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

Attachment N.16. Other Eligibility Certification and Benefit Issuance Errors
Worksheet (SFA-2)

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.

SFA-2

OMB #0584-0006
Administrative Review
Other Eligibility Certification and Benefit Issuance Error Worksheet

Expiration Date xx/
xx/20xx

NA [ ]

SFA:
Student Name

School

ERROR TYPES:
ID - Incorrectly Denied
VE - Verification Error
OHM - Other Household Member

Last updated SY 17-18

AI – Annual Income

Error
Type

Description of Error(s)

Corrective Action
Required

Date of
Correction

SFA-2, INST

OTHER ELIGIBILITY CERTIFICATION AND BENEFIT ISSUANCE ERROR WORKSHEET
INSTRUCTIONS
GENERAL COMMENTS

This form is used to record denied application errors, verification
errors, and other household members certified or issued benefits
in error whose eligibility or benefit issuance must be corrected as a
result of the Certification and Benefit Issuance review.
If the review did not identify any of these errors, check [√] N/A.

SFA

Enter the name of the SFA being reviewed

STUDENT NAME

Enter the student’s name or other identifier such as student
identification number or application number. When an identifier
other than the student’s name is used, adequate information must
be provided to the SFA/school to identify the student(s) in error for
corrective action purposes.

SCHOOL

Enter the name of the school which the student in error attends.

ERROR TYPE

Indicate the type of error. Use I.D. for Incorrectly Denied, V.E. for
Verification Error, and O.H.M. for Other Household Member.
Describe the error.

DESCRIPTION OF ERROR

Incorrectly Denied Application
Examples of incorrectly denied application errors include denying
an application for a lack a signature when there was a valid
signature, denying an application for lacking the SSN (last four
digits) when the application contained the required SSN (last four
digits), denying an application for missing income when the
income was listed correctly, denying an application for having a
missing case numbers (i.e. SNAP) when a case number was
entered, and denying an application because of other information
was determined to be missing but the application was complete.
Incorrectly denied applications also include: errors in gross income
calculation, incorrectly calculating household size, incorrectly
determining the frequency of income, not converting multiple
income sources to annual income, not counting the correct number
of household members, incorrect arithmetic, misclassifying
reportable income, and other income computation errors.
Verification Error
Verification errors occur when the final determination of a verified
application is incorrect based on verification documentation.
Categorical eligibility errors in verification documentation include:
invalid case numbers, categorical eligibility claims known to be
false, and invalid categorical standards.
Gross income calculation errors in the verification process include:
incorrectly calculating household size, incorrectly determining the
frequency of receipt of income, not converting multiple income
sources to annual income, not counting the child in the list of
household members or counting the child twice, incorrect
arithmetic, misclassifying reportable income, and other income
computation errors.

Last updated SY 17-18

SFA-2, INST

OTHER ELIGIBILITY CERTIFICATION AND BENEFIT ISSUANCE ERROR WORKSHEET
INSTRUCTIONS
Other errors in the verification process include: any errors that are
not included in the above categories that cause a change in
eligibility determination or benefit level as identified by the SA.
Other Household Member
For other household members certified or issued benefits in error
whose eligibility or benefit issuance must be corrected as a result
of the Certification and Benefit Issuance review, record the
certification or benefit issuance error.
Annual Income
The household provides annual income on the application but the
circumstances surrounding the reporting of annualized income do
not meet the special situations identified in the Eligibility Manual.
CORRECTIVE ACTION
REQUIRED

Enter the corrective action necessary to resolve the identified
error.

DATE OF CORRECTIVE ACTION

Enter the date of corrective action.

Last updated SY 17-18