Rural Non-Congregate Sites” – Rural sites which provide non-congregate meal service.

5. “Operating Days” the number of days that meals are distributed at a site. For non-congregate meal service, include days that multiple meals are distributed for via meal pickup or meal delivery.

TYPE OF SUBMISSION

4A. "30-Day Report" - Due in FNS Regional Offices on the last day of the month following the month being reported. This report may contain ACTUAL and ESTIMATED data.

4B. "90-Day Report" - The 90-Day Report must be submitted to the FNS Regional Office within ninety days following the month being reported. This is a "final" report and must consist of ACTUAL data only.

4C. "Revised 90-Day Report" - Submit revisions to the latest 90-Day Report in accordance with FNS instructions.

4D. "Closeout Report" - Submit the Annual Financial

Reconciliation (Closeout) of Program Grants Report in accordance with FNS instructions.

4E. "Other Reports" - Submit other reports in accordance with FNS instructions. Use the "Remarks" section if necessary to describe the purpose of the report.

Part A – Monthly Reporting

Note: Estimates will need to be developed to complete the 30-day report.

Item

Line 5 – SSO Lunches

Enter the ACTUAL, ESTIMATED, AND TOTAL number of SSO lunches served in Congregate Settings in Column (A).

Enter the ACTUAL, ESTIMATED, AND TOTAL number of SSO lunches served in Rural Non-Congregate Settings in Column (B).

Enter the ACTUAL, ESTIMATED, AND TOTAL Average Daily SSO lunches served in Column (C). Average Daily Meals includes lunches served in both congregate and non-congregate settings.

Line 6 – SSO Snacks

Enter the ACTUAL, ESTIMATED, AND TOTAL number of SSO snacks served in Congregate Settings in Column (A).

Enter the ACTUAL, ESTIMATED, AND TOTAL number of SSO snacks served in Rural Non-Congregate Settings in Column (B).

Enter the ACTUAL, ESTIMATED, AND TOTAL Average Daily SSO snacks served in Column (C). Average Daily Meals includes lunches served in both congregate and non-congregate settings.

Line 7 – SSO Breakfasts

Enter the ACTUAL, ESTIMATED, AND TOTAL number of SSO breakfasts served in Congregate Settings in Column (A).

Enter the ACTUAL, ESTIMATED, AND TOTAL number of SSO breakfasts served in Rural Non-Congregate Settings in Column (B).

Enter the ACTUAL, ESTIMATED, AND TOTAL Average Daily SSO breakfasts served in Column (C). Average Daily Meals includes lunches served in both congregate and non-congregate settings.

Line 8 – Schools Operating SSO

Enter the total number of schools operating the SSO during the report month in Column (C).

Line 9 – SSO Sites

Enter the total number of sites serving SSO meals in Congregate settings in Column (A).

Enter the total number of sites serving SSO meals in Rural Non-Congregate settings in Column (B).

Enter the total number of sites serving SSO meals in Column (C).

Line 9 Example:

Site A – Rural Non-Congregate Meal Service Only

Site B – Congregate Meal Service Only

Site C – Both Rural Non-Congregate and Rural Congregate Meal Service

Total Congregate Sites: 2

Total Rural Non-Congregate Sites: 2

Total Site: 3

Line 10 – SSO Operating Days

Enter the total number of operating days for SSO sites serving meals in congregate settings in Column (A).

Enter the total number of operating days for SSO sites serving meals in rural-non-congregate settings in Column (B).

Enter the total number of operating days for SSO sites during the report month in Column (C).