State and Local Burden - SA, SFA/LEA/Schools

7 CFR Part 210 National School Lunch Program

Attachment N11. Fiscal Action Workbook.xlsx

State and Local Burden - SA, SFA/LEA/Schools

OMB: 0584-0006

Document [xlsx]
Download: xlsx | pdf

Overview

Sheet1
NSLP - Standard
SBP - Standard
SSO - NSLP (Closed and Migrant)
SSO - SBP (Closed and Migrant)
NSLP-Std RECALC
SBP-Std RECALC
SSO-NSLP RECALC
SSO-SBP RECALC
NSLP - P2 & CEP
SBP - P2 & CEP
NSLP - P2 & CEP RECALC
SBP - P2 & CEP RECALC
NSLP - P3
SBP - P3
SMP
FA Summary


Sheet 1: Sheet1

Attachment T11. Fiscal Action Workbook

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.

Sheet 2: NSLP - Standard


























































































`






`



































Attachment N.11. Fiscal Action Workbook OMB#0584-0006 Expiration Date: xx/xx/20xx






















































































For Non-Provision Schools and Base-Year Provision 2 & 3 Schools, FFVP, and ASSP



























































































































































































































Review Information:
1: Establish SFA Count of Reviewed Students
2: Establish SA Count of Reviewed Students
3% Threshold Calculation
3: TOTAL FISCAL ACTION FOR NSLP STANDARD:















































































All























Free to Reduced
Windows User: Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2.
3 Free


Error rates per type Free to Reduced
0.000%


Benefit Issuance Changes


0
















































































Review Period
Month Being Reviewed:


Period:
SFA Count of Students Eligible for Free and Reduced-Price Meals:
FREE
REDUCED PRICE


Free to Paid


0


Free to Paid
0.000%


CBI Error Percentage


0.00%
















































































Day of Review









Windows User: Data for Free and Reduced Price categories is recorded on the SFA-1, Section 4, Box A.





Reduced to Paid


Reduced



Reduced to Paid
0.000%


3% Threshold Met or Exceeded


NO Yes $0.00















































































Other
SFA Name:









Reduced to Free


0



Reduced to Free
0.000%


Assess Fiscal Action


State agency has the discrection to take fiscal action when application errors do not exceed 3% error threshold YES No















































































2 1































































































































































































































































































































































































No.
Name of Site
4: Number of Meals Claimed by the Site:
5A: Adjust for Consolidation Errors (Deductions):
5B: Adjust for Consolidation Errors (Additions):
6: Number of Meals Claimed Adjusted for Consolidation Errors:
7: Total Non-Reimbursable Meals:
8: Number of Reimbursable Meals by Benefit Type:
9: Reimbursement Rates for Each Benefit Type:
Section 4 multiplied by rate 10: Reimbursement Amounts Claimed by SFA:
11: SFA-wide Reimbursable Meals by Benefit Type Adjusted by Error Rate per Application Category

12A: Adjustment to Meals per Site by Category (CB&I)


12B: Allowable Total Meals after Fiscal Action


12C: Allowable Total Reimbursement after Fiscal Action

13: Total FFVP Reclaim
(use a negative number):

14A: Number of After School Snacks Adjustments (Disallowed = negative # or Added = positive #) for Each Benefit Type:
14B: Reimbursement Rates for Each Benefit Type of After School Snack:
14C: Total After School Snack Adjustment:
15: TOTAL FISCAL ACTION FOR SITE:
























































































































FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID



FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID



TOTAL FREE
TOTAL REDUCED
TOTAL PAID
TOTAL

Change in Free Meals
Change in RP Meals
Change in Paid Meals


Free
Reduced
Paid


Free
Reduced
Paid



FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID



































































































































































































































































NSLP/Month of On-site review: Data for Free, Reduced Price, and Paid categories is recorded on the S-1, Line 19. NSLP/Review Period: Data for Free, Reduced Price, and Paid categories is recorded on the S-1, Line 20.





0


NSLP/Day of Review: Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13. NSLP/Review Period: Data for deductins to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17 B. Other Meal Claim Errors (If applicable): Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-2, Section 1, Column F.







NSLP/Day of Review: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13.. NSLP/Review Period: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17B. Other Meal Claim Errors (If applicable): Data for additions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.







0
0
0


NSLP/Day of Review: From the S-1 form, enter the SUM of Lines 10, 11, 12, and 12A.. NSLP/Review Period: From the S-1 form, enter the SUM of lines 14, 15, 16 and 16 A. Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 2, Column D (number of meals only).



0
0
0
0


Enter the total NSLP reimbursement rate that the site receives for Free Meals. $0.00
Enter the total NSLP reimbursement rate that the site receives for Reduced Price Meals. $0.00
Enter the total NSLP reimbursement rate that the site receives for Paid Meals. $0.00


$0.00
$0.00
$0.00

Section 8 Total
0
0
0
0

0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00



FFVP Data is recorded on the S-1, Line 21 for Day of Review and Review Period. Other Meal Claim Errors (If applicable): FFVP Data is recorded on the S-2, Section 4, Columns D and E.



ASP Data for Free, Reduced Price and Paid catergories is recorded on the S-1, Line 22 A for Day of Review and 22 B for Review Period. Other Meal Claim Errors (If applicable): Afterschool Snack Data is recorded on the S-2, Section 3, Column D (meals only).







Enter the total ASP reimbursement rate that the Site receives for Free Snacks. $0.00
Enter the total ASP reimbursement rate that the Site receives for Reduced Price Snacks. $0.00
Enter the total ASP reimbursement rate that the Site receives for Paid Snacks. $0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00

Free to Reduced
0.00
0.00





0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00














































0
0
































0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00

Free to Paid
0.00


0.00



0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00

Reduced to Paid


0.00
0.00



0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00

Reduced to Free
0.00
0.00





0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00

Total Adjusted Meal Count
0.00
0.00
0.00
0.00

0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00

Rounded Total
0
0
0
0

0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00


























































































0
0
0



















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00

Difference
0
0
0



0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00


























































































0
0
0


$0.00
$0.00
$0.00











































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00














































0
0

































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00






























































































0



















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00














































0
0
































0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00



















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00















$0.00
$0.00
$0.00


$0.00


$0.00







































































































































TOTALS:


0 0 0 0 0
0


0
0 0 0 0 0 0 0 0 0 0 0


0 0 0 0 0


0


0 0 0 0 0 0 0










$0.00
$0.00
$0.00












0 0 0 0 0 0 0
0
0
0


$0.00
$0.00
$0.00



$0.00


0
0
0










$0.00


$0.00






































































































































Sheet 3: SBP - Standard





























































































`






`








Fiscal Action Formula for Breakfast (SBP) - Standard






























































For Non-Provision Schools and Base-Year Provision 2 & 3 Schools











































































































































































Review Information:
1: Establish SFA Count of Reviewed Students
2: Establish SA Count of Reviewed Students
3% Threshold Calculation
3: TOTAL FISCAL ACTION FOR SBP STANDARD:























































All























Free to Reduced
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2. 0 3 Free


Error rates per type Free to Reduced
0.000%


Benefit Issuance Changes


0
























































Review Period
Month Being Reviewed:


Period:
SFA Count of Students Eligible for Free and Reduced-Price Meals:
FREE
REDUCED PRICE


Free to Paid
0
0


Free to Paid
0.000%


CBI Error Percentage


0.00%
























































Day of Review









Data for Free and Reduced Price categories is recorded on the SFA-1, Section 4, Box A. 0
0


Reduced to Paid
0
Reduced



Reduced to Paid
0.000%


3% Threshold Met or Exceeded


NO Yes $0.00























































Other
SFA Name:









Reduced to Free
0
0



Reduced to Free
0.000%


Assess Fiscal Action


State agency has the discrection to take fiscal action when application errors do not exceed 3% error threshold YES No























































2 1























































































































































































































































































































No.
Name of Site
4: Number of Meals Claimed by the Site:
5A: Adjust for Consolidation Errors (Deductions):
5B: Adjust for Consolidation Errors (Additions):
6: Number of Meals Claimed Adjusted for Consolidation Errors:
7: Total Non-Reimbursable Meals:
8: Number of Reimbursable Meals by Benefit Type:
9: Reimbursement Rates for Each Benefit Type:
Section 4 multiplied by rate 10: Reimbursement Amounts Claimed by SFA:

11: SFA-wide Reimbursable Meals by Benefit Type Adjusted by Error Rate per Application Category



12A: Adjustment to Meals per Site by Category (CB&I)


12B: Allowable Total Meals after Fiscal Action


12C: Allowable Total Reimbursement after Fiscal Action

13: Total Fiscal Action For Site









































































































FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID



FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID




TOTAL FREE
TOTAL REDUCED
TOTAL PAID
TOTAL



Change in Free Meals
Change in RP Meals Change in RP Meals Change in Paid Meals


Free
Reduced
Paid


Change in Free Meals
Change in RP Meals
Change in Paid Meals




























































































































































































































NSLP/Month of On-site review: Data for Free, Reduced Price, and Paid categories is recorded on the S-1, Line 19. NSLP/Review Period: Data for Free, Reduced Price, and Paid categories is recorded on the S-1, Line 20.





0


NSLP/Day of Review: Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13. NSLP/Review Period: Data for deductins to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17 B. Other Meal Claim Errors (If applicable): Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-2, Section 1, Column F.







NSLP/Day of Review: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13.. NSLP/Review Period: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17B. Other Meal Claim Errors (If applicable): Data for additions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.







0
0
0


NSLP/Day of Review: From the S-1 form, enter the SUM of Lines 10, 11, 12, and 12A.. NSLP/Review Period: From the S-1 form, enter the SUM of lines 14, 15, 16 and 16 A. Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 2, Column D (number of meals only).



0
0
0
0


Enter the total SBP reimbursement rate that the site receives for Free Meals. $0.00
Enter the total SBP reimbursement rate that the site receives for Reduced Price Meals. $0.00
Enter the total SBP reimbursement rate that the site receives for Paid Meals. $0.00


$0.00
$0.00
$0.00


Section 8 Total
0
0
0
0



0 0 0 0 0 0 0
0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


Enter the total NSLP reimbursement rate that the site receives for Free Meals. $0.00
Enter the total NSLP reimbursement rate that the site receives for Reduced Price Meals. $0.00
Enter the total NSLP reimbursement rate that the site receives for Paid Meals. $0.00


$0.00
$0.00
$0.00


Free to Reduced
0.00
0.00







0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Free to Paid
0.00


0.00





0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Reduced to Paid


0.00
0.00





0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Reduced to Free
0.00
0.00







0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Totaled
0.00
0.00
0.00
0.00



0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Rounded Total
0
0
0
0



0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Difference
0
0
0





0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00



























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00

















































































































TOTALS:


0 0 0 0 0
0


0 0 0 0 0 0 0 0 0 0 0 0 0


0 0 0 0 0


0


0 0 0 0 0 0 0










$0.00
$0.00
$0.00















0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00

$0.00

Sheet 4: SSO - NSLP (Closed and Migrant)


























































































`






`































Fiscal Action Formula for Lunch (NSLP) - Seamless Summer Option (Closed and Migrant Sites)


















































































For Non-Provision Schools and Base-Year Provision 2 & 3 Schools and ASSP



















































































































































































































Review Information:
1: Establish SFA Count of Reviewed Students
2: Establish SA Count of Reviewed Students
3% Threshold Calculation
3: TOTAL FISCAL ACTION FOR NSLP STANDARD:











































































All























Free to Reduced
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2.
3 Free


Error rates per type Free to Reduced
0.000%


Benefit Issuance Changes


0












































































Review Period
Month Being Reviewed:


Period:
SFA Count of Students Eligible for Free and Reduced-Price Meals:
FREE
REDUCED PRICE


Free to Paid


0


Free to Paid
0.000%


CBI Error Percentage


0.00%












































































Day of Review









Data for Free and Reduced Price categories is recorded on the SFA-1, Section 4, Box A.





Reduced to Paid


Reduced



Reduced to Paid
0.000%


3% Threshold Met or Exceeded


NO Yes $0.00











































































Other
SFA Name:









Reduced to Free


0



Reduced to Free
0.000%


Assess Fiscal Action


State agency has the discrection to take fiscal action when application errors do not exceed 3% error threshold YES No











































































2 1



















































































































































































































































































































































































No.
Name of Site
4: Number of Meals Claimed by the Site:
5A: Adjust for Consolidation Errors (Deductions):
5B: Adjust for Consolidation Errors (Additions):
6: Number of Meals Claimed Adjusted for Consolidation Errors:
7: Total Non-Reimbursable Meals:
8: Number of Reimbursable Meals by Benefit Type:
9: Reimbursement Rates for Each Benefit Type:
Section 4 multiplied by rate 10: Reimbursement Amounts Claimed by SFA:
11: SFA-wide Reimbursable Meals by Benefit Type Adjusted by Error Rate per Application Category

12A: Adjustment to Meals per Site by Category (CB&I)


12B: Allowable Total Meals after Fiscal Action


12C: Allowable Total Reimbursement after Fiscal Action


13A: Number of After School Snacks Adjustments (Disallowed = negative # or Added = positive #) for Each Benefit Type:
13B: Reimbursement Rates for Each Benefit Type of Snacks:
13C: Total After School Snack Adjustment:
14: TOTAL FISCAL ACTION FOR SITE:
























































































































FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID



FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID



TOTAL FREE
TOTAL REDUCED
TOTAL PAID
TOTAL

Change in Free Meals
Change in RP Meals
Change in Paid Meals


Free
Reduced
Paid


Free
Reduced
Paid



FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID































































































































































































































































SSO NSLP/Data for Month of On-site review is recorded on SSO S-1 Line 12.





0


SSO NSLP/ Data for deductions to Free, Reduced Price, and Paid categories is recorded on the SSO S-1, Line 9. Other Meal Claim Errors (If applicable): Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-2, Section 1, Column F.







SSO NSLP/ Data for additions to Free, Reduced Price, and Paid categories is recorded on the SSO S-1, Line 9. Other Meal Claim Errors (If applicable): Data for additions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.







0
0
0


SSO NSLP/From the SSO S-1 form enter the SUM of Lines 6,7, 8a, and 8b. Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 2, Column D (number of meals only).



0
0
0
0


Enter the total SSO NSLP reimbursement rate that the site receives for Free Meals. $0.00
Enter the total SSO NSLP reimbursement rate that the site receives for Reduced Price Meals. $0.00
Enter the total SSO NSLP reimbursement rate that the site receives for Paid Meals. $0.00


$0.00
$0.00
$0.00

Section 8 Total
0
0
0
0

0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00



ASP Free, Reduced Price, and Paid Data is recorded on the SSO S-1, Line 10 A for Day of Review and Line 10B for the Review Period Other Meal Claim Errors (If applicable): Afterschool Snack Data is recorded on the S-2, Section 3, Column D (meals only).







Enter the total ASP reimbursement rate that the Site receives for Free Snacks. $0.00
Enter the total ASP reimbursement rate that the Site receives for Reduced Price Snacks. $0.00
Enter the total ASP reimbursement rate that the Site receives for Paid Snacks. $0.00


$0.00


$0.00















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00

Free to Reduced
0.00
0.00





0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00














































0
0
































0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00























$0.00














0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00

Free to Paid
0.00


0.00



0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00

Reduced to Paid


0.00
0.00



0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00

Reduced to Free
0.00
0.00





0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00

Total Adjusted Meal Count
0.00
0.00
0.00
0.00

0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00

Rounded Total
0
0
0
0

0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00




























































































0
0















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00

Difference
0
0
0



0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0

0
0
0


$0.00
$0.00
$0.00























$0.00














0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00















































































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00














































0
0





































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






































$0.00














0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






































$0.00














0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






































$0.00














0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00














































0
0
































0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00







































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00























































































0






















































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00



































































































































TOTALS:


0 0 0 0 0
0


0 0 0 0 0 0 0 0 0 0 0 0 0


0 0 0 0 0


0


0 0 0 0 0 0 0










$0.00
$0.00
$0.00












0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00



0
0
0










$0.00


$0.00


































































































































Sheet 5: SSO - SBP (Closed and Migrant)




























































































`






`







Fiscal Action Formula for Breakfast (SBP) - Standard (Closed and Migrant Sites)




























































For Non-Provision Schools and Base-Year Provision 2 & 3 Schools







































































































































































Review Information:
1. Establish SFA Count of Reviewed Students
2. Establish SA Count of Reviewed Students
3% Threshold Calculation
3: TOTAL FISCAL ACTION FOR SBP STANDARD:





















































All























Free to Reduced
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2. 0 3 Free


Error rates per type Free to Reduced
0.000%


Benefit Issuance Changes


0






















































Review Period
Month Being Reviewed:


Period:
SFA Count of Students Eligible for Free and Reduced-Price Meals:
FREE
REDUCED PRICE


Free to Paid
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2. 0 0 0


Free to Paid
0.000%


CBI Error Percentage


0.00%






















































Day of Review









Data for Free and Reduced Price categories is recorded on the SFA-1, Section 4, Box A. 0
0


Reduced to Paid
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2. 0 0 Reduced



Reduced to Paid
0.000%


3% Threshold Met or Exceeded


NO Yes $0.00





















































Other
SFA Name:









Reduced to Free
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2. 0 0 0



Reduced to Free
0.000%


Assess Fiscal Action


State agency has the discrection to take fiscal action when application errors do not exceed 3% error threshold NO No





















































2 1

















































































































































































































































































































No.
Name of Site
4: Number of Meals Claimed by the Site:
5A: Adjust for Consolidation Errors (Deductions):
5B: Adjust for Consolidation Errors (Additions):
6: Number of Meals Claimed Adjusted for Consolidation Errors:
7: Total Non-Reimbursable Meals:
8: Number of Reimbursable Meals by Benefit Type:
9: Reimbursement Rates for Each Benefit Type:
Section 4 multiplied by rate 10: Reimbursement Amounts Claimed by SFA:

11: SFA-wide Reimbursable Meals by Benefit Type Adjusted by Error Rate per Application Category


12A: Adjustment to Meals per Site by Category (CB&I)


12B: Allowable Total Meals after Fiscal Action


12C: Allowable Total Reimbursement after Fiscal Action
13: Total Fiscal Action For Site







































































































FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID



FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID




TOTAL FREE
TOTAL REDUCED
TOTAL PAID
TOTAL


Change in Free Meals
Change in RP Meals Change in RP Meals Change in Paid Meals


Free
Reduced
Paid


Change in Free Meals
Change in RP Meals
Change in Paid Meals























































































































































































































SSO SBP/Data for Month of On-site review is recorded on SSO S-1 Line 12.





0


SSO SBP/ Data for deductions to Free, Reduced Price, and Paid categories is recorded on the SSO S-1, Line 9. Other Meal Claim Errors (If applicable): Data for deductions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.







SSO SBP/ Data for additions to Free, Reduced Price, and Paid categories is recorded on the SSO S-1, Line 9. Other Meal Claim Errors (If applicable): Data for additions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.







0
0
0


SSO SBP/ From the SSO S-1 fom enter the SUM of Lines 6,7, 8a and 8b. Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 2, Column D (number of meals only).



0
0
0
0


Enter the total SSO SBP reimbursement rate that the site receives for Free Meals. $0.00
Enter the total SSO SBP reimbursement rate that the site receives for Reduced Price Meals. $0.00
Enter the total SSO SBP reimbursement rate that the site receives for Paid Meals. $0.00


$0.00
$0.00
$0.00


Section 8 Total
0
0
0
0


0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Free to Reduced
0.00
0.00






0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Free to Paid
0.00


0.00




0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Reduced to Paid


0.00
0.00




0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Reduced to Free
0.00
0.00






0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Totaled
0.00
0.00
0.00
0.00


0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Rounded Total
0
0
0
0


0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Difference
0
0
0




0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

























































































































0


















0
0
0






0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00















































































































TOTALS:


0 0 0 0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0


0


0 0 0 0 0 0 0










$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00
$0.00

Sheet 6: NSLP-Std RECALC



















































January



















































































































Fiscal Action Formula for Lunch (NSLP) - Standard *ONLY USED FOR FULL RECALCULATION*


February



















































































































For Non-Provision Schools and Base-Year Provision 2 & 3 Schools


March




































































































































































April



















































































































Review Information:
1. Establish SFA Count of Reviewed Students
2. Establish SA Count of Reviewed Students
3% Threshold Calculation


May


3: TOTAL FISCAL ACTION FOR NSLP STANDARD:










































































































All























Free to Reduced
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2.
3 Free


Error rates per type Free to Reduced
0.000%


Benefit Issuance Changes
0


June













































































































Review Period
Month Being Reviewed:


Period:
SFA Count of Students Eligible for Free and Reduced-Price Meals:
FREE
REDUCED PRICE


Free to Paid


0


Free to Paid
0.000%


CBI Error Percentage
0.00%


July













































































































Day of Review









Data for Free and Reduced Price categories is recorded on the SFA-1, Section 4, Box A.





Reduced to Paid


Reduced



Reduced to Paid
0.000%


3% Threshold Met or Exceeded
NO Yes

August


$0.00










































































































Other
SFA Name:











Reduced to Free


0



Reduced to Free
0.000%


Assess Fiscal Action
State agency has the discrection to take fiscal action when application errors do not exceed 3% error threshold YES No

September













































































































2 1







































October






























































































































































November




































































































































































December



















































































































No.
Name of Site
4: Number of Meals Claimed by SFA at the Reviewed Site Requiring Recalculation:
5: Number of Meals Claimed by SFA at the Reviewed Site for the 30-Consecutive-Operating-Day Recalculation Period:
6A: Adjust for Consolidation Errors (Deductions):
6B: Adjust for Consolidation Errors (Additions):
7: Number of Meals Claimed Adjusted for Consolidation Errors:
8: Select Month Being Recalculated:
9: Normalization Factor:
10: Operating Days in Month being Recalculated:
11: Normalized & Recalculated Meal Counts at the Reviewed Site:
12: Total Non-Reimbursable Meals:
13: Total Number of Reimbursable Meals:
14: Normalized & Recalculated Reimbursable Meal Counts at the Reviewed Site:
15: Reimbursement Rates for Each Benefit Type:
16: Reimbursement Amounts Claimed by SFA:

17: SFA-wide Reimbursable Meals by Benefit Type Adjusted by Error Rate per Application Category

18A: Adjustment to Meals per Site by Category (CB&I)
18B: Allowable Total Meals after Fiscal Action

18C: Allowable Total Reimbursement after Fiscal Action

19: Total FFVP Reclaim (use negative number):
20A: Number of After School Snacks Adjustments (Disallowed = negative # or Added = positive #) for Each Benefit Type:
20B: Reimbursement Rates for Each Benefit Type of After School Snack:
20C: Total After School Snack Adjustment:
21: TOTAL FISCAL ACTION FOR SITE:

















































































































































FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID



FREE
REDUCED PRICE
PAID



FREE
REDUCED PRICE
PAID




FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID




TOTAL FREE
TOTAL REDUCED
TOTAL PAID
TOTAL

Change in Free Meals
Change in RP Meals
Change in Paid Meals
Free
Reduced
Paid

Free
Reduced
Paid



FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID





























































































































































































































































































































NSLP/Month of On-Site Review: Data for Free, Reduced Price, and Paid categories is recorded on the S-1, Line 19. NSLP/Review Period: Data for Free, Reduced Price, and Paid categories is recorded on the S-1, Line 20.







SBP: Data is recorded on the S-1, line 25C.





0


NSLP/Day of Review: Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13. NSLP/Review Period: Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17 B. Other Meal Claim Errors (If applicable): Data for deductions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.







NSLP/Day of Review: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13. NSLP/Review Period: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17 B. Other Meal Claim Errors (If applicable): Data for additions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.







0
0
0


10

0.99839832
1.01344958
1.04112113


NSLP/Data for the total days claimed by the site for the month being recalulated is recorded on the S-1, Line 25 B



0
0
0


NSLP/Day of Review: From the S-1 form enter the SUM of Lines 10, 11, 12 and 12 A. NSLP/Review Period:From the S-1 form enter the SUM of Lines 14, 15, 16 and 16 A. Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 2, Column D (number of meals only)



0


0
0
0
0


Enter the total NSLP reimbursement rate that the site receives for Free Meals. $0.00
Enter the total NSLP reimbursement rate that the site receives for Reduced Price Meals. $0.00
Enter the total NSLP reimbursement rate that the site receives for Paid Meals. $0.00


$0.00
$0.00
$0.00


Section 14 Total
0
0
0
0

0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00 0.00

FFVP Data is recorded on the S-1, Line 21 for Day of Review and Review Period. Other Meal Claim Errors (If applicable): FFVP Data is recorded on the S-2, Section 4, Columns D and E.



ASP Data for Free, Reduced Price and Paid catergories is recorded on the S-1, Line 22 A for Day of Review and 22 B for Review Period. Other Meal Claim Errors (If applicable): Afterschool Snack Data is recorded on the S-2, Section 3, Column D (meals only).







Enter the total ASP reimbursement rate that the Site receives for Free Snacks. $0.00
Enter the total ASP reimbursement rate that the Site receives for Reduced Price Snacks. $0.00
Enter the total ASP reimbursement rate that the Site receives for Paid Snacks. $0.00


$0.00


$0.00



























































































































































































0


















0
0
0



3

1.00441378
1.00802785
0.99510091






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Free to Reduced
0.00
0.00





0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0


1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Free to Paid
0.00


0.00



0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Reduced to Paid


0.00
0.00



0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Reduced to Free
0.00
0.00





0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Total Adjusted Meal Count
0.00
0.00
0.00
0.00

0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Rounded Total
0
0
0
0

0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Difference
0
0
0



0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00














$0.00
$0.00
$0.00


$0.00


$0.00










































































































































































TOTALS


0
0
0


0
0
0
0


0
0
0


0
0
0


0
0
0














0


0
0
0


0


0


0
0
0
0










$0.00
$0.00
$0.00













0 0 0 0 0 0 0
0
0

$0.00
$0.00
$0.00


$0.00


0
0
0










$0.00


$0.00

Sheet 7: SBP-Std RECALC



















































January


























































































Fiscal Action Formula for Breakfast (SBP) - Standard *ONLY USED FOR FULL RECALCULATION*


February


























































































For Non-Provision Schools and Base-Year Provision 2 & 3 Schools


March











































































































































April


























































































Review Information:
1. Establish SFA Count of Reviewed Students
2. Establish SA Count of Reviewed Students
3% Threshold Calculation


May


3: TOTAL FISCAL ACTION FOR NSLP STANDARD:















































































All























Free to Reduced
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2. 0 3 Free


Error rates per type Free to Reduced
0.000%


Benefit Issuance Changes
0


June


















































































Review Period
Month Being Reviewed:
0
Period:
SFA Count of Students Eligible for Free and Reduced-Price Meals:
FREE
REDUCED PRICE


Free to Paid
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2. 0
0


Free to Paid
0.000%


CBI Error Percentage
0.00%


July


















































































Day of Review










Data for Free and Reduced Price categories is recorded on the SFA-1, Section 4, Box A. 0
0


Reduced to Paid
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2. 0
Reduced



Reduced to Paid
0.000%


3% Threshold Met or Exceeded
NO Yes

August


$0.00














































































Other
SFA Name:
0









Reduced to Free
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2. 0
0



Reduced to Free
0.000%


Assess Fiscal Action
State agency has the discrection to take fiscal action when application errors do not exceed 3% error threshold YES No

September


















































































2 1







































October



































































































































November











































































































































December


























































































No.
Name of Site
4: Number of Meals Claimed by SFA at the Reviewed Site Requiring Recalculation:
5: Number of Meals Claimed by SFA at the Reviewed Site for the 30-Consecutive-Operating-Day Recalculation Period:
6A: Adjust for Consolidation Errors (Deductions):
6B: Adjust for Consolidation Errors (Additions):
7: Number of Meals Claimed Adjusted for Consolidation Errors:
8: Select Month Being Recalculated:
9: Normalization Factor:
10: Operating Days in Month being Recalculated:
11: Normalized & Recalculated Meal Counts at the Reviewed Site:
12: Total Non-Reimbursable Meals:
13: Total Number of Reimbursable Meals:
14: Normalized & Recalculated Reimbursable Meal Counts at the Reviewed Site:
15: Reimbursement Rates for Each Benefit Type:
16: Reimbursement Amounts Claimed by SFA:

17: SFA-wide Reimbursable Meals by Benefit Type Adjusted by Error Rate per Application Category

18A: Adjustment to Meals per Site by Category

18B: Allowable Total Meals after Fiscal Action
18C: Allowable Total Reimbursement after Fiscal Action
19. Total Fiscal Action for Site
































































































































FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID



FREE


REDUCED PRICE
PAID



FREE
REDUCED PRICE
PAID




FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID




TOTAL FREE
TOTAL REDUCED
TOTAL PAID
TOTAL

Change in Free Meals
Change in RP Meals
Change in Paid Meals

Free
Reduced
Paid
Free
Reduced
Paid


















































































































































































































































































SBP/Month of On-Site Review: Data for Free, Reduced Price, and Paid categories is recorded on the S-1, Line 19. SBP/Review Period: Data for Free, Reduced Price, and Paid categories is recorded on the S-1, Line 20.







SBP: Data is recorded on the S-1, line 24C.





0


SBP/Day of Review: Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13. SBP/Review Period: Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17 A. Other Meal Claim Errors (If applicable): Data for deductions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.







SBP/Day of Review: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13. SBP/Review Period: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17 A. Other Meal Claim Errors (If applicable): Data for additions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.







0
0
0


1

0.99052544


1.01007311
1.00979385


SBP/Data for the total days claimed by the site for the month being recalulated is recorded on the S-1, Line 24 B



0
0
0


SBP/Day of Review: From the S-1 form enter the SUM of Lines 10, 11 , 12 and 12 A. SBP/Review Period: From the S-1 form enter the SUM of Lines 14, 15, 16 and 16 A. Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 2, Column D (number of meals only)



0


0
0
0
0


Enter the total SBP reimbursement rate that the site receives for Free Meals. $0.00
Enter the total SBP reimbursement rate that the site receives for Reduced Price Meals. $0.00
Enter the total SBP reimbursement rate that the site receives for Paid Meals. $0.00


$0.00
$0.00
$0.00


Section 14 Total
0
0
0
0

0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Free to Reduced
0.00
0.00





0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0


1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Free to Paid
0.00


0.00



0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0


1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Reduced to Paid


0.00
0.00



0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Reduced to Free
0.00
0.00





0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Total Adjusted Meal Count
0.00
0.00
0.00
0.00

0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Rounded Total
0
0
0
0

0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Difference
0
0
0



0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0


1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00



































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544


1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00






























































































































0

















TOTALS


0
0
0


0
0
0
0


0
0
0


0
0
0


0
0
0
















0


0
0
0


0


0


0
0
0
0










$0.00
$0.00
$0.00













0 0 0 0 0 0
0
0
0
$0.00
$0.00
$0.00
$0.00

Sheet 8: SSO-NSLP RECALC



















































January











































































`






`































Fiscal Action Formula for Seamless Summer Option (SSO) Lunch (NSLP) - Standard *ONLY USED FOR FULL RECALCULATION*


February




















































































































For Non-Provision Schools and Base-Year Provision 2 & 3 Schools


March





































































































































































April




















































































































Review Information:
1. Establish SFA Count of Reviewed Students
2. Establish SA Count of Reviewed Students
3% Threshold Calculation


May


3: TOTAL FISCAL ACTION FOR NSLP STANDARD:











































































































All























Free to Reduced
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2.
3 Free


Error rates per type Free to Reduced
0.000%


Benefit Issuance Changes
0


June














































































































Review Period
Month Being Reviewed:


Period:
SFA Count of Students Eligible for Free and Reduced-Price Meals:
FREE
REDUCED PRICE


Free to Paid


0


Free to Paid
0.000%


CBI Error Percentage
0.00%


July














































































































Day of Review









Data for Free and Reduced Price categories is recorded on the SFA-1, Section 4, Box A.





Reduced to Paid


Reduced



Reduced to Paid
0.000%


3% Threshold Met or Exceeded
NO Yes

August


$0.00











































































































Other
SFA Name:











Reduced to Free


0



Reduced to Free
0.000%


Assess Fiscal Action
State agency has the discrection to take fiscal action when application errors do not exceed 3% error threshold YES No

September














































































































2 1







































October































































































































































November





































































































































































December




















































































































No.
Name of Site
4: Number of Meals Claimed by SFA at the Reviewed Site Requiring Recalculation:
5: Number of Meals Claimed by SFA at the Reviewed Site for the 30-Consecutive-Operating-Day Recalculation Period:
6A: Adjust for Consolidation Errors (Deductions):
6B: Adjust for Consolidation Errors (Additions):
7: Number of Meals Claimed Adjusted for Consolidation Errors:
8: Select Month Being Recalculated:
9: Normalization Factor:
10: Operating Days in Month being Recalculated:
11: Normalized & Recalculated Meal Counts at the Reviewed Site:
12: Total Non-Reimbursable Meals:
13: Total Number of Reimbursable Meals:
14: Normalized & Recalculated Reimbursable Meal Counts at the Reviewed Site:
15: Reimbursement Rates for Each Benefit Type:
16: Reimbursement Amounts Claimed by SFA:

17: SFA-wide Reimbursable Meals by Benefit Type Adjusted by Error Rate per Application Category

20A: Amount of NSLP Fiscal Action by Site: 18A: Adjustment to Meals per Site by Category (CB&I)


18B: Allowable Total Meals after Fiscal Action


18C: Allowable Total Reimbursement after Fiscal Action


19A: Number of After School Snacks Adjustments (Disallowed = negative # or Added = positive #) for Each Benefit Type:
19B: Reimbursement Rates for Each Benefit Type of Snacks:
19C: Total Snack Adjustment:
20: TOTAL FISCAL ACTION FOR SITE:



















































































































































FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID



FREE
REDUCED PRICE
PAID



FREE
REDUCED PRICE
PAID




FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID




TOTAL FREE
TOTAL REDUCED
TOTAL PAID
TOTAL

Change in Free Meals
Change in RP Meals
Change in Paid Meals


Free
Reduced
Paid


Free
Reduced
Paid


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID
































































































































































































































































































































SSO NSLP/Data for Month of On-site review is recorded on SSO S-1 Line 12.







SSO NSLP/ Data is recorded on the SSO S-1, Line 14 C.





0


SSO NSLP/ Data for deductions to Free, Reduced Price, and Paid categories is recorded on the SSO S-1, Line 9. Other Meal Claim Errors (If applicable): Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-2, Section 1, Column F.







SSO NSLP/ Data for additions to Free, Reduced Price, and Paid categories is recorded on the SSO S-1 Line 9. Other Meal Claim Errors (If applicable): Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-2, Section 1, Column F.







0
0
0


10

0.99839832
1.01344958
1.04112113


Data from the total days claimed by the site for month being recalculated is recorded on the SSO S-1, Line 14 B.



0
0
0


SSO NSLP/ Data is recorded on the SSO S-1, Lines 6, 7, 8a and 8 b. Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 2, Column D (number of meals only).



0


0
0
0
0


Enter the total SSO NSLP reimbursement rate that the site receives for Free Meals. $0.00
Enter the total SSO NSLP reimbursement rate that the site receives for Reduced Price Meals. $0.00
Enter the total SSO NSLP reimbursement rate that the site receives for Paid Meals. $0.00


$0.00
$0.00
$0.00


Section 14 Total
0
0
0
0


0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00



ASP Free, Reduced Price, and Paid Data is recorded on the SSO S-1, Line 10 A for Day of Review and Line 10B for the Review Period Other Meal Claim Errors (If applicable): Afterschool Snack Data is recorded on the S-2, Section 3, Column D (meals only).







Enter the total Snack reimbursement rate that the Site receives for Free Snacks. $0.00
Enter the total Snack reimbursement rate that the Site receives for Reduced Price Snacks. $0.00
Enter the total Snack reimbursement rate that the Site receives for Paid Snacks. $0.00


$0.00


$0.00




























































































































































































0


















0
0
0



3

1.00441378
1.00802785
0.99510091






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Free to Reduced
0.00
0.00






0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0


1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Free to Paid
0.00


0.00




0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00

























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Reduced to Paid


0.00
0.00




0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Reduced to Free
0.00
0.00






0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Total Adjusted Meal Count
0.00
0.00
0.00
0.00


0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Rounded Total
0
0
0
0


0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Difference
0
0
0




0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00

























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00

















































































0
0



































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00
























































































































0


































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00











$0.00
$0.00
$0.00


$0.00


$0.00











































































































































































TOTALS


0
0
0


0
0
0
0


0
0
0


0
0
0


0
0
0














0


0
0
0


0


0


0
0
0
0










$0.00
$0.00
$0.00














0 0 0 0 0 0

0
0
0


$0.00
$0.00
$0.00



0
0
0










$0.00


$0.00

Sheet 9: SSO-SBP RECALC



















































January

























































































Fiscal Action Formula for Seamless Summer option (SSO) Breakfast (SBP) - Standard *ONLY USED FOR FULL RECALCULATION*


February

























































































For Non-Provision Schools and Base-Year Provision 2 & 3 Schools


March










































































































































April

























































































Review Information:
1. Establish SFA Count of Reviewed Students
2. Establish SA Count of Reviewed Students
3% Threshold Calculation


May


3: TOTAL FISCAL ACTION FOR NSLP STANDARD:
















































































All























Free to Reduced
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2. 0 3 Free


Error rates per type Free to Reduced
0.000%


Benefit Issuance Changes
0


June



















































































Review Period
Month Being Reviewed:
0
Period:
SFA Count of Students Eligible for Free and Reduced-Price Meals:
FREE
REDUCED PRICE


Free to Paid
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2. 0
0


Free to Paid
0.000%


CBI Error Percentage
0.00%


July



















































































Day of Review









Data for Free and Reduced Price categories is recorded on the SFA-1, Section 4, Box A. 0
0


Reduced to Paid
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2. 0
Reduced



Reduced to Paid
0.000%


3% Threshold Met or Exceeded
NO Yes

August


$0.00















































































Other
SFA Name:
0









Reduced to Free
Data for Free and Reduced Price categories is recorded on the SFA-1, Section 2. 0
0



Reduced to Free
0.000%


Assess Fiscal Action
State agency has the discrection to take fiscal action when application errors do not exceed 3% error threshold YES No

September



















































































2 1







































October




































































































































November










































































































































December

























































































No.
Name of Site
4: Number of Meals Claimed by SFA at the Reviewed Site Requiring Recalculation:
5: Number of Meals Claimed by SFA at the Reviewed Site for the 30-Consecutive-Operating-Day Recalculation Period:
6A: Adjust for Consolidation Errors (Deductions):
6B: Adjust for Consolidation Errors (Additions):
7: Number of Meals Claimed Adjusted for Consolidation Errors:
8: Select Month Being Recalculated:
9: Normalization Factor:
10: Operating Days in Month being Recalculated:
11: Normalized & Recalculated Meal Counts at the Reviewed Site:
12: Total Non-Reimbursable Meals:
13: Total Number of Reibursable Meals:
14: Normalized & Recalculated Reimbursable Meal Counts at the Reviewed Site:

15: Reimbursement Rates for Each Benefit Type:
16: Reimbursement Amounts Claimed by SFA:

17: SFA-wide Reimbursable Meals by Benefit Type Adjusted by Error Rate per Application Category


18A: Adjustment to Meals per Site by Category
18B: Allowable Total Meals after Fiscal Action
18C: Allowable Total Reimbursement after Fiscal Action
19. Total Fiscal Action for Site































































































































FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID
TOTAL


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID



FREE
REDUCED PRICE
PAID



FREE
REDUCED PRICE
PAID




FREE
REDUCED PRICE
PAID
TOTAL



FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID




TOTAL FREE
TOTAL REDUCED
TOTAL PAID
TOTAL


Change in Free Meals
Change in RP Meals
Change in Paid Meals
Free
Reduced
Paid
Free
Reduced
Paid
















































































































































































































































































SSO SBP/Data for Month of On-site review is recorded on SSO S-1 Line 12.







SSO SBP: Data is recorded on the SSO S-1, Line 13 C.





0


SSO SBP/ Data for deductions to Free, Reduced Price, and Paid categories is recorded on the SSO S-1, Line 9. Other Meal Claim Errors (ifapplicable): Data for deductions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.







SSO SBP/ Data for additions to Free, Reduced Price, and Paid categories is recorded on the SSO S-1, Line 9. Other Meal Claim Errors (ifapplicable): Data for additions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.







0
0
0


1

0.99052544
1.01007311
1.00979385


Data from the total days claimed by the site for month being recalculated is recorded on the SSO S-1, Line 27 B.



0
0
0


SSO SBP/ From the SSO S-1 fom enter the SUM of Lines 6,7, 8a and 8b. Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 2, Column D (number of meals only).



0


0
0
0
0



Windows User: Enter the total SSO SBP reimbursement rate that the site receives for Free Meals. $0.00
Windows User: Enter the total SSO SBP reimbursement rate that the site receives for Reduced Price Meals. $0.00
Windows User: Enter the total SSO SBP reimbursement rate that the site receives for Paid Meals. $0.00


$0.00
$0.00
$0.00


Section 14 Total
0
0
0
0


0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Free to Reduced
0.00
0.00






0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0


1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Free to Paid
0.00


0.00




0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Reduced to Paid


0.00
0.00




0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Reduced to Free
0.00
0.00






0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Total Adjusted Meal Count
0.00
0.00
0.00
0.00


0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Rounded Total
0
0
0
0


0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


Difference
0
0
0




0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00


































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00





























































































































0


































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

































































































































































0


















0
0
0



1

0.99052544
1.01007311
1.00979385






0
0
0






0


0
0
0
0



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00






























































































































0
















TOTALS


0
0
0


0
0
0
0


0
0
0


0
0
0


0
0
0














0


0
0
0


0


0


0
0
0
0











$0.00
$0.00
$0.00














0 0 0 0 0 0 0
0
0
$0.00
$0.00
$0.00
$0.00

Sheet 10: NSLP - P2 & CEP





















































































































































































Fiscal Action Formula for Lunch (NSLP) - Provision 2 & CEP































































































































































For Non-Base-Year Provision 2 & Community Eligibility Provision Schools


















































































































































































































































































































































Review Information:
1: TOTAL FISCAL ACTION FOR NSLP Provision 2 & CEP:













































































































































































































































































































































Month Being Reviewed:




Period:












































































































































































$0.00

































































































































































SFA Name:




All


















































































































































































































































































































































































































































































































































































































































































































No.
Name of Site
2: Total Number of Meals Claimed by the Site:
3: Adjust for Consolidation Errors:
4: Meals Adjusted for Consolidation Errors:
5: Total Non-Reimbursable Meals:
6A: SFA Claiming Percentages: NOTE: If CEP is used ensure 1.6 multiplier is accounted for and leave % Reduced Price field blank
6B: SA Claiming Percentages: NOTE: If CEP is used ensure 1.6 multiplier is accounted for and leave % Reduced Price field blank
7: Maximum Number of Reimbursable Meals by Benefit Type:
8: Reimbursement Rates for Each Benefit Type:
9: Reimbursement Amounts Claimed by SFA:
10: Maximum Allowable Reimbursement Based on SA Assessment:
11: Amount of NSLP Fiscal Action:
12: Total FFVP Reclaim
(negative number):

13A: Number of After School Snacks Adjustments (Disallowed = negative # or Added = positive #) for Each Benefit Type:
13B: Reimbursement Rates for Each Benefit Type of After School Snack:
13C: Total After School Snack Adjustment:
14: TOTAL FISCAL ACTION FOR SITE:







































































































































































































































Deductions
Additions




% Free
% Reduced Price
% Paid


% Free
% Reduced Price
% Paid


Free
Reduced Price
Paid
Total


Free
Reduced Price
Paid


Free
Reduced price
Paid


Free
Reduced Price
Paid




FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID
































































































































































































































































































































































































































NSLP/Month of On-Site review: Data is recorded on the S-1, Line 19. NSLP/Review Period: Data is recorded on the S-1, Line 20.



NSLP/Day of Review: Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13.. NSLP/Review Period: Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17 B. Other Meal Claim Errors (If applicable): Data for deductions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.

NSLP/Day of Review: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13. NSLP/Review Period: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17B. Other Meal Claim Errors (If applicable): Data for additions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.



0


NSLP/Day of Review:From the S-1 form enter the SUM of Lines 10, 11, 12 and 12A. NSLP/Review Period: From the S-1 form enter the SUM of Lines 14, 15, 16, and 16 A. Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 2, Column D (number of meals only)



NSLP SFA Claiming %: Free, Reduced Price, and Paid percentages are recorded on the SFA-1A, Column B that corresponds to the School Site.







NSLP SA Claiming %: Free, Reduced Price, and Paid percentages are recorded on the SFA-1A, Column C that corresponds to the School Site.







0
0
0
0


Enter the total NSLP reimbursement rate that the site receives for Free Meals. $0.00
Enter the total NSLP reimbursement rate that the site receives for Reduced Price Meals. $0.00
Enter the total NSLP reimbursement rate that the site receives for Paid Meals. $0.00


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


FFVP Data is recorded on the S-1, Line 21 for Day of Review and Review Period. Other Meal Claim Errors (If applicable): FFVP Data is recorded on the S-2, Section 4, Columns D and E.



ASP Data is recorded on the S-1, Line 22A for Day of Review. Line 22B for Review Period Other Meal Claim Errors (If applicable): Afterschool Snack Data is recorded on the S-2, Section 3, Column D (meals only).







Enter the total ASP reimbursement rate that the Site receives for Free Snacks.

Windows User: Enter the total ASP reimbursement rate that the Site receives for Reduced Price Snacks.

Windows User: Enter the total ASP reimbursement rate that the Site receives for Paid Snacks.



$0.00


$0.00








































































0





































































































































































































0






















0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00














































































































































































































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00






















$0.00


$0.00
































































































































































































































































Totals


0


0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0
0 0 0
0
0
0 0 0 0 0 0 0 0 0 0 0 0 0
0
0
0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0
0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 0









































































Sheet 11: SBP - P2 & CEP
















































































Fiscal Action Formula for Breakfast (SBP) - Provision 2 & CEP


























































For Non-Base-Year Provision 2 & Community Eligibility Provision Schools








































































































































Review Information:
1: TOTAL FISCAL ACTION FOR SBP Provision 2 & CEP:



































































































































Month Being Reviewed:




Period:







































































$0.00




























































SFA Name:




All






























































































































































































































































































No.
Name of Site
2: Total Number of Meals Claimed by the Site:
3: Adjust for Consolidation Errors:
4: Meals Adjusted for Consolidation Errors:
5: Total Non-Reimbursable Meals:
6A: SFA Claiming Percentages: NOTE: If CEP is used ensure 1.6 multiplier is accounted for and leave % Reduced Price field blank
6B: SA Claiming Percentages: NOTE: If CEP is used ensure 1.6 multiplier is accounted for and leave % Reduced Price field blank
7: Maximum Number of Reimbursable Meals by Benefit Type:
8: Reimbursement Rates for Each Benefit Type:
9: Reimbursement Amounts Claimed by SFA:
10: Maximum Allowable Reimbursement Based on SA Assessment:
11: TOTAL FISCAL ACTION FOR SITE:



































































Deductions
Additions




% Free
% Reduced Price
% Paid


% Free
% Reduced Price
% Paid


Free
Reduced Price
Paid
Total


Free
Reduced Price
Paid


Free
Reduced price
Paid


Free
Reduced Price
Paid





















































































































































SBP/Month of On-Site Review: Data is recorded on the S-1, Line 19. SBP/Review Period: Data is recorded on the S-1, Line 20.



SBP/Day of Review: Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13. SBP/Review Period: Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17A. Other Meal Claim Errors (If applicable): Data for deductions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.

SBP/Day of Review: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13. SBP/Review Period: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17A. Other Meal Claim Errors (If applicable): Data for additions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.



0


SBP/Day of Review: From the S-1 form enter the SUM of Lines 10,11,12,12A. SBP/Review Period: From the S-1 form enter the SUM of Lines 14,15,16,16A. Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 2, Column D (number of meals only)



SBP SFA Claiming %: Free, Reduced Price, and Paid percentages are recorded on the SFA-1A, Column B that corresponds to the School Site







SBP SA Claiming %: Free, Reduced Price, and Paid percentages are recorded on the SFA-1A, Column C that corresponds to the School Site







0
0
0
0


Enter the total SBP reimbursement rate that the site receives for Free Meals.

Enter the total SBP reimbursement rate that the site receives for Reduced Price Meals.

Enter the total SBP reimbursement rate that the site receives for Paid Meals.



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
































































































0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


















































































Totals


0


0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0
0 0 0
0
0
0 0 0 0 0 0 0 0 0 0 0 0 0
0
0
0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Sheet 12: NSLP - P2 & CEP RECALC



























January

































January
































































Fiscal Action Formula for Lunch (NSLP) - Provision 2 & CEP *ONLY USED FOR FULL RECALCULATION*

February

































February
































































For Non-Base-Year Provision 2 & Community Eligibility Provision Schools

March

































March

























































































April

































April
































































Review Information:
1: TOTAL FISCAL ACTION FOR NSLP Provision 2 & CEP:

May

































May



















































































June

































June

































































Month Being Reviewed:








Period:


July

































July
















































































$0.00

August

































August


































































SFA Name:








All


September

































September


















































































October

































October

























































































November

































November

























































































December

































December
































































No.
Name of Site
2: Number of Meals Claimed Requiring RECALC:
3: Meal Count for 30-Day Recalc. Period:
4: Adjust for Consolidation Errors:
5: Meals Adjusted for Consolidation Errors:
6: Select Month Being Recalculated:
7: Normalization Factor
8: Operating Days in Month being Recalculated:
9: Normalized and Recalculated Meal Count:
10: Total Non-Reimbursable Meals:
11A: SFA Claiming Percentages: NOTE: If CEP is used ensure 1.6 multiplier is accounted for and leave % Reduced Price field blank
11B: SA Claiming Percentages: NOTE: If CEP is used ensure 1.6 multiplier is accounted for and leave % Reduced Price field blank
12: Maximum Number of Reimbursable Meals by Benefit Type:
13: Reimbursement Rates for Each Benefit Type:
14: Reimbursement Amounts Claimed by SFA:
15: Maximum Allowable Reimbursement Based on SA Assessment:
16: Amount of NSLP Fiscal Action:
17: Total FFVP Reclaim (use negative):
18A: Number of After School Snacks Adjustments (Disallowed = negative # or Added = positive #) for Each Benefit Type:
18B: Reimbursement Rates for Each Benefit Type of After School Snack:
18C: Total After School Snack Adjustment:
19: TOTAL FISCAL ACTION FOR SITE:




























































































Deductions
Additions








% Free
% Reduced Price
% Paid


% Free
% Reduced Price
% Paid


Free
Reduced Price
Paid
Total


Free
Reduced Price
Paid


Free
Reduced price
Paid


Free
Reduced Price
Paid




FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID






























































































































































































































Windows User: NSLP/Month of On-Site Review: Data is recorded on the S-1, Line 19 NSLP/Review Period: Data is recorded on the S-1, Line 20.



Windows User: NSLP: Data is recorded on the S-1, line 25C.



Windows User: NSLP/Day of Review: Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13. NSLP/Review Period: Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17B. Other Meal Claim Errors (If applicable): Data for deductions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.

Windows User: NSLP/Day of Review: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13. NSLP/Review Period: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17B. Other Meal Claim Errors (If applicable): Data for additions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.



0


1

0.999430930


Total operating days for recalculation can be found on the S-1, Line 25B.



0


NSLP/Day of Review: From the S-1 form enter the SUM of Lines 10,11,12 and 12A. NSLP/Review Period: From the S-1 form enter the SUM of Lines 14,15,16 and 16A. Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 2, Column D (number of meals only)



NSLP SFA Claiming %: Free, Reduced Price, and Paid percentages are recorded on the SFA-1A, Column B that corresponds to the School Site







NSLP SA Claiming %: Free, Reduced Price, and Paid percentages are recorded on the SFA-1A, Column C that corresponds to the School Site







0
0
0
0


Enter the total NSLP reimbursement rate that the site receives for Free Meals. $0.00
Enter the total NSLP reimbursement rate that the site receives for Reduced Price Meals. $0.00
Enter the total NSLP reimbursement rate that the site receives for Paid Meals. $0.00


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


ASP Data is recorded on the S-1, Line 22A for Day of Review. Line 22B for Review Period Other Meal Claim Errors (If applicable): Afterschool Snack Data is recorded on the S-2, Section 3, Column D (meals only).







Enter the total ASP reimbursement rate that the Site receives for Free Snacks.

Enter the total ASP reimbursement rate the Site receives for Reduced Price Snacks.

Enter the total ASP reimbursement rate the Site receives for Paid Snacks.



$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0


1

0.999430930






0






















0
0
0
0


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00




















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00



















































































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00


$0.00


















$0.00


$0.00

































































































































Totals


0


0 0 0 0 0 0 0 0 0 0 0 0 0 0
51 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0
0 0 0
0
0
0 0 0 0 0 0 0 0 0 0 0 0 0
0
0
0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0 0 0 0 0 0 0 0 0 0 0
0
0
0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00

Sheet 13: SBP - P2 & CEP RECALC



























January

































January




































Fiscal Action Formula for Breakfast (SBP) - Provision 2 & CEP *ONLY USED FOR FULL RECALCULATION*

February

































February




































For Non-Base-Year Provision 2 & Community Eligibility Provision Schools

March

































March





























































April

































April




































Review Information:
1: TOTAL FISCAL ACTION FOR SBP Provision 2 & CEP:

May

































May























































June

































June





































Month Being Reviewed:








Period:


July

































July




















































$0.00

August

































August






































SFA Name:








All


September

































September






















































October

































October





























































November

































November





























































December

































December




































No.
Name of Site
2: Number of Meals Claimed Requiring RECALC:
3: Meal Count for 30-Day Recalculation Period:
4: Adjust for Consolidation Errors:
5: Meals Adjusted for Consolidation Errors:
6: Select Month Being Recalculated:
7: Normalization Factor
8: Operating Days in Month being Recalculated:
9: Normalized and Recalculated Meal Count:
10: Total Non-Reimbursable Meals:
11A: SFA Claiming Percentages: NOTE: If CEP is used ensure 1.6 multiplier is accounted for and leave % Reduced Price field blank
11B: SA Claiming Percentages: NOTE: If CEP is used ensure 1.6 multiplier is accounted for and leave % Reduced Price field blank
12: Maximum Number of Reimbursable Meals by Benefit Type:
13: Reimbursement Rates for Each Benefit Type:
14: Reimbursement Amounts Claimed by SFA:
15: Maximum Allowable Reimbursement Based on SA Assessment:
16: TOTAL FISCAL ACTION FOR SITE:









































































Deductions
Additions








% Free
% Reduced Price
% Paid


% Free
% Reduced Price
% Paid


Free
Reduced Price
Paid
Total


Free
Reduced Price
Paid


Free
Reduced price
Paid


Free
Reduced Price
Paid














































































































































































NSLP/Month of on-Site Review: Data is recorded on the S-1, Line 19. NSLP/Review Period: Data is recorded on the S-1, Line 20.



NSLP: Data is recorded on the S-1, line 24C.



SBP/Day of Review: Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13. SBP/Review Period: Data for deductions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17A. Other Meal Claim Errors (If applicable): Data for deductions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.

Windows User: SBP/Day of Review: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 13. SBP/Review Period: Data for additions to Free, Reduced Price, and Paid categories is recorded on the S-1, Line 17A. Other Meal Claim Errors (If applicable): Data for additions to Free, Reduced Price and Paid categories is recorded on the S-2, Section 1, Column F.



0


1

0.999430930


Windows User: Total operating days for recalculation can be found on the S-1, Line 24B.



0


NSLP/Day of Review: From the S-1 form enter the SUM of Lines 10,11,12 and 12A. NSLP/Review Period: From the S-1 form enter the SUM of Lines 14,15,16 and 16A. Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 2, Column D (number of meals only)



SBP SFA Claiming %: Free, Reduced Price, and Paid percentages are recorded on the SFA-1A, Column B that corresponds to the School Site







SBP SA Claiming %: Free, Reduced Price, and Paid percentages are recorded on the SFA-1A, Column C that corresponds to the School Site







0
0
0
0


Windows User: Enter the total SBP reimbursement rate the site receives for Free Meals.

Windows User: Enter the total SBP reimbursement rate the site receives for Reduced Price Meals.

Windows User: Enter the total SBP reimbursement rate the site receives for Paid Meals.



$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0


1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00
























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00























































































































0



1

0.999430930






0






















0
0
0
0










$0.00
$0.00
$0.00


$0.00
$0.00
$0.00


$0.00





































































































Totals


0


0 0 0 0 0 0 0 0 0 0 0










0


0 0 0 0 0


















0 0 0 0 0 0 0










$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0

Sheet 14: NSLP - P3






















































































Fiscal Action Formula for Lunch (NSLP) - Provision 3
































































For Non-Base-Year Provision 3 Schools




















































































































































Review Information:
1: TOTAL FISCAL ACTION FOR NSLP Provision 3:















































































































































Month Being Reviewed:




Period:













































































$0.00


































































SFA Name:




All






















































































































































































































































































































No.
Name of Site
2: Funds (to be) Provided to Site for Month:
3: Adjust for Incorrect Payment if Necessary:
4: Number of Meals Claimed by the Site:
5: Total Non-Reimbursable Meals:
6: Maximum Number of Reimbursable Meals by Benefit Type:
7: Reimbursement Rates for Each Benefit Type:
8: Reimbursment Claimed by Site:
9: Maximum Allowable Reimbursement
10: Amount of NSLP Fiscal Action:
11: Total FFVP Reclaim (use negative number):
12A: Number of After School Snacks Adjustments (Disallowed = negative # or Added = positive #) for Each Benefit Type:
12B: Reimbursement Rates for Each Benefit Type of After School Snack:
12C: Total After School Snack Adjustment:
13: TOTAL FISCAL ACTION FOR SITE:





























































Deductions
Additions


FREE
REDUCED PRICE
PAID



FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID






FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID






















































































































































NSLP/Review Period: Data is recorded on SFA-1A, Line 1D. NSLP/Day of Review: Data is recorded on SFA-1A, Line 2D. $0.00


NSLP/Review Period: Data is obtained by calculating the difference between SFA-1A, Lines 1D and Line 1E. NSLP/Day of Review: Data is obtained by calculating the difference between SFA-1A, Lines 2D and 2E. Record any overages on the deductions line and any shortages on the additions line. $0.00
NSLP/Review Period: Data is obtained by calculating the difference between SFA-1A, Lines 1D and Line 1E. NSLP/Day of Review: Data is obtained by calculating the difference between SFA-1A, Lines 2D and 2E. Record any overages on the deductions line and any shortages on the additions line. $0.00


NSLP/Day of Review: Data for Free, Reduced Price, and Paid categories is recorded on the S-1, Line 21. NSLP/Review Period: Data for Free, Reduced Price, and Paid categories is recorded on the S-1, Line 22.







NSLP/Day of Review: From the S-1 form enter the SUM of Lines 10,11, 12 and 12 A. NSLP/Review Period: From the S-1 form enter the SUM of Lines 14, 15, 16 and 16 A. Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 2, Column D (number of meals only) 0


0
0
0


Enter the total NSLP reimbursement rate that the site receives for Free Meals.

Windows User: Enter the total NSLP reimbursement rate the site receives for Reduced Price Meals.

Windows User: Enter the total NSLP reimbursement rate the site receives for Paid Meals.



$0.00


$0.00


$0.00






ASP Data is recorded on the S-1, Line 22A for Day of Review. Line 22B for Review Period. Other Meal Claim Errors (If applicable): Afterschool Snack Data is recorded on the S-2, Section 3, Column D (meals only).







Enter the total ASP reimbursement rate that the Site receives for Free Snacks.

Enter the total ASP reimbursement rate that the Site receives for Reduced Price Snacks.

Enter the total ASP reimbursement rate that the Site receives for Paid Snacks.



$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00




























































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00






















$0.00


$0.00
























































































Totals


$0.00


$0.00 $0.00 $0.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0










$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00


$0.00 0 0 0 0 0 0 0 0










$0.00 $0.00 $0.00 $0.00 $0.00

Sheet 15: SBP - P3


























































Fiscal Action Formula for Breakfast (SBP) - Provision 3




































For Non-Base-Year Provision 3 Schools




























































































Review Information:
1: TOTAL FISCAL ACTION FOR NSLP Provision 3:























































































Month Being Reviewed:




Period:

















































$0.00






































SFA Name:




All






































































































































































































No.
Name of Site
2: Funds (to be) Provided to Site for Month:
3: Adjust for Incorrect Payment if Necessary:
4: Number of Meals Claimed by the Site:
5: Total Non-Reimbursable Meals:
6: Maximum Number of Reimbursable Meals by Benefit Type:
7: Reimbursement Rates for Each Benefit Type:
8: Reimbursment Claimed by Site:
9: Maximum Allowable Reimbursement
10: TOTAL FISCAL ACTION FOR SITE:










































Deductions
Additions


FREE
REDUCED PRICE
PAID



FREE
REDUCED PRICE
PAID


FREE
REDUCED PRICE
PAID








































































































Windows User: NSLP/Review Period: Data is recorded on SFA-1A, Line 1D. NSLP/Day of Review: Data is recorded on SFA-1A, Line 2D. $0.00


SBP/Review Period: Data is obtained by calculating the difference between SFA-1A, Lines 1D and 1E. SBP/Day of Review: Data is obtained by calculating the difference between SFA-1A, Lines 2D and 2E. Record any overages on the deductions line and any shortages on the additions line. $0.00
SBP/Review Period: Data is obtained by calculating the difference between SFA-1A, Lines 1D and 1E. SBP/Day of Review: Data is obtained by calculating the difference between SFA-1A, Lines 2D and 2E. Record any overages on the deductions line and any shortages on the additions line. $0.00


NSLP/Day of Review: Data for Free, Reduced Price, and Paid categories is recorded on the S-1, Line 21. NSLP/Review Period: Data for Free, Reduced Price, and Paid categories is recorded on the S-1, Line 22.







NSLP/Day of Review: From the S-1 form enter the SUM of Lines 10, 11,12 and 12 A. NSLP/Review Period: From the S-1 form enter the SUM of Lines 14, 15, 16 and 16 A. Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 2, Column D (number of meals only) 0


0
0
0


Enter the total SBP reimbursement rate that the site receives for Free Meals.

Enter the total SBP reimbursement rate that the site receives for Reduced Price Meals.

Enter the total SBP reimbursement rate that the site receives for Paid Meals.



$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00
































































$0.00


$0.00
$0.00










0


0
0
0










$0.00


$0.00


$0.00




























































Totals


$0.00


$0.00 $0.00 $0.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



0
0
0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Sheet 16: SMP
























Fiscal Action Formula for Special Milk Program (SMP)
























Review Information:
1: TOTAL FISCAL ACTION FOR SMP:
















Month Being Reviewed:




Period:













0.00



SFA Name:




All


























































No.
Name of Site
2: SMP Milk Reimbursement Rate
3: Number of Non-Reimbursable Milks:
4: TOTAL FISCAL ACTION FOR SITE:




























































Enter the total SMP reimbursement rate the site receives for Free Milks and a separate entry for Paid Milks. $0.00


SMP/Day of Review and Review Period: Data is recorded on the S-1, Line 23 Other Meal Claim Errors (If applicable): Data is recorded on the S-2, Section 5, Column D (number of milks only). 0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00


































$0.00


0


$0.00






































0


$0.00





Sheet 17: FA Summary

Fiscal Action Formula - Summary
For Non-Provision Schools, Base Year Provision 2 & 3 Schools, and Non-Base Year Provision Schools

















Review Information:


















Month Being Reviewed:


Period:














All





SFA Name:













































Establish Total Fiscal Action:

























TOTAL







Total NSLP - Standard: $0.00






























TOTAL







Total NSLP - SSO: $0.00






























TOTAL







Total NSLP - Provision 2 & CEP: $0.00






























TOTAL







Total NSLP - Provision 3: $0.00






























TOTAL







Total Fresh Fruit & Vegetable Program:





$0.00






























TOTAL







Total Afterschool Snack Program:





$0.00






























TOTAL







Total NSLP Fiscal Action:





$0.00



























TOTAL







Total SBP - Standard: $0.00






























TOTAL







Total SBP - Standard SSO: $0.00






























TOTAL







Total SBP - Provision 2 & CEP: $0.00






























TOTAL







Total SBP - Provision 3: $0.00






























TOTAL







Total SBP Fiscal Action:





$0.00



























TOTAL







Total SMP Errors: $0.00


















































File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

© 2024 OMB.report | Privacy Policy