Determining Eligibility For s2

Coordinated Review Effort (CRE) Self-Evaluation Tool

Yes No Determining Eligibility

1. Are applications for CNP benefits readily retrievable by school? 2. Were the current year’s application for CNP benefits, letter to households and eligibility guidelines used by each school? 3. Are the parents or guardians of all children enrolled in the sponsor’s school(s) given an application for meal benefits and the letter to households at the beginning of the school year? 4. Do all income applications include: a. Name(s) of student(s) for whom application is made? b. Names of all household members? c. Signature of an adult household member? d. Social security number of the adult who signed the application or an indication that he/she does not have one (i.e. the word “none”)? e. Income of each household member, by source? 5. Do all Food Assistance/TAF applications include: a. Name(s) of student(s)? b. Valid Food Assistance/TAF number? c. Signature of an adult household member? 6. All foster and institutionalized children are on individual applications with any personal use income recorded? 7. All applications include the date the determination was made and the signature of the determining official? 8. Was the correct eligibility determination made for each application processed? 9. Does the sponsor have a system for handling temporarily approved applications (those indicating zero income or temporary income) which includes: a. A temporary approval of no more than 60 calendar days? b. A process for notifying the household that their benefits will be terminated unless the information on the application is updated? c. Termination of benefits if the household fails to respond? 10. Is the determining official the same as is indicated in the Program Agreement? 11. Do students receive benefits based on last year’s eligibility no longer than the first 30 calendar days after the beginning of the school year?

Yes No Direct Certification

1. Are copies of Direct Certification letters for all students approved for meal benefits on file? 2. Does the sponsor compare at least two (2) items of information on Direct Certification letters to student enrollment information to ensure accurate provision of benefits? 3. Are copies of the letter, Notification to Households on the Direct Certification List/Electronic File (Form 7-A), on file for all students approved for free meal benefits based on Direct Certification?

03/2011 Child Nutrition & Wellness, KSDE – www.kn-eat.org Form 15-A Coordinated Review Effort (CRE) Self-Evaluation Tool – Page 2

Yes No Verification

1. Was the count of meal applications on file on October 1 taken? 2. Was the proper sampling method used? 3. Was exactly 3% of meal applications selected for verification? 4. Was confirmation reviews completed on meal applications selected for verification? 5. Was all required documentation obtained during verification? a. Were copies of all correspondence with the household on file (notice to household of selection, notice of adverse action, etc.)? b. Was the verification process completed by November 15? c. Was the verification process documented and completed for each selected application? d. Was the Post-Verification Results screen completed in KN-CLAIM by December 15? e. Were households whose benefits must be reduced or terminated given the required 10-calendar days written notification prior to the change?

Yes No Counting and Claiming

1. Is the collection procedure in use at each serving site the same as the approved procedure indicated on the Site Application in KN-CLAIM? 2. Is the medium of exchange for paid, reduced price and free meals: a. Coded in a manner which does not cause overt identification of children receiving reduced price and free meals? (Prohibited codes include color-coding and use of obvious identifiers such as P, R, F.) b. Available through prepayment or charging thus making reduced price and free meal recipients appear as students who have prepaid or charged? (Be sure to check lunch, breakfast and snack procedures.) c. Distributed using a common location at a regular time for all students to obtain their tickets or tokens? d. Collected in a manner which ensures that the same procedures are used for all categories of meals? 3. Is the meal count by category (paid, reduced price, free) taken at the point- of-service? (That point in the food service operation when a determination can accurately be made that a reimbursable paid, reduced price, or free meal has been served to an eligible child.) 4. If the cashier is at the beginning of the line, is there a monitor stationed at the end of the line who removes from the count any meal which does not contain sufficient food or menu items to qualify for reimbursement? 5. Is there a system in place to ensure that second meals are not claimed for reimbursement? 6. After viewing the collection procedure in operation, does it appear that it yields an accurate count by category? (It is important to observe the cashier[s] at the end of the serving period to ensure that the count as taken on the line is the same as that reported on the daily record. Perform the same procedures that the cashiers perform [count the number of meals by category from the tickets, roster, etc.] and compare the numbers to the cashiers’ reported numbers. Compare the counts by category taken on the day of the review to counts recorded for prior days that month to determine if they are reasonable.) 7. Are the counts from all lines properly consolidated, if there is more than one serving line?

Yes No Counting and Claiming, continued

8. Do the names on the roster of eligible students match approved applications on file and on the direct certification list? 9. If more than one roster is used, are all rosters the same? 10. Are the dates of changes due to withdrawals, transfers, etc., reflected on the list or on another tracking document? 11. Is the count of eligible students updated on a daily basis and in a timely manner? 12. Are changes made in eligibility due to verification or other reasons: a. Immediately for increases in benefits (no longer than 3 operating days)? b. Immediately after the 10 calendar day adverse action notice period for decreases in benefits? 13. Have edit checks been accurately completed on the Daily Record of Lunches Served (Form 9-A)? 14. When the daily meal counts by category exceed the average daily attendance, is the validity of the count examined and documented prior to submission of the claim? 15. Are all serving areas where meals are claimed for reimbursement available to all students (paid, reduced price and free students)? 16. Are meals priced as a unit? 17. If reimbursable premium meals are offered, are reduced price and free meal recipients given the option of receiving the premium meal at no additional charge? 18. Is there an alternative meal counting procedure in place in case of loss of power in an automated system? 19. When reviewing the daily record of lunches served, check for the following indicators of errors: patterns of numbers; repetition of numbers; constant counts by category; served count equal to delivered count; identical counts for breakfast and lunch; 100% participation; or category count exceeding the number of eligible students. a. Are meal counts evaluated for errors including those listed above? b. Are corrections made and documented as required? 20. Are prepaid and charged meals counted on the day they are served, not the day the money is collected? 21. Is the recommended procedure for handling lost, stolen and misused meal tickets in place? 22. When preparing the monthly reimbursement claim, are the numbers of meals claimed by category for all schools consolidated correctly?

Yes No On-Site Reviews

1. Is an on-site review of the meal counting and claiming procedure completed and documented prior to February 1 each year for sponsors with more than one serving site? 2. Are corrective actions for the counting and claiming procedures developed and documented as needed? 3. If needed, is a documented follow-up review conducted within 45 days to ensure that corrective action was taken?

Yes No Food Based Menu Planning

1. Is each of the required five food items offered on every lunch menu? 2. Is each of the required four food items offered on every breakfast menu? 3. Have recipes been calculated accurately to ensure they contribute the recorded amounts of each component? (This is determined by using Yield Charts, the amount of creditable ingredient called for in the recipe, and the number of portions the recipe yields to determine contribution per portion.) 4. Are CN labels or product analysis forms for all pre-prepared food items on file? 5. Are food production records maintained for all meals claimed for reimbursement? 6. Are substitutions made in the menu reflected on the production records? 7. Is 100% full-strength fruit juice being served? If so, is it contributing no more than one-half of the required serving size of the fruit/vegetable component for lunch? 8. Are utensils that yield standard-sized servings used for portioning all menu items? 9. Based on the menu system being used, are the required number of bread servings offered each week (Serving week = 5 days): a. Enhanced Food Based Menu Planning: Grades K-6: 12 servings/week? b. Enhanced Food Based Menu Planning: Grades 7-12: 15 servings/week? d. Enhanced Food Based Menu Planning: Optional K-3: 10 servings/week? 10. Are required forms of milk available throughout the entire serving period? 11. Are all required components offered in sufficient amounts before the cashier counts the meal as reimbursable? 12. If the school is using “Offer”, may a child refuse any one or two of the food items offered?

Yes No Nutrient Standard Menu Planning (NSMP):

1. Are an entrée, milk and at least one other menu item offered at lunch? 2. Are milk and at least two other menu items offered at breakfast? 3. Are menus being analyzed using the most recent version of the CNP database and USDA approved software? 4. Is a nutrient analysis available for review? 5. Are food production records maintained for all meals claimed for reimbursement? 6. Are substitutions made in the menu reflected on the production records? 7. Are utensils that yield standard-sized servings used for portioning all food items? 8. If the school is using “Offer” at lunch: a. Has the student selected an entrée and at least one other item? b. Has the student declined no more than two items when four or more are offered? c. Is milk included when students take the maximum number of menu items allowed?

Yes No Civil Rights

1. Is USDA’s approved nondiscrimination poster displayed in a prominent place in the meal service area where it is visible to students? 2. Are the nondiscrimination statement and the procedures to file complaints included on program materials? 3. If a significant number of persons in the community speak a language other than English, are foreign language translations available? 4. Are procedures established to receive complaints alleging discrimination? 5. Are complaints forwarded to the address on USDA’s approved nondiscrimination poster? 6. Is there no separation by race, color, national origin, sex, age, or disability in the eating periods, seating arrangements, serving lines or eating areas?

Yes No Record Keeping

1. Are records maintained for a period of five years after the final claim for reimbursement for the fiscal year or until resolution of any audits or reviews? 2. For schools using Provision 2: Are base year documents kept at least 5 years after last claim is filed or until resolution of any audits or reviews?

Yes No Food Safety & Sanitation

1. Is there a Food Safety (HACCP) Plan on file and adapted to fit site? 2. Are Control Processes identified for each menu item? 3. Are temperatures of men items, receiving, and refrigerator/freezer taken and recorded? 4. Are thermometers calibrated at least every two weeks? 5. Is the Food Safety Checklist completed on a monthly basis? 6. Is the HACCP plan reviewed/revised annually? 7. Is the most recent sanitation inspection posted in view of participants? 8. Are all food service personnel current on the required food safety training? 9. Is the Food Safety Training log in KN-CLAIM current?

Yes No Wellness Policy Implementation

1. Are goals/achievements identified for current year. 2. Are implementation plans or documentation of goals/achievements completed for the current year? 3. Are the vending requirements met? 4. Has the school/health wellness committee met?

03/2011 Child Nutrition & Wellness, KSDE – www.kn-eat.org Form 15-A