Unanticipated School Closure Notification Form

Unanticipated School Closure Notification Form
TDA recognizes that in School Year 2021-2022, COVID-19 outbreaks may necessitate the closure of schools, some of which may have no option of offering remote instruction during the temporary closure. Additionally, several unanticipated non-pandemic events have occurred that have forced schools to shut down. TDA is approving all schools, whether operating SSO or NSLP this school year, to serve children via SSO during an unanticipated school closure. Note that for the school to be considered closed under this guidance, no instruction of any kind, including virtual learning, should be offered during the closure.

Additionally, USDA has issued a waiver allowing schools to operate SSO at the closed school site. Because TDA is required to report on the usage of this waiver, and to facilitate claiming and Administrative Reviews, TDA requests that any CE experiencing an unanticipated school closure in its district submit this notification form.
1. Select the Program in which you are serving and claiming breakfast and lunch meals as of 9/30/2021:*

National School Lunch Program (NSLP)Seamless Summer Option (SSO)
·         For unanticipated school closures, there is no approval required to operate SSO at a school or non-school site. However, CEs serving breakfast and lunch under SBP/NSLP and who will need to serve breakfast and lunch under SSO, during an unanticipated school closure, will need to submit this form.

·         A PY 2021-2022 SSO application must be submitted in TX-UNPS to TDA to operate SSO during unanticipated school closures.

·         If the CE has not previously operated SSO, then form SNP-005, Permanent Agreement Contracting Entity Specific Amendment must be completed and submitted to TDA via email: NSLP-SBP.bops@TexasAgriculture.gov. The form is located in TX-UNPS under the application tab, download forms.

·         The CE is responsible for ensuring information submitted in the PY 2021-2022 SSO application aligns with information submitted in Questions #2-#7 in this form, as incorrect information may delay reimbursement claims.

·         The CE must return to serving breakfast and lunch under SBP/NSLP once the CE and/or site reopens.

·         If planning to serve Grab and Go meals or utilize other non-congregate methods of service during the unanticipated school closure, you must submit the Declare or Decline Meal Service Options Waiver Form to inform TDA about waiver usage.

NOTE: Once the school reopens, if no longer using any waivers, submit the Declare/Decline form again to indicate that the waivers are no longer needed.
·         While no approval is required to operate SSO at a school or non-school site during an unanticipated school closure, TDA requires any district serving breakfast and lunch under SSO during an unanticipated school closure to submit this form. TDA may reach out to you for more information, as required.

·         If planning to serve Grab and Go meals or utilize other non-congregate methods of service during the school closure, you must submit the Declare or Decline Meal Service Options Waiver Form to inform TDA about waiver usage.

·         If operating non-congregate service at the school site, you do not need to submit a new application for the Grab-and-Go site, even if you intend to feed the community; you may claim all meals to the current school site. If a new site is established to serve children offsite, a new site application is required.

NOTE: Once the school reopens, if no longer using any waivers, submit the Declare/Decline form again to indicate that the waivers are no longer needed.
2. Is this a district-wide closure during which all schools in your district are not providing curriculum, including virtual instruction?

YesNo
3. Enter the name of the school(s) and site ID(s) for the school(s) that closed (no curriculum offered, including virtual instruction):
4. Please list the reason for the unanticipated school closure:

COVID-19-relatedOther (please provide brief description)
5. List the dates the school(s) was/were closed.
5. Beginning Date

MonthDayYear
Date
5. End Date

MonthDayYear
Date
6. List the dates of service during the unanticipated school closure.
6. Beginning Date

MonthDayYear
Date
6. End Date

MonthDayYear
Date
7. Were any meals distributed at closed school sites?

YesNo
8. During the closure, did you operate a closed enrolled site(s), open site(s), or both?

Closed EnrolledOpenBoth
9. Did you operate non-congregate service during the unanticipated school closure?

YesNo
Contracting Entity (CE) Name:*
Enter name as displayed in the TX-UNPS application.
CE Identification (ID):*
Enter the 5-digit number from the TX-UNPS application and claims.
Attestation Statement
Check that each of the following statements is true:*

I am an Authorized Representative (AR) of the Contracting Entity (CE) listed on the "FND-101, CERTIFICATE of AUTHORITY for EXTERNAL USERS" of "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.I understand that it is the CE's RESPONSIBILITY TO IMPLEMENT THIS WAIVER 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)
Enter the name of Authorized Representative*

First NameLast Name
Each party acknowledges and agrees that information in this form is attested to by the name entered in the field above and shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.

After the form is submitted, you will receive a confirmation email message with a copy of your submitted response. Please save the email for your records.
Contact Name*

First NameLast Name
Contact Position/Role

SuperintendentChild Nutrition DirectorAdministratorDietitianManager/SupervisorAuthorized IndividualOther
Contact Email:*
example@example.com
Contact Phone*
Please enter a valid phone number.
Should be Empty: