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

Attachment N.19. Community Eligibility Provision ISP and
Claiming Percentage Validation Worksheet (SFA-2A)

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-2A, INST
Administrative Review
Community Eligibility Provision
Identified Student Percentage and Claiming Percentage Validation Worksheet
INSTRUCTIONS

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

More than one Form may be used to document State agency review of the Identified Student Percentage and
claiming percentages.
NOTE: Refer to FNS Memo SP 19-2016, Community Eligibility Provision: Guidance and Q&As for additional
information on CEP.
BLOCK 1

Enter the name of the School Food Authority
Enter the agreement number, if applicable
Record the total number of schools participating in the National School Lunch
Program
Record the total number of schools participating in CEP

BLOCK 2

Select the level of Election
District-wide: If the entire district is approved for CEP based on the district wide
numbers, then the SA should review the ISP and claiming percentages for the
entire district. This can be completed by validating the aggregate numbers of
the entire district. Since the entire district is CEP, this process would replace the
requirements for monitoring Benefit Issuance

Individual School(s): If a school selected for review is approved for CEP based on
that individual school then the SA should review the ISP and claiming
percentages for that individual school. This process may be completed along
with the review of Benefit Issuance for the remainder of the district buildings
that do not participate in CEP.
Groups of Schools: If a school selected for review is approved for CEP based on
a group of schools then the SA should review the ISP and claiming percentages
for that group of schools. This process may be completed along with the review
of Benefit Issuance for the remainder of the district buildings that do not
participate in CEP.
BLOCK 3

District/School Information
Enter the name of each school participating in CEP
Enter the total number of enrolled students for the schoolas of April 1st in the
year prior to the first year of CEP implementation. This number should have
been documented by the SFA as a part of CEP election.

SFA-2A, INST
BLOCK 4

BLOCK 5

As Submitted by SFA for Election of CEP
The data needed to complete this information may be collected from SA
documentation retained during the CEP Election process. These data fields may
be completed as part of the Off-site Assessment.
Enter the total number of Identified Students as submitted by the SFA for CEP
approval. Enter the percentage of identified students as submitted by the SFA
for CEP approval. Enter the claiming percentage for free meals as submitted by
the SFA for CEP approval. Enter the claiming percentage for paid meals as
submitted by the SFA for CEP approval.

As Reviewed by the State Agency
Enter the total number of Identified Students as reviewed by the SA. The SA
reviewer will need to review all supporting documentation as of April 1st from
the year prior to the first year of CEP implementation. The documentation may
include: lists of students directly certified through SNAP, TANF, and FDPIR; lists
of homeless/migrant/runaway students as certified by the appropriate local
official; lists of students eligible via participation in Head Start and Even Start;
documentation to support the extension of categorical eligibility via direct
certification; documentation for Foster Children certified through means other
than application.

Calculate the Identified Student Percentage by dividing the Total Number of
Identified Students by the Total Number of Enrolled Students as of April 1st and
carry to four decimal places. Multiply by 100 to convert to a percentage. DO
NOT ROUND.
Calculate the Claiming Percentage for Free Meals by multiplying the Identified
Student Percentage by 1.6.
Calculate the Claiming Percentage for Paid Melas by subtracting the Claiming
Percentage for Free Meals from 100.
The SFA and SA validated claiming percentages will be transferred to the SFA-1A

SFA-2A

Administrative Review
Community Eligibility Provision
Identified Student Percentage and Claiming Percentage Validation Worksheet

1. SFA Name

Agreement Number

2. Level of Election
(Check one, list if individual or groupings of schools)

Number of Schools
Total Number of Schools

[ ] N/A

Number of School
Participating
in CEP

District-Wide
Individual
School(s):
Groupings of
Schools:

3. District/School Information
Total # of Enrolled
District/School name
Students as of
April 1, ________

Total # of
Identified
Students

4. As Submitted by SFA for Election of CEP
Identified Student
Percentage

Free Rate Claiming
Percentage

Paid Rate Claiming
Percentage

Total # of
Identified
Students

5. As Reviewed by the State Agency on Review
Identified Student Free Rate Claiming Paid Rate Claiming
Percentage
Percentage
Percentage

Last updated School Year 2017-2018