This section was prepared for and is directed to sponsors’ claim preparers to help claim preparers’ complete Summer Food Service Program (SFSP) claims for reimbursement.
The amount of reimbursement will be computed by the California Department of Education on the basis of USDA-approved rates. The following section provides an item-by-item description of claim data that all SFSP claim preparers are required to report:
| Item |
Description |
|---|---|
| 1 |
Agreement Number, Vendor Number, Name, and Address: Place a pre-printed label in the space provided. If no labels are available, print or type the sponsor’s agreement number, vendor number, name, and address in the space provided. |
| 2 |
Adjusted Claims: Check this box if revising the sponsor’s previously reported data. Please complete the form in its entirety; report all previously reported data inclusive of changes. |
| 3 |
Month Covered: Enter the number of the month and year this claim covers. Example: October 2003 = 10/2003 January 2004 = 01/2004 |
| 4 & 5 |
For state use only. |
| 6 |
Period Covered: This information should cover activities during one calendar month; however, the sponsor may include no more than 10 operating days of the month before the first full month of operation and no more than 10 operating days of the month after the last full month of operation. Do not report data that span across three calendar months. For example, 7 days in June and 25 days in July will be reported as a July claim; 25 days in May and 8 days in June will be reported as a May claim. Please enter the four-digit year. For example, from: 06/23/2008; to: 07/31/2008. Do not split one month onto two separate claim forms. |
| 7 |
Approved Sites: Enter the number of approved sites operating during the claim period. |
| 7a |
CCNSP Sponsors Only: Enter the number of approved CCNSP pilot sites operating during the claim period. |
| 8 |
Number of Days: Enter the number of days during the claim period on which meal service was provided. |
| 9 |
Average Daily Number of Eligible Children: Use the highest total number of eligible first main meals served (breakfast, lunch, or supper) during the claiming period, and divide by the number in item 8 (days) on the claim form. Remember to always round the total up to the next whole number. For example, 426 meals (for lunch) divided by 20 days (item 8) = 21.30, which rounds to 22. |
| 10-13 |
Food Service to Children: Enter the first, second, and total meals served to eligible children by meal type. Second meals served may not exceed 2 percent of the first meals served. Follow standard mathematical procedures for rounding second meals. For example, 356 first meals (for lunch) x 2 percent equals 7.12 second meals, which rounds to 7. |
| 13a |
CCNSP SPONSORS ONLY. Enter the First and Second pilot snack meals on the lines provided. Follow standard mathematical procedures for rounding second meals. For example, 356 first meals (for lunch) x 2 percent = 7.12 second meals, which rounds to 7. |
Do not fill in the boxes below the signatures. This area is for state use only.
Review your entries. When you are satisfied that they are true and correct to the best of your knowledge, sign and date the claim. The claim will be returned for correction if it is not properly completed. Place an original signature on both the original and the copy of the claim before mailing it to avoid delays in receiving the reimbursement.
Special Note: An adjusted claim for reimbursement completely voids all previously submitted data for the same claiming period. Therefore, the claim preparer must include all of the sponsor’s reporting data for the entire operation for that same period.
