| A1-1. SFA ID |
A1-2. SFA Name |
A1-3. Review Period (Month) |
A1-4. Review Period (Year) |
A1-5. Total # Schools offering SBP |
A2-1. Sampling Methodology (Select [1] one) |
A2-2. Total # of Students Reviewed (i.e. Sample Size #) |
A2-3. SFA Count of Reviewed Students (#) |
A2-4. SA Count of Reviewed Students (#) |
A2-5. Application Errors by Type (#) |
A2-6. Total # of Applications Miscategorized |
A2-7. Total # of Benefit Issuance Errors |
A3-1. NSLP Total Overclaim/Underclaim ($ -/+) |
A3-2. SBP Total Overclaim/Underclaim ($ -/+) |
A3-3. Afterschool Snacks Total Overclaim/Underclaim ($ -/+) |
A3-4. Was Overclaim Disregarded (Select [1] if Yes) |
A3-5. Were Funds Withheld or Recovered (Select [1] if Yes) |
A3-6. Underclaim paid to SFA ($) |
A4-1. Risk Flag(s) Triggered (Select [1] all that apply) |
| A2-1A. 100% |
A2-1B. 95% Confidence Level /Electronic System |
A2-1C. 99% Confidence Level / Manual System |
A2-3A. Free |
A2-3B. Reduced price |
A2-4A. Free |
A2-4B. Reduced price |
A2-5A. Child or Household Name |
A2-5B. Case Number |
A2-5C. Income Amount or Source |
A2-5D. Social Security # (last 4 digits) |
A2-5E. Adult Signature |
A2-6A. Free -> Reduced Price |
A2-6B. Free -> Paid |
A2-6C. Reduced price -> Paid |
A2-6D. Reduced price -> Free |
A2-7A. Free -> Reduced Price |
A2-7B. Free -> Paid |
A2-7C. Reduced price -> Paid |
A2-7D. Reduced price -> Free |
A4-1A. SFA Enrollment |
A4-1B. NonProfit School Food Service Account |
A4-1C. Paid Lunch Equity |
A4-1D. Revenue from NonProgram Foods |
A4-1E. Indirect Costs |