This section was prepared for and is directed to sponsors’ claim preparers to help them complete claims for reimbursement for the School Nutrition Program (SNP) Seamless Summer Feeding Option Program (SSFO).
Sites that are eligible for the SSFO must be reported on a separate claim form (CNFS 71-5S) by using the assigned agreement number (identified by 09 as the last two digits). See Appendix A-10 for a sample of the Claim for Reimbursement for School Nutrition Programs for the Seamless Summer Feeding Option. Yearly cost and revenue totals for SSFO sites must be included in the revenue and cost totals reported on the June school nutrition claim form (CNFS 71-5).
Enter program information for only one claim month in items 1 through 16. This information should cover activities during one calendar month, with the exception of the beginning and the end of the school year. For these periods, you may include up to ten operating days within the month of August on the September claim or up to ten operating days within the month of June on the May claim.
| Item | Description |
|---|---|
1 |
Agreement Number, Name, and Address: Place printed labels on the original claim form and one copy. Use only those labels designated for Seamless Summer Feeding Option Program (green). If labels are not available, type or print the sponsor’s agreement number, name, and address in the spaces provided. If more labels are needed, contact CNFS. |
2 |
Month/Year: Enter the two-digit month and four-digit year that the claim covers, not the month that the claim is prepared. The month and the year must be reported numerically as shown in the following examples: December 2003 = l | 2 2 | 0 | 0 | 4 January 2004 = 0 | 1 2 | 0 | 0 | 5 Note: A sponsor may claim reimbursement only for those months indicated on the sponsor’s approved Annual Participation Statement. |
3 |
Mark the appropriate box that applies:
Note: If a correction to an original claim has been requested by the Department of Education, the claim is still marked as an original (box a). Please write the word “correction” at the top of the claim form. |
4 |
Adjustment Number: Do not complete. This item is for state use only. |
5 |
Reason Code: Do not complete. This item is for state use only. |
6 |
Number of Children Receiving Free Meals: Enter the number of children that are receiving free breakfasts and lunches or suppers. An actual count should be made each month. Column B should include enrollment for lunch plus enrollment for supper for eligible sites. Item 6 cannot be less than Column E (free meals served) divided by Column C (number of operating days) of items 12 through 14 except in the case of migrant sites and camps. |
10 |
Number of Children Receiving Free Supplements (Snacks): Enter the number of children receiving free meal supplements only. An actual count must be made each month. This total cannot be less than Item 16 E (free meals served) divided by item 16 C (number of operating days). |
12-16 |
Column A, Authorized Sites Participating: Enter the number of authorized sites operating during the month for each program. This number may not exceed the number of sites initially authorized to participate in the Seamless Summer Feeding Option Program or authorized subsequently on a Site Change Request Form. New sites must be approved by NSD before being claimed for reimbursement. Column B, Enrollment: Enter the total active enrollment for authorized participating sites during the report month for each program. Of the number reported in item 6, enter only the number of children who participated in each corresponding lunch/supper and/or breakfast programs. This total cannot exceed the number of children reported in item 6, with the exception of migrant sites and camps. Enrollment in the Meal Supplements Program will be equal to the number reported in item 10. For line 12 (lunch/supper), column B should include enrollment for lunch plus enrollment for supper for eligible sites. Column C, Number of Operating Days: Enter the number of days in the claim month when reimbursable meals or supplements were served at any authorized site for each program. Column E, Free Meals Served: Enter the number of free meals or free supplements served to children in each program during the month. You must report suppers on line 12 (National School Lunch/Supper). An individual site may not claim both lunch and supper meals on the same day, with the exception of migrant sites and camps, which are authorized to serve any combination of three meals on the same day. For both residential and nonresidential camps, only the meals served to income-eligible children (on the basis of free or reduced-price applications) may be claimed. Column G, Total Meals Served: Enter the total number of meals or supplements served to children in each program during the month. Total meals (column G) should equal free meals (column E). Do not include meals or supplements served to adults. |
Certification: Before submitting a sponsor’s
claim, be sure to complete this section. Include the name and
telephone number of the person preparing the claim, the preparation
date, and the original signature of an authorized agency official,
title, and date. The signature of the authorized official must
be original and in ink. Only original signatures will be accepted.
A sponsor’s claim will be returned for correction if it is not properly completed. Place an original signature on the claim before mailing the claim to avoid delays in the sponsor’s reimbursement. The agency’s authorized official signing the claim is responsible for reviewing and analyzing meal counts to ensure accuracy.
Special Note: An adjusted claim for reimbursement completely voids all the previously submitted data for the same claiming period. Therefore, when submitting an adjustment, the sponsor must report all data whether there has been a change or not.
If you would like to determine the federal and state reimbursement earned for the month, complete the Monthly Reimbursement Calculation Worksheet Appendix A-4. Do not submit the worksheet with the sponsor’s claim; it is for your reference only.
