Attachment N1. Off-site Assessment Tool

Attachment N1. Off-site Assessment Tool

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.

Administrative Review Off-site Assessment Tool

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

General Instructions/Intent
The Off-site Assessment Tool encompasses questions about and requests for information from the
School Food Authority (SFA) with regard to several of the monitoring areas of the
Administrative Review. This tool is designed to decrease the amount of time needed for the
on-site portion of the review, as well as provide both the State Agency (SA) and SFA with
essential information to help the reviewer focus on any areas of non-compliance and target any
technical assistance that may be necessary while on-site.
The Tool is intended to be completed off-site prior to the on-site portion of the administrative
review, and used by the SA as a method to gather some of the information necessary to complete
the administrative review. Some of the requested information may already be on-file at the SA,
while other areas may require input from the School Food Service Director, or other appropriate
SFA points of contact. The SA may contact the SFA for input on these questions using whatever
method is most appropriate (email, phone call, etc.), and should work collaboratively with the
SFA to gather all requested information. Electronic submission of documentation is encouraged
wherever possible. The SA may begin completing the Off-site Assessment Tool as far in advance
of the on-site review as is deemed necessary. If the tool is utilized as intended, the reviewer
should be prepared to provide any technical assistance that may be necessary during the on-site
portion of the review.
Resource Management is the only section in which the completion of an off-site assessment is
required. The SA must secure the SFA’s answers to the Resource Management questions
contained in the Off-site Assessment Tool prior to reviewing Resource Management. The goal of
collecting the SFA’s answers in the Resource Management section of the Off-site Assessment
Tool is so that the SA can determine if a Comprehensive Resource Management Review will be
needed for any of the four Resource Management areas. If a comprehensive review is necessary,
the SA must work with the SFA to determine if the comprehensive review of any Resource
Management areas will occur on-site or off-site. If the SA will be unable to secure the necessary
documentation to conduct the review off-site, the SA must conduct the Resource Management
Comprehensive review on-site. All other sections of the Off-site Assessment Tool may be
completed on-site at the discretion of the SA. Regardless of format and timing, all responses to
all other sections must be completed no later than the first day of the on-site portion of the
review.
In addition to the completion of the Off-site Assessment Tool, the SA is required to select sites
for review (see Site Selection Procedures in Administrative Review Manual). Once site selection
has been completed, SA must complete the Meal Compliance Risk Assessment Tool for each site
selected for review. The site with the highest score is most at risk for noncompliance with the
required meal pattern and must receive a targeted menu review (see Dietary Specifications and
Nutrient Analysis module for options to complete targeted menu review). If the SA chooses to
use the Dietary Specifications Assessment Tool to complete the targeted menu review, an off-site
review of documentation is required.

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During the off-site assessment phase, the SA should document any technical assistance provided
and any corrective action implemented by the SFA. Regardless of when corrective action
occurs, all findings must be documented in the final report.
Section II: Meal Access and Reimbursement
Reminders:
The SA should attempt to answer questions using available data before contacting the SFA.
In addition to completing the questions on the Off-site Assessment Tool, the SA should follow the
instructions for selecting the students for certification and benefit issuance review as described in
the Certification and Benefit Issuance Module in the Administrative Review Manual.
The SA must ensure that the information the SFA provides to answer these questions mirrors the
current free and reduced-price policy statement on file with the SA.
The SA should notify the SFA that all verification materials must be available at the SFA’s
central office for the on-site portion of the review.
Section III: Meal Pattern and Nutritional Quality
Reminders:
In order to complete this section of the Off-site Assessment Tool, the SA must complete the Meal
Compliance Risk Assessment Tool for each of the sites selected for review (see site selection
procedures in Administrative Review Manual). The results of the Meal Compliance Risk
Assessment Tool will determine which site shall receive the targeted menu review, using one of
the four options as described in the Administrative Review Manual. Please note that pre-K meals
following the CACFP meal pattern should not be included in the dietary specifications.
Prior to the on-site portion of the review, the SA should notify the SFA that each site selected for
review must be prepared to provide meal pattern compliance documentation demonstrating that
daily/weekly meal component requirements for one week of the review period are met. If
appropriate, SA can request this documentation from the SFA prior to the beginning of the
on-site review.
Reviewers may examine any food crediting documentation, including but not limited to food
labels, product formulation statements, CN labels, and bid documentation to ensure meal pattern
compliance. (This documentation will be examined for all reviewed sites. For the site selected,
this documentation will also be used for the targeted menu review process.)
For efficiency, the SA should review the same menus, production records, and
standardized recipes from the week the SA reviewed in the Module: Meal Components and
Quantities as selected for the targeted menu review.

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NOTE: If the SA has chosen Option #1 (Completion of the Dietary Specifications Assessment
Tool) for completing the targeted menu review, the required documentation must be submitted to
the SA within a sufficient timeframe to allow the SA to properly assess the documentation and
determine the risk level of the site selected for the targeted menu review.
Section IV: Resource Management
Reminders:
This section is designed to capture information from the SFA about its financial operations
during the Resource Management (RM) Review period. Using the SFA’s responses to the Offsite Assessment Tool for the RM Review period, the SA will apply specific risk indicators to the
SFA and determine whether a Resource Management Comprehensive review of any one, or
multiple area(s), is warranted. The SA must secure the SFA’s answers to the questions included
in the Resource Management section of the Off-site Assessment Tool. The SA should then
review all of the information provided, which may include supplemental information provided
by the SFA, and complete the Resource Management Risk Indicator Tool. While FNS does not
require SFAs to include comments when they answer the questions in the Off-site Assessment
Tool, State agencies may require SFAs to provide them or to provide additional documentation.
As a best practice, State agencies should use the information provided in the comments to better
understand SFA financial management practices and to evaluate the accuracy of the SFA’s
answers. The results of the tool will inform the SA if a comprehensive RM review of any
section(s) is necessary.
The Resource Management review period used by the State agency to assess compliance with the
Resource Management section of the Administrative Review may consist of either the previous
school year or last audited school year. When reviewing the SFA’s implementation of the Paid
Lunch Equity and/or the Revenue from Nonprogram Foods, the State agency may review the
current school year instead of the previous or last audited school year if sufficient financial data
is available. The State agency must indicate for the SFA in the Off-site Assessment Tool which
Resource Management review period the SFA should use when answering questions 700-712.
Important: Any failure, whether by the SFA or SA, to adhere to assessing the SFA’s need
for comprehensive reviews in any of the four areas prior to the Resource Management
Review requires that a Resource Management Comprehensive Review of all areas will be
conducted.
Recommended: The State agency is strongly encouraged to utilize specialized staff to the extent
practicable to collect and evaluate responses in this section.
Risk Indicators for Resource Management:
When evaluating the responses to questions 700-712, follow the risk assessment for the Resource
Management module in the Administrative Review Manual to determine whether a resource
management comprehensive review of any or all areas is necessary. Some sections contain
multiple questions that may indicate risk (referred to as a “risk indicator”). State agencies are
not required to conduct a Resource Management comprehensive review unless an SFA receives

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risk indicators in any of the Resource Management areas. For State agencies conducting
Resource Management reviews on-site, if the Resource Management Risk Indicator Tool is not
completed off-site prior to the Resource Management review, a comprehensive review of all four
Resource Management areas is required.
As a best practice, all State agency reviewers, including those reviewers who do not conduct
Resource Management reviews, should be familiar with the questions in the Off-site Assessment
Tool and how SFAs receiving an Administrative Review answered them. During the on-site
review of the breakfast and lunch meal services, the on-site reviewer should assess if the
information provided by the SFA as part of the Off-site Assessment Tool – Resource
Management section is consistent with the reviewer’s observations of the SFA’s meal services.
For instance, if the SFA indicated it charged the target weighted average paid lunch price at all of
its school sites and thus did not receive a risk indicator under the Paid Lunch Equity, the on-site
reviewer should look at the paid lunch price charged during site reviews to see if the lunches
were consistently priced at or above the target average weighted paid lunch price. If there appear
to be any discrepancies between the information reported by the SFA and the reviewer’s on-site
observations, the SA must follow up with the SFA to determine if a RM Comprehensive Review
is necessary in RM areas that did not initially receive a risk indicator. For example, if an on-site
reviewer notices adults being served meals at a Community Eligibility Provision (CEP) school
but the SFA indicated it did not sell adult meals in the Off-site Assessment Tool by answering
“not applicable” to questions 710 and/or 711, the on-site reviewer should discuss the discrepancy
with the SFA to determine if the SFA answered the questions incorrectly. If the on-site reviewer
is conducting the RM review, the reviewer should either change the SFA’s answer(s) in the Offsite Assessment Tool and corresponding RM Risk Indicator Tool to questions 710 and/or 711 to
“yes” if the SFA answered the question(s) incorrectly or, if an off-site reviewer is conducting the
RM review, the on-site reviewer should communicate the information to the off-site RM
reviewer so that the RM reviewer can follow up with the SFA.
Section V: General Program Compliance
Reminders:
The SA may assist the SFA with the completion of this section, if necessary. If this section is
not returned to the SA for evaluation prior to the on-site review, this section and applicable
documentation must be available for SA review at the start of the on-site portion of the review.
Section VI: Other Federal Programs
Reminders:
This section is intended to be completed by the SA. If this section is not completed by the SA
prior to the on-site review, this section must be completed by the SA during the on-site portion of
the review.

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If the SA elects to conduct the claim validation for the Fresh Fruit and Vegetable Program during
the off-site phase, complete questions 1900 - 1902 of the On-site Assessment Tool.
Separate review forms have been provided for the review of the Afterschool Snack Program,
Special Milk Program, and Seamless Summer Option. The SA may complete any applicable
portion of those forms off-site at their discretion. Any section of the applicable forms that are
not completed prior to the on-site portion of the review must be completed during the on-site
portion of the review if necessary.
Section IX: Special Provision Options
The intent of this section is for the SA to understand the Special Provision Option policies and
procedures in place at the SFA. The review addresses the implementation and operation
of Provision 1, 2, and 3 sites and sites operating CEP.

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Administrative Review Off-site Assessment Tool Questions
Section II: Meal Access and Reimbursement

SCHOOL FOOD AUTHORITY:
School Year:
Module: Certification and Benefit Issuance
100. Does the SFA meet one of the following criteria:

YES

NO

 SFA-wide Special Provision Non-Base Year (Provision
2/3)
 RCCI, without day students
 SFA-wide Community Eligibility Provision
Note: If one of the above is checked, skip questions 101 – 205 and
proceed to question 300. If the SFA does not meet one of the above
criteria answer the following questions (101-205).
 N/A

101. Who is the determining official for certifying household applications?

(Names and/or position titles):

102.
Electronic

a. Does the SFA use an electronic applications approval system
or a manual application approval system? If a combination of
electronic and manual is used check both boxes.
b. Does the SFA use an electronic benefit issuance system or a
manual benefit issuance system? If a combination of electronic
and manual check both boxes.

Administrative Review Off-site Assessment Tool

Manual

a. 

a. 

b. 

b. 

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Section II: Meal Access and Reimbursement
Electronic application system means household applications are submitted by the household
through a web-based or scanned application system. The system has limited to virtually no
manual data entry by the SFA. Records are kept at the SFA electronically. All direct certification
matches at the SFA level are completed with a computer match.
Manual application system means household applications are submitted by the household to the
SFA. SFA completes eligibility determination and direct certification matches and enters data
manually into a system and/or keeps written records. Hard copy records are kept on file at the
SFA.
If the SFA has implemented an electronic system, but one or more aspect of the application
processing is conducted manually (e.g., applications are submitted online, and also on paper – SFA
staff processes paper applications) the reviewer will consider it a manual/combination system.
This would include instances where SFA staff are entering paper applications into the online
electronic system for determinations.
Electronic benefit issuance system means that the transfer of a student’s benefits to the Point of
Service document is completed through a computerized system. The system has limited to
virtually no manual data entry by the SFA; however, updates to benefits may be made manually in
the electronic system. Benefit issuance identification and rosters are kept electronically.
Manual benefit issuance system means that the transfer of a student’s benefits to the POS
document is completed manually by the SFA. All updates to benefits are made manually by the
SFA. Benefit issuance identification and rosters are manually developed. Hard copy records are
kept on file at the SFA.
If the SFA has implemented an electronic system, but one or more aspect of the benefit issuance
process is conducted manually (i.e., the SFA has an electronic benefit issuance system at most
sites, but utilizes rosters/ tickets/tokens or any other benefit issuance method at some sites and
SFA staff must manually make updates to those alternate systems), the reviewer will consider it a
manual/combination system.
103. At the beginning of the school year, how is benefit status handled for children who have
not submitted an application for the current school year?
Comments:

104.

If the SFA has an electronic application approval system, answer the below questions,
if not proceed to the next question.
a. How are records maintained and for how long?
b. Describe the backup to the electronic-based approval system.
c. List the method used to obtain household signature.

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Section II: Meal Access and Reimbursement

Comments:
a.
b.
c.

How long does the applications approval take from the date the SFA receives the
application from the household?

105.
Comments:

106. Within the SFA, who has access to the applications within the system?

(Names and/or position titles):

107.

a. When and how are households notified of students’ certified eligibility?
b. How are denied households notified? Review copy of the application approval/denial
notification letter.

Comments:
a.
b.

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Section II: Meal Access and Reimbursement

108. Who is the hearing official?

(Name and/or position title):

109.

Who at the SFA receives the direct certification documents from the state or local agency,
and who is responsible for issuing and updating the benefit list?

Program

Name/title of person
receiving direct
certification documents
from SA

Name/title of person
issuing direct certification
benefits to students

SNAP
TANF
FDPIR
Homeless
Migrant
Foster Children
Head Start
110. Does the SFA use the direct certification notification letter
provided by the State agency?

YES

If no, does the letter contain all required information, and is it
approved by the State agency?
(Obtain a copy of the letter used.)

YES

NO

NO

N/A

Comments:

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Administrative Review Off-site Assessment Tool Questions
Section II: Meal Access and Reimbursement
111. What is the SFA’s procedure for extending free school meal eligibility to all children who
are members of a household in which one person in that household is receiving SNAP,
TANF, or FDPIR benefits?
Comments:

112. Does the benefit issuance system identify how eligibility was
determined?
(e.g., through application, direct certification, etc.)

YES

NO

Comments:

113.

a. Who has access to the benefit issuance system and/or documentation?
b. What safeguards are in place to ensure that only authorized individuals have access to
the benefit issuance system and/or documentation?

a. (Names and/or position titles):
b.
114. How are benefits issued and distributed to students?
(e.g., via electronic system with code numbers for students, ticket system)
Comments:

115. How are eligibility determinations transferred to the benefit issuance document?
Comments:

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Section II: Meal Access and Reimbursement
116. How are benefit issuance document(s) transferred to the point of service system?
Comments:

117. How are eligibility status updates made to the point of service and to the benefit issuance
document(s)?
Comments:

118. How frequently are updates made to the point of service and benefit issuance
document(s)?
Comments:

119.

Does the benefit issuance document indicate the date the eligibility
status changes were made?

YES

NO

Comments:

120.

How and when are the following changes made to the point of service and benefit
issuance document:
a. new students
b.transfer students
c. withdrawn students
d. 30 day carryover of prior eligibility

Comments:
a.
b.
c.
d.

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Administrative Review Off-site Assessment Tool Questions
Section II: Meal Access and Reimbursement
121.

a. Is there a backup system for updating benefit issuance
document(s)?
b. If yes, describe the backup system for updating benefit
issuance document(s).

YES

NO

YES

NO

Comments:

Module: Verification
200.

Obtain a copy of the SFA’s most recently submitted FNS-742
(Verification Collection Report).
a. Did the SFA choose the correct verification sample size?
b. Did the SFA verify the correct number of applications
based on their verification sample size?
c. Was the most recent report timely and accurate?
If no, is this a recurring problem?

Comments:

201.

Who serves as the SFA’s verifying official?

(Name and/or position title):

202.

Who serves as the confirming official?

(Name and/or position title or software used is acceptable):

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Section II: Meal Access and Reimbursement

203.

Describe the SFA’s verification process (including SFA’s verification for cause process,
deadlines, due dates, selection procedures, etc).

Comments:

204.

YES

Does the SFA use an electronic system to identify error-prone
applications? If yes, explain in the comments what software the
SFA uses?

NO

Comments:

Module: Meal Counting and Claiming
300.

Does the SFA use an electronic or manual system to count and
consolidate reimbursable meals? If a combination of electronic
and manual is used check both boxes.

Electronic

Manual





Electronic System means meal counts are generated by an automated Point of Service (POS)
system that may connect to the claim for reimbursement. Electronic systems have the ability to
identify a student’s benefit category, tally daily meal counts, transfer daily meal counts to the
SFA, consolidate meal counts for the SFA, and/or submit the claim for reimbursement. The
system is limited to virtually NO MANUAL data entry at the POS. Meal counts are kept
electronically.
Manual System means meal counts are generated by a manual Point of Service system. Meal
counts are manually tallied, consolidated, and transferred to the SFA. Consolidation of meal
counts by the SFA is completed manually. Hard copy records are kept on file.
If the SFA has implemented an electronic system, but one or more aspect of the benefit issuance
process is conducted manually (e.g., the SFA has an electronic POS, but utilizes a roster at an
alternate service location and SFA staff manually enters meal counts from the alternate service
location), the reviewer will consider it a manual/combination system.

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Section II: Meal Access and Reimbursement
301.

How does the SFA’s point of service system identify a student’s eligibility?
Include all types of distinct counting methods (e.g., check-off list for grades 1-3, tickets
for grades 4-8).

Comments:

302.

Does the SFA have a backup system to their primary meal
counting and claiming system should the primary system fail/not
operate?

YES

NO

If YES, describe backup system in the comments.
Comments:

303.

How often are cashiers and substitute cashiers trained on the meal counting and claiming
system (including the backup system)?

Comments:

304.

At the end of meal service, how does the SFA obtain the daily meal counts by category
from each school’s point(s) of service?

Comments:

305.

What are the SFA’s meal counting and claiming policies and procedures for the
following situations:
N/A

a) Offer vs. Serve?

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Section II: Meal Access and Reimbursement
N/A

b) Incomplete/Non-Reimbursable
Meals?

N/A
c) Second Meals?

N/A
d) Visiting student meals?

N/A
e) Adult and non-student meals?

N/A
f) Student worker meals?

N/A
g) A la carte?

N/A
h) Field trips?

N/A

i) Lost, stolen, misused, forgotten or
destroyed tickets, tokens, IDs, and
PINS?

N/A

j) Charged and/or pre-billed/prepaid
meals?

N/A

k) Students without funds to pay for
meals?

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Section II: Meal Access and Reimbursement
N/A

l) New students without approved
certification of free or reduced-price
benefits?
m) Local Charge Policy and Unpaid
Meal Policy Procedures?
306.

What procedures are used as internal controls to ensure the meal counts do not exceed
enrollment or attendance adjusted enrollment?

Comments:

307.

Electronic Systems Only:

YES

NO

N/A

YES

NO

N/A

Are meal counts automatically consolidated?
If YES, does the software program contain edits and internal
controls?
If NO, when and how are edit checks and internal controls
completed?
Comments:

308.

Have alternate points of service been approved by the SA?
If there are alternative points of service, describe in the comments
the number and types of alternate points of service operating
during each meal service (e.g., meals in classrooms, bus).

Comments:

309. If a school has more than one meal service line, how does the point of service system
prevent duplicate or second meals from being claimed?
Comments:

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Section II: Meal Access and Reimbursement

310. At the site level, how are the total daily meal counts by category submitted to the SFA for
consolidation?
Comments:

311. Describe the SFA’s procedures for consolidating daily meal counts by category for each
site to process the claim for reimbursement, if applicable.
Comments:

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Administrative Review Off-site Assessment Tool Questions
Section III: Nutritional Quality and Meal Pattern
Module: Dietary Specifications and Nutrition Analysis
600. Based on the results of the Meal Compliance Risk Assessment Tool, what site has been
selected for the targeted menu review?
School selected for targeted menu review:

601. How will the SA proceed with the targeted menu review?




602.

Option 1: Complete the Dietary Specifications Assessment Tool
Option 2: Validate Existing Nutrient Analysis
Option 3: Conduct Nutrient Analysis
Option 4: Use FNS-approved Process Utilizing FNS-Approved Menu Planning Tools

If Option 1 is selected, what initial risk level has been assigned for the targeted menu
review site based on the results of the Dietary Specifications Assessment Tool?

 N/A
Risk Level:

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Administrative Review Off-site Assessment Tool Questions
Section IX: Special Provision Options

Module: Maintenance of Nonprofit School Food Service Account
Indicate the Resource Management review period to be used when answering Q700-705:
 Previous School Year
700.

 Last Audited School Year

Did the SFA have the ability to accurately track all revenues
and expenditures for the nonprofit school food service
separately from all other transactions?

YES

NO

YES

NO

YES

NO

YES

No

If yes, describe the method used in the comments box, such as
having a separate account only for food service revenues and
expenditures, identifying all financial transactions by a separate
fund code, using a separate ledger or other system to track
revenues and expenditures specific to food service.
Comments:

701.

At the end of the SFA’s RM review period, did the food
service have net cash resources that exceeded three months’
average expenditures?
If the SFA has a plan approved by the State agency to use the
excess funds, note this in the comments section.

Comments:

702.

Did the SFA transfer funds other than approved indirect costs
out of the food service account to support general school
district expenses or non-food service-related activities?
If so, describe in the comments section.

Comments:

703.

Excluding the purchase of equipment using equipment grant
funds, if the SFA used food service funds to buy equipment*
during the school year under review, did it receive prior
approval from the State agency either directly or via the State’s
pre-approved equipment list?
*Equipment has a per-unit acquisition cost which equals or

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Administrative Review Off-site Assessment Tool Questions
Section IX: Special Provision Options
exceeds the lesser of the capitalization level established by the
State agency or SFA for financial statement purposes, or $5,000.

In the comments section or via attachment, please provide:
•
•

•

Your capitalization threshold for equipment purchases;
and
Information about equipment purchases made with food
service funds during the Resource Management review
period that required pre-approval either directly from
the State agency or via the State’s approved equipment
list.
If the only equipment purchased was made partially or
in full with an equipment grant received from the State
agency, answer “N/A” and do not list these equipment
purchases.

Comments:

704.

Did the SFA have any financial findings related to unallowable
costs or financial mismanagement in the child nutrition
programs on a previous administrative review or as part of an
audit (for example, OIG, Single Audit (previously called A-133
audits), other state audits) within the past three years?

YES

NO

YES

NO

If yes, describe in comments section.

Comments:

705.

Did the SFA have internal control procedures in place to
ensure that only allowable costs were charged to the nonprofit
school food service account?
If yes, detail in the comments section all internal control
procedures that were in place at the SFA. Some examples may
include:
•

Written procedures

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Section IX: Special Provision Options
•
•
•
•

Annual allowable cost training;
Financial management standard operating procedures;
The assignment of financial responsibilities to different
individuals;
Policies for ensuring that bad/delinquent debt is not
paid for with food service funds

Comments:

Module: Paid Lunch Equity
Indicate the Resource Management review period to be used when answering Q706-708:
 Previous School Year

 Last Audited School Year

706. Did the SFA use the USDA Paid Lunch Equity Tool or
a comparable mechanism to evaluate its need to raise
its paid lunch prices?

 Current School Year
YES

NO

NO,
$0
Balance

N/A-1

N/A2

If the SFA charged the target weighted average paid
lunch price at all sites, indicate the amount it charged
for paid lunches in the comments section.
If “No- SFA had a positive or zero Food Service
balance as of 1/31/2018 and was exempt from the PLE
requirements” is selected, please indicate the balance
in the nonprofit food service account as of 1/31/2018
in the comments section.
* N/A-1 should be selected if all sites at the SFA are
nonpricing;
**N/A-2 should be selected if the SFA charged at least
the target weighted average paid lunch price at all
sites.

Comments:

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707.

YES
Did your SFA receive a transfer of non-Federal funds
into the food service account to reduce or eliminate the
need to raise paid lunch prices?

NO

N/A
1

N/A
2

N/A
3

If yes, indicate the amount of non-Federal funds added
to the food service account to support paid lunch
prices.
* N/A-1 may only be selected if all sites at the SFA
were nonpricing;
**N/A-2 may only be selected if the SFA charged at
least the target weighted average paid lunch price at
all sites.
***N/A-3 may only be selected if SFA had a positive
or zero Food Service balance as of 1/31/2018 and was
exempt from the PLE requirements.
Comments:

708.

Did your SFA adjust its paid lunch prices for the RM
Review Period at the level at or above what was
required by the USDA Paid Lunch Equity tool or
comparable mechanism?

YES

NO

N/A
1

N/A
2

N/A
3

N/A
4

Please note in the comments section if the SFA
received prior approval from the State agency for a
PLE exemption.
* N/A-1 may only be selected if all sites at the SFA
were nonpricing or if the SFA charged at least the
target weighted average paid lunch price at all sites.
**N/A-2 may only be selected if the SFA charged at
least the target weighted average paid lunch price at
all sites.
***N/A-3 may only be selected if the SFA received a
PLE exeption from the State agency for the review
period.
****N/A-4 may only be selected if SFA had a positive

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or zero Food Service balance as of 1/31/2018 and was
exempt from the PLE requirements.

Comments:

Module: Revenue from Nonprogram Foods
Indicate the Resource Management review period to be used when answering Q709-711:
 Previous School Year
709.

 Last Audited School Year  Current School Year

With the exception of milk, did the SFA sell Smart
Snacks*, second entrees, and/or catering (e.g.,
foods/beverages for school board meetings; foods for
outside entities and programs)?

YES

NO

* Smart snacks are any food or beverage sold to
students at schools during the school day other than
those foods provided as part of the reimbursable
school meal programs. Examples include a la carte
items sold in the cafeteria and foods sold in school
stores, snack bars, and vending machines.
Comments:

710.

If the SFA provided adult meals for teachers and/or
parents, did it obtain full payment from the adults
receiving the meals and/or recover the cost of those
meals by some other means (general fund transfer,
etc.)?

YES

NO

NA

Please indicate in the comments section how the cost
of the adult meals was recovered.
Comments:

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711.

If the SFA charged for adult meals, were the meal
prices sufficient to cover the overall cost of the meals
in compliance with FNS Instruction 782-5, Rev. 1?

YES

NO

NA

Detail in the comments section how the SFA
calculated its adult meal prices (example- meal
equivalents plus commodity value, etc.) and the dollar
amount(s) charged for adult meals,
Comments:

Module: Indirect Costs
Indicate the Resource Management review period to be used when answering Q711:
 Previous School Year

 Last Audited School Year

Were indirect costs* charged to the SFA’s nonprofit school
food service account?

712.

YES

NO

Comments:

*For more information about indirect costs, please see Policy Memo SP 60-2016, “Indirect Costs
Guidance for State Agencies and SFAs.”

Module: Civil Rights
800.

What non-discrimination statement is used for Program materials? Please provide exact
language.

Comments:

801.

Did the School Food Authority publish a public
release as required for the School Year being
reviewed?

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Yes

No

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Provide a copy.
RCCIs are not required to submit a public release
unless their enrollment includes day students.
802.

What services does the SFA provide to households comprised of persons with Limited
English Proficiency (LEP)?

Comments:

803.

What is the SFA’s procedure for receiving and processing complaints alleging civil
rights discrimination within FNS school meal programs?
Provide a copy.

Comments:

804.

Has the School Food Authority received any written or verbal
complaints alleging discrimination in FNS Programs in the
current or prior school year?

YES

NO

If yes, obtain the following information: date, nature of
complaint, and agency complaint was reported to.
Comments:

805.

What procedures are in place for accommodating students with disabilities?

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Comments:

806.

When was the SFA’s most recent civil rights training for staff who interact with program
applicants or participants (e.g., cafeteria staff, determining officials) and their
supervisors?
Provide supporting documentation demonstrating topics covered and attendance of staff.

Comments:

807.

a. How does the SFA collect racial/ethnic data?
b. How often is this information collected?
c. Provide documentation to support the response.

Comments:
a.
b.
c.

Module: SFA On-site Monitoring
900.

YES

NO

a. Was the on-site monitoring of
breakfast completed prior to
February 1st?
b. Was the on-site monitoring of
lunch completed prior to February
1st?
c. How does the SFA ensure that all
schools are meeting program
requirements? For example, list in
the comments, how and when the

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monitoring is conducted?

Comments:
c.

Module: Local School Wellness Policy
Yes

1000.

No

Provide a copy or appropriate web
address of the current local school
wellness Policy.
Are the minimum required elements
written into the Local School
Wellness Policy? In comments,
explain how required elements are
being met.
Comments:

1001. How does the public know about the local school wellness policy?
Provide documentation to support the response (or appropriate web address(es)).
Comments:

1002. When and how does the review and update of the local school wellness policy occur?
Provide documentation to support the response (or appropriate web address(es)).
Comments:

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1003. a. Who is involved in reviewing and updating the local school wellness policy?
b. What is their relationship with the SFA?
Comments:
a.
b.
1004.

How are potential stakeholders made aware of their ability to participate in the
development, review, update, and implementation of the local school wellness
policy?
Provide documentation to support the response (or appropriate web address(es)).

Comments:

1005. Provide a copy of the most recent assessment on the implementation of the local
school wellness policy.
How does the public know about the results of the most recent assessment on the
1006.
implementation of the local school wellness policy?
Provide documentation to support the response (or appropriate web address(es)).
Comments:

Module: Smart Snacks
1100.

What are the SFA’s food sale policies? List all types of food/beverage sales to include
the selling of non-food items in combination with food items.

Comments:

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1101. What is the SFA’s process for determining compliance with non-packaged or recipe food
items (combination foods that do not have a label)?
Comments:

1102. How does the SFA account for accompaniments when determining whether food items
meet the Smart Snack standards?
Comments:

1103. Who is responsible for tracking Smart Snacks compliance at the:
a) SFA level:
b) School level:
c) For foodservice:

Comments:
a.
b.
c.

Module: Professional Standards
1200.

What is the LEA student enrollment? (select one)

a) 2,499 or
less
b) 2,500 –

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9,999
c) 10,000 or
more
1201.

List the employee count for each of the following:

Directors
Managers
Other Full-Time
Nutrition Staff
>20 hours/week
Part-Time
Nutrition Staff
<20 hours/week
Staff hired after
January 1 of the
School Year being
reviewed
Non-school
nutrition staff that
have
responsibilities
that include duties
related to the
program
1202.

a) Has the SFA hired any new directors on or
after July 1, 2015? If no, proceed to
Question 1204.

YES

NO

N/A

b) If a new School Nutrition Program
Director has been hired, did they meet the
hiring standards requirements?

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Comments:

1203.

a. If a new School Nutrition Program Director has been
hired, did they complete food safety training within 30 days
of being hired?

YES

NO

YES

NO

YES

NO

b. If yes, proceed to question 1204. If no, was previous food
safety certification obtained in the last 5 years? If yes, list
the date of certification in comments.

Comments:

1204.

Did School Nutrition Program Directors meet the training
requirement?

If no, after review of the scheduled/planned trainings for the
remainder of the school year is the School Nutrition Program
Director expected to meet annual training requirements?
List completed training hours and expected/planned training
hours in the comments.
Comments:

1205.

Did School Nutrition Program Managers, if applicable, meet

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the training requirements?
If not, after review of scheduled/planned trainings, trainings
for the remainder of the school year is the School Nutrition
Program Manager expected to meet the annual training
requirements?
List completed training hours and expected/planned training
hours in the comments.
Comments:
1206.

YES

NO

YES

NO

YES

NO

Have the school nutrition staff met the annual training
requirements for the current school year including part-time,
full-time and any staff hired after January 1, if applicable?
For staff hired after January 1, employees must meet at least
half of the annual training requirements.
If not, review the scheduled/planned trainings for the
remainder of the school year.
List completed training hours and expected/planned training
hours in the comments.
Comments:
1207.

Has the State Agency allowed the SFA flexibility to
complete annual training requirements over a 2 year period?
If yes, list in the comments section, the first school year to
which the flexibility was applied.

Comments:

1208.

Is the SFA tracking training hours on an annual basis?
Please describe how the SFA tracks and monitors annual
training including frequency and tracking mechanism.

Comments:

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Did the employees that work outside of the school nutrition
program whose responsibilities include duties related to the
operation of the school nutrition program receive training
applicable to their duties related to the program?

1209.

YES

NO

If yes, list their names and job titles in the comments.
Comments:

Module: School Breakfast and Summer Food Service Program Outreach
 Not applicable
1600. How did the SFA inform households of the availability of the School Breakfast Program
prior to (or at the beginning) of the school year and provide reminders about the
availability of the School Breakfast Program throughout the school year?
Comments:

1601. How did the SFA inform eligible households about the availability and location of free
meals for students via the Summer Food Service Program?
Comments:

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Indicate if any additional federal programs are operated by the SFA and will be examined
during the review:





Afterschool Snack Program
Seamless Summer Option
Fresh Fruit and Vegetable Program
Special Milk Program

** For Provision 2 ONLY**
 Not applicable (if no schools in the SFA operate Provision 2, skip this page)
2100. Are non-federal funds being properly allocated to account for the
difference of offering all meals to students at no charge and the
Federal reimbursement?

YES

NO

Comments:

2101.

What procedures are/were used to calculate the Base Year claiming percentages for each
school implementing Provision 2?

Comments:

2102. What procedures are used to apply the Base Year claiming percentages to the Non-base
Year’s claims for reimbursement?
Comments:

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2103.

If applicable, were adjustments made to the claiming percentages
established during the Base Year?

YES

NO

YES

NO

If yes, describe the procedure used for the adjustment.
Comments:

2104. Has the SFA ensured all meals are provided at no cost to all
enrolled students during Provision 2 Base Year?
If no, explain.
Comments:

** For Provision 3 ONLY **
 Not applicable (if no schools in the SFA operate Provision 3, skip this page)

2105. Are non-federal funds being properly allocated to account for the
difference of offering all meals to students at no charge and the
Federal reimbursement?

YES

NO

Comments:

2106.

What procedures are/were used to calculate the Base Year level of federal assistance for
each school implementing Provision 3?

Comments:

2107. What procedures are used to apply the Base Year level of federal assistance to the Nonbase Year’s claims for reimbursement?
Comments:

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2108.

If applicable, were adjustments made to the level of federal
assistance established during the Base Year?

YES

NO

If yes, describe the procedure used for the adjustment.
Comments:

** For Community Eligibility Provision ONLY **
 Not applicable (if no schools in the SFA operate Community Eligibility Provision, skip
this page)

2109. Are non-federal funds being properly allocated to account for the
difference of offering all meals to students at no charge and the
Federal reimbursement?

YES

NO

Comments:

2110. What procedures are used to apply the established ISPs to the current School Year’s
claims for reimbursement? (Documentation supporting establishment of ISP and
corresponding claiming percentages will be verified during completion of the On-site
Review Assessment Tool)
If applicable, were adjustments made to the ISP and corresponding claiming percentages
in the current SY? If yes, describe the procedure used for the adjustment.
Comments:

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** For Provision 1 ONLY **
 Not applicable (if no schools in the SFA operate Provision 1, skip this page)

2111. Are all households provided meal applications and allowed to
apply for meal benefits each school year?

YES

NO

Comments:

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