School Year 2020-2021 Meal Distribution Waiver Usage Intake Form for SFSP/SSO Operators

School Year 2020-2021 Meal Distribution Waiver Usage Intake Form for SFSP/SSO Operators

For School Food Authorities and Non-school Entities
On August 31, 2020, USDA issued a nationwide waiver allowing the Summer Food Service Program (SFSP) and Seamless Summer Option (SSO) to continue to operate through December 31, 2020, under the COVID-19 flexibilities granted at the end of Program Year 2019-2020. CEs choosing to operate SFSP or SSO in lieu of the National School Lunch Program (NSLP) must use this form to indicate their intention to utilize these specific flexibilities, which include:
- Non-congregate meal service
- Alternative meal times
- No child present/Parent pick-up
Note the following:
- CEs who have previously indicated the intention to utilize these flexibilities via the intake forms from spring/summer are currently not required to submit this form again unless the waiver usage has changed.
- These ﬂexibilities under SSO/SFSP CE are only available until June 30, 2021. Note that all expiration dates are subject to change by USDA and may be extended or shortened depending on the status of the public health emergency and the availability of funding.
- If the requesting CE is a School Food Authority (SFA), all sites in the SFA must operate as an SSO/SFSP site. A district may not operate both NSLP and a summer feeding program.
- Non-school entities will only be approved to serve meals under SFSP
(1) in an area where a school has elected not to continue meal service

OR

(2) if serving a different meal type (for example, supper) than the SFSP meals provided by the area SFA.
- The submission of this form is not an approval to operate the program. While TDA approves the usage of the waivers in this form, CEs must have an approved site application prior in order to claim meals under these programs.
- If a CE is participating in SSO and changes their meal counting and collection procedures, they must complete an Attachment B, Policy Statement for Free and Reduced-Price Meals, Attachment B: Meal Count/Collection Procedure(s) in TX-UNPS
- Upon submission of this form, you will receive an email conﬁrmation that the waiver opt-in has been accepted. Please print this receipt for your records. TDA will also indicate completed receipt of this form in TX-UNPS Packet Notes.
1-1. Do sites under your CE sponsorship operate as a public, private, or charter school ?*

YesNo
1-2. Do you also plan on claiming reimbursements through a CACFP At-Risk Afterschool Care Program?

YesNo
1-3. Do you plan on utilizing the same summer food waivers for the At-Risk program?

YesNo
At-Risk operators are required to submit a COVID-19 Monthly Waivers Update and Meal Count Data Submissions Form of non-congregate and congregate At-Risk meals served. Once you submit this current form, you will receive a link via the confirmation email to the COVID-19 Monthly Waivers Update and Meal Count Data Submissions form. Retain this confirmation email and the link for access to the COVID-19 Monthly Waivers Update and Meal Count Data Submissions form.
Note: If you are operating the At-Risk program under different flexibilities than the summer program, you must also submit the COVID-19 Meal Distribution Waiver (Initial Notification) form that is specific to CACFP and NSLP Contracting Entities (CE) to opt into flexibilities specific to the At-Risk program.

Note that while SFSP and SSO operations will track congregate and non-congregate meals via TX-UNPS claims, At-Risk operators must submit a COVID-19 Monthly Waivers Update and Meal Count Data Submissions form that reports the number of congregate and non-congregate meals served under the At-Risk program.
Check each of the following statements as true:
1-2. As a Private Non-Profit (PNP) that is not a School Food Authority (SFA), I understand

The SFA's application takes priority.I cannot operate in the same area as an SFA operating SFSP unless I I serve a different meal type.Approval of this form is NOT approval to operate. Approval to operate is through the application in TX-UNPS once TDA has determined that there is no duplicate coverage.
1-3. List the school district names and campus name(s) the SFSP operations will cover.
2. Meal Service
2-1. What was the first date of SFSP/SSO service?*

MonthDayYear
Date
2-2. Meal Program Used*

SFSP (Summer Food Service Program)SSO (Seamless Summer Option)
2-3. Are you serving non-congregate meals?*

YesNo
2-4. How will food be provided? Check all that apply.*

Household deliverySite distribution (grab & go)Standard congregate service
2-5. What quantity of food will be served? Check all that apply:*

One (1) meal per student per meal periodMultiple unitized meals distributed at the same time each day the site operates. (Example: breakfast and lunch served at the same time.)Unitized individually packaged meals distributed for multiple days at a designated pick-up time.Bulk components for multiple days of meals distributed at a designated pick-up time.
2-6. I understand that the use of the multiple meal distribution method may require new record keeping strategies in order to accurately demonstrate that each child is served one meal for each meal type provided for each day at the site where the child is receiving meals. I understand that if records related to counting and claiming are inaccurate, insufficient, and/or not retained that the result may be adverse and/or fiscal action.
2-7. Select the day(s) of the week multiple meals are to be delivered through a non-congregate pick-up meal or home deliver method.

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
2-8. Bulk Food Components for Multiple Meal Distribution

Requires separate TDA flexibility approval
NOTE: By checking the option for Bulk Food Components for Multiple Meal Distribution, the CE must complete additional questions describing how the CE will implement a strategy that is compliant with applicable regulations, including, but not limited to meal pattern requirements.
If you indicated you will use bulk food packaged distribution, you will be directed to the application for Bulk Food Components for Multiple Meal Distribution when you submit this form. Upon submittal, you will receive confirmation (1) acknowledging that you have requested Bulk Food Distribution Approval and (2) providing a link to the Bulk Food Components for Multiple Meal Distribution Form in case you could not complete both forms in one session.

If you have already submitted the bulk distribution form and been approved to distribute bulk food components, you DO NOT need to resubmit this form.
2-9. Do you plan on using the flexibility that allows parents to pick up meals without children present?

YesNo
2-10. Please indicate the district's plan to identify eligible children for the parent/guardian to pick up a meal (check all that apply).

Official letter/email/electronic school application from school or child care facility listing children enrolledIndividual student report cardsAttendance record from parent portal of the school website, printed or electronic, that includes the child names.Birth certificates for children not in schoolStudent ID cardsOther official ID issued by a child care facility.
2-11. Has the CE assessed its ability to implement a parent pick-up process in compliance with federal regulation and current TDA guidance?

YesNo
2-12. Select the method(s) you will use to target the eligible free and reduced-price eligible population for each site:

Social mediaEmails to parentsRobocalls/Call-outsDistrict websitePosters/flyersSchool campus marqueeNewspaperText messagesOther
2-13. How will you document meal content? Check all that apply.

Food Production Record (FPR)Meal Production Record (MPR)Menu Planning SoftwareVendor provided for vended foodMeal delivery ticketsExcelOther
2-14. How will you record meal counts? Check all that apply.

Daily Meal Count Attendance FormDaily Meal Strike SheetsRostersManual Tally SheetsMenu Planning SoftwareExcelOther
2-15. How will you ensure food safety? Check all that apply.

Time/Temp documentedStored in hot/cold unitsCN HACCP PlanUse protective wear such as face mask and glovesDelivered by CE one-hour prior to serviceOther
2-16. How will multiple meals served at one time be tracked? Check all that apply.

Daily Meal Count Attendance FormsDaily Meal Strike SheetsRostersPOSSoftware programOther
3. Contact Information
TDA may contact you with additional questions. Identify a contact responsible for responding to all TDA follow up required for COVID-19.
3-1. CE Contact Name*

First NameLast Name
3-2. CE Contact Email Address*
example@example.com
3-3. CE Contact Phone Number*

Area CodePhone Number
4. Contracting Entity Information

The CE Name and CE ID entered on this form must match the name and ID on the current application in TX-UNPS.
4-1. CE Name:*
As listed on the TX-UNPS application
4-2. CE ID*
5-digit CE ID from TDA (ex: 00522)
Attestation Statement
4-3. Click on the calendar icon to confirm today's date:*

MonthDayYear
Current date
NOTE: Only CE staff may submit this form. A food service management company (FSMC) staff member cannot submit this form on behalf of the CE or attest to its accuracy.
4-4. ATTESTATION STATEMENT: Check each of the following statements as true.*

I am an Authorized Representative (AR) of the Contracting Entity (CE) listed on the FND-101, CERTIFICATE of AUTHORITY for EXTERNAL USERS or FND-135, USER ACCESS MANAGER FORM that has been approved by TDA prior to this submission of this waiver notification.I certify that the CE has retained documentation related to the information submitted in this request for all meals served and claimed under this waiver. This includes but is not limited to counting and food production records.I understand that it is the CE'S RESPONSIBILITY TO IMPLEMENT THESE WAIVERS IN COMPLIANCE WITH ALL APPLICABLE REGULATIONS, and that NON-COMPLIANCE MAY RESULT IN ADVERSE AND/OR FISCAL ACTION.i am employed by the CE named on this waiver. I am not an employee of a food service management company (FSMC).
Each party acknowledges and agrees that this information in this form is attested by the name entered in the above field and shall be considered as an original signature for all purposed and shall have the same force and effect as an original signature.
4-5. Authorized Representative attesting to the information on this form:*

First NameLast Name
4-6. Title of Authorized Representative*
4-7. Email address for Authorized Representative:*
example@example.com
4-8. Email address for Superintendent
Enter email address if different than the Authorized Representative's email
4-9. Email address for Child Nutrition Director (CND)
Enter email address if different than the Authorized Representative's email.
4-10. Alternate Email
Enter the email address for any other personnel that needs to be informed
A copy of your submitted responses will be sent to the listed email addresses. Please print and retain the automated email receipt for your records.
Please check after you have made the requested corrections:

I have corrected the indicated fields.
TDA Internal Use Only
TDA Review - the following field(s) need to be corrected:

CE name does not match the name on the application in TX-UNPSCE ID is incorrectAuthorized Representative cannot be verified in TX-UNPSAn employee from an FSMC cannot submit or attest to the accuracy of the waiver
Should be Empty:

School Year 2020-2021 Meal Distribution Waiver Usage Intake Form for SFSP/SSO Operators

Check each of the following statements as true:

2. Meal Service

3. Contact Information

4. Contracting Entity Information

Attestation Statement

TDA Internal Use Only