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

Attachment N.18. Special Provisions Non-Base Year and
CEP Claiming Percentage/Funding Level Summary Form
(SFA-1A)

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-1A
{ } NSLP
{ } SBP

Special Provisions Non-Base Year and CEP
Claiming Percentage/Funding Level Summary Form

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

Claiming Percentages and Funding Levels (Review Period, Day of Review Period, and/or any other Review
Claiming Period)
A. Site name/SPO Type/Month

B. SFA Claiming % *

1)

F-

C. SA Validated
Claiming
F-

R-

R-

PF-

PF-

R-

R-

PF-

PF-

R-

R-

PF-

PF-

R-

R-

PF-

PF-

R-

R-

PF-

PF-

R-

R-

PF-

PF-

R-

R-

PF-

PF-

R-

R-

PF-

PF-

R-

R-

PF-

PF-

R-

R-

P-

P-

2)

3)

4)

5)

6)

7)

8)

9)

10)

D. SFA Funding
Level

E. SA Validated
Funding Level

Total: _________

Total: __________

Total: _________

Total: _________

Total: _________

Total: _________

Total: _________

Total: _________

Total: _________

Total: _________

Total: _________

Total: _________

Total: _________

Total: _________

Total: _________

Total: _________

Total: _________

Total: _________

Total: _________

Total: _________

School Year 2018- 2019

SFA-1A
Special Provisions Non-Base Year and CEP
Claiming Percentage/Funding Level Summary Form
Use this form for all sites for the Review Period, Day of Review Period, and/or any other Review
Claiming Period where errors occurred:
A: Record the name of each Special Provision Option site and type selected for review and the
month impacted.
B: This column is for Provision 2 and CEP only. Record the claiming percentages used by the SFA
to calculate the reviewed site’s monthly claim for reimbursement. * For CEP there will be no
Reduced Price category. This information is listed on the S-1, Line 1.
C: This column is for Provision 2 and CEP only. Record the SA validated claiming percentages for
the reviewed site. * For CEP there will be no Reduced Price category.
D: This column is for Provision 3 only. For Provision 3 record the funding level used by the SFA to
calculate the reviewed site’s monthly claim for reimbursement. This information is listed on the
S-1, Line 1.
E: This column is for Provision 3 only. Record the SA validated funding level for the reviewed
site.
NOTE: The data recorded on SFA-1A will be transferred to the appropriate tab of the Fiscal
Action Workbook. See the Fiscal Action Module of the Administrative Manual. Additionally,
hoovers have been included in the Fiscal Action Workbook for reference.

School Year 2018- 2019