SY2024-2025 Verification Report

SY2024-2025 Verification Report
THIS FORM IS CURRENTLY OPEN FOR TESTING ONLY

Any submissions made prior to November 1st will be deleted on October 31st.

OFFICIAL SUBMISSIONS WILL OPEN NOVEMBER 1st.
ALL CEs contracted to operate NSLP and/or SBP are required to complete this form. Submission of this form IS MANDATORY. The data reported here is required for TDA's submission of the FNS-834 and FNS-742 to USDA.

Your completed submission is due

November 26.

How to use this form
1. WATCH for error and warning messages. Displayed messages are intended to help ensure the accuracy of your report. If you are unsure how to resolve something, your ESC representative can assist.
2. REVIEW your answers. Prior to final submission, please carefully review your answers to ensure the data is correctly reported.
3. SAVE your progress and return to the form if needed. At the bottom of every page is the option to SAVE. This will send your provided email address a link to continue at a later time. PLEASE NOTE: the Verification Report requirement will not be considered fulfilled until the form is submitted by clicking SUBMIT.
4. SUBMIT your report. After reviewing your answers, click to the next page, complete the attestation statements, and click SUBMIT. You will see a confirmation message displayed on screen. Multiple submissions are not permitted. If you need to resubmit your Verification Report, please contact DirectCertification@TexasAgriculture.gov for assistance.
5. RETAIN a copy of your confirmation email. A PDF copy of your submission will be sent to your email as documentation of your submission.
6. RESOLVE any errors or warnings. If TDA identifies any errors after submission, you may be contacted by TDA or your ESC representative to make corrections. You can access the original submission through an edit link provided in the confirmation email.

PLEASE COMPLETE ALL SECTIONS
DEFINITIONS

CE - Contracting Entity

CEP - Community Eligibility Provision

ESC - Education Service Center

RCCI - Residential Child Care Institution

SFA - School Food Authority

TDA - Texas Department of Agriculture

The standard USDA verification report (FNS-742) refers to SFAs while the term most commonly used by TDA for program sponsors is CE. For the purposes of this report, all references to program sponsors will be CE.

The standard USDA verification report refers to alternative provisions while the term most commonly used by TDA to refer to Provision 2 and CEP is special provisions. For the purposes of this report, all references will be to special provisions.

The following information can be found in your TX-UNPS CE Application.
Type of Organization*
ESC Region*
Type Public
Type Private
CE ID*
CE Name*
School Year From*
School Year To*
CE City*
Found as CE Street Address
CE Zip Code*
Found as CE Street Address
CE ID, CE Name, CE City, CE Zip Code Data Source:

PDI - Daily SNP Site Tracking; I:PDI_ReportsFNDaily_Site_Tracking
Verification Report Contact

The Verification Report Contact does not have to be the child nutrition director. It should be the person submitting the report.
Reporting Contact - Name*

First NameLast Name
Reporting Contact - Email*
example@example.com
Reporting Contact - Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Reporting Contact - Title*
A TDA or an ESC representative may need to contact the person that completed verification activities if errors are identified or clarification on your submission is needed.
Did you personally complete verification activity?*

YesNoNo, verification activity was not required.
Please provide the contact information for the person that completed verification activity.
Verification Contact - Name*

First NameLast Name
Verification Contact - Email*
example@example.com
Verification Contact - Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Verification Contact - Title*
Attestation Statements

Confirm the following statements are true prior to continuing.
Authorized Representative*

I confirm I am an Authorized Representative of the Contracting Entity as the User Access Manager listed on the Certificate of Authority for User Access Manager (FND-135) or a user assigned by the authorized User Access Manager prior to the submission of this report.
Employed by CE*

I confirm I am employed by the CE named on this submission. I am not an employee of a Food Service Management Company (FSMC).
INSTRUCTIONS

ANNUALLY, each CE, including ALL RCCIs, with schools approved to operate the National School Lunch Program (NSLP) and/or School Breakfast Program (SBP) must report verification information. All CEs, including CEs with all schools exempt from verification requirements, must complete applicable sections.

CEs that are Special Milk Only are exempt from filing an CE Verification Collection Report.

Please proceed to Section 1.

All CEs must report Section 1.

For ALL schools/institutions approved to operate the NSLP and/or SBP as of October 31 report:
- TOTAL number of schools and/or institutions
- TOTAL enrollment
As of October 31, how many SCHOOLS operated NSLP and/or SBP? [1-1 A]*
Do NOT include RCCIs
As of October 31, how many total STUDENTS were enrolled at these schools? [1-1 B]*
Do NOT include RCCI students
Students per School Check
! Cannot report one or more students enrolled in zero schools. Please review the numbers reported.
! The total number of students cannot be less than the total number of schools. Please review the numbers reported.
> The total number of students per school is much higher than expected. Please review the numbers reported.
As of October 31, did the CE operate any RCCI sites?*

NoYes
As of October 31, how many RCCIs operated NSLP and/or SBP? [1-2 A]*
As of October 31, how many STUDENTS were enrolled at these RCCIs? [1-2 B]*
Students per RCCI Check
Total Schools/RCCIs Check
Total Students Check
Students per School/RCCI Check
! You are reporting zero sites and zero students. Please review the numbers reported.
! Cannot report one or more students enrolled in zero RCCIs. Please review the numbers reported.
! You reported the CE operated RCCIs but are also reporting zero RCCIs sites and/or students. Please review your responses.
! The total number of students cannot be less than the total number of RCCIs. Please review the numbers reported.
> The total number of students per RCCI is much higher than expected. Please review the numbers reported.
> The total number of schools and RCCIs reported is much higher than expected. Please review the number of schools and RCCIs reported.
> The total number of schools reported is equal to the total number of RCCIs reported. This is highly unusual. Please review the number of schools and RCCIs reported.
How many of the RCCIs reported had DAY students? [1-2a A]*
Do NOT include RCCIs with NO DAY students
How many DAY students attend the RCCIs reported in 1-2 a A? [1-2a B]*
Do NOT include residential students
How many of the RCCIs reported had NO day students? [1-2b A]*
How many residential students attend the RCCIs reported in 1-2b A? [1-2b B]*
Total RCCI Check
Total RCCI Student Check
! Cannot report zero students. If there were no students enrolled on October 31st, do not report the site.
! You are reporting all RCCI students are DAY students. Please review your responses.
! Cannot report one or more students enrolled in zero schools. Please review the numbers reported.
! The total number of students cannot be less than the total number of schools. Please review the numbers reported.
! The number of RCCIs with day students + RCCIs with no day students does not equal the TOTAL number of RCCIs reported as operating NSLP and/or SBP. Please review the numbers reported.

If there is only 1 institution that has both day and residential students, enter the information only for RCCIs with DAY students.
! The number of DAY students + residential students reported is greater than the TOTAL number of RCCI students reported above. Please review the numbers reported.

If there is only 1 institution that has both day and residential students, enter the information only for RCCIs with DAY students.

Only CEs with special provisions (CEP or Provision 2) must report Section 2.

Report schools or institutions operating the NSLP and/or SBP under special provisions as of October 31.
Are there any schools and/or RCCIs operating under special provisions?*

NoYes
* You are reporting there are no schools and/or RCCIs operating under special provisions (Provision 2 and CEP). If this is accurate, the remaining fields in Section 2 are not required.

Please proceed to Section 3.
Are ALL schools and/or RCCIs operating under special provisions?*

NoYes
As of October 31, how many SCHOOLS and/or RCCIs were operating Provision 2 in a BASE year? [2-1 A]*
As of October 31, how many STUDENTS were enrolled at schools and/or RCCIs operating Provision 2 in a BASE year? [2-1 B]*
! Cannot report one or more students enrolled in zero schools. Please review the numbers reported.
! The number of schools cannot be greater than the number of students. Please review the numbers reported.
! The number of schools and/or RCCIs reported as Provision 2 in a BASE year cannot be greater than the total number of schools and/or RCCIs reported in Section 1.

You reported a total of {totalSchoolsrccis} schools and/or RCCIs in Section 1. Please review the numbers reported in Section 1 and Section 2.
! The number of students reported as Provision 2 in a BASE year cannot be greater than the total number of students reported in Section 1.

You reported a total of {totalStudents116} students in Section 1. Please review the numbers reported in Section 1 and Section 2.
As of October 31, how many SCHOOLS and/or RCCIs were operating Provision 2 in a NON BASE year? [2-2 A]*
As of October 31, how many STUDENTS were enrolled at schools and/or RCCIs operating Provision 2 in a NON BASE year? [2-2 B]*
! Cannot report one or more students enrolled in zero schools. Please review the numbers reported.
! The number of schools cannot be greater than the number of students. Please review the numbers reported.
! The number of schools and/or RCCIs reported as Provision 2 in a NON BASE year cannot be greater than the total number of schools and/or RCCIs reported in Section 1.

You reported a total of {totalSchoolsrccis} schools and/or RCCIs in Section 1. Please review the numbers reported in Section 1 and Section 2.
! The number of students reported as Provision 2 in a NON BASE year cannot be greater than the total number of students reported in Section 1.

You reported a total of {totalStudents116} students in Section 1. Please review the numbers reported in Section 1 and Section 2.
How many of these students were reported as FREE in a NON BASE year? [2-2a B]*
How many of these students were reported as REDUCED PRICE in a NON BASE year? [2-2b B]*
NON BASE F/RP Students Check
! The number of FREE and REDUCED PRICE students cannot be greater than the total number of students reported as enrolled for Provision 2 NON BASE year. Please review the numbers reported.
! The number of students reported as FREE in a NON BASE year cannot be greater than the total number of students reported in Section 1.

You reported a total of {totalStudents116} students in Section 1. Please review the numbers reported in Section 1 and Section 2.
! The number of students reported as REDUCED PRICE in a NON BASE year cannot be greater than the total number of students reported in Section 1.

You reported a total of {totalStudents116} students in Section 1. Please review the numbers reported in Section 1 and Section 2.
As of October 31, how many SCHOOLS were operating the Community Eligibility Option (CEP)? [2-3 A]*
RCCIs are not eligible to operate CEP
As of October 31, how many STUDENTS were enrolled at schools operating CEP? [2-3 B]*
! Cannot report one or more students enrolled in zero schools. Please review the numbers reported.
! The number of schools cannot be greater than the number of students. Please review the numbers reported.
! The number of schools reported as CEP cannot be greater than the total number of schools reported in Section 1.

You reported a total of {asOf34} schools in Section 1. Please review the numbers reported in Section 1 and Section 2.
! The number of students reported as CEP cannot be greater than the total number of students reported in Section 1.

You reported a total of {number35} students enrolled in schools in Section 1. Please review the numbers reported in Section 1 and Section 2.
How many schools and/or RCCIs are operating other alternatives? [2-4 A]
How many students are enrolled? [2-4 B]
How many schools and/or RCCIs are operating a special provision for NSLP ONLY or SBP ONLY? [2-5 A]
How many students are enrolled? [2-5 B]
Total Schools/RCCIs Special Provision Check
Total Students Special Provision Check
Non-Base Year Schools Special Provision Check
Non-Base Year Students Special Provision Check
! You reported schools and/or RCCIs are operating under special provisions, but you are also reporting zero schools and zero students as Provision 2 and CEP.
! The total number of schools and/or institutions reported as operating special provisions cannot be greater than the total number of schools and/or institutions reported in Section 1.

You reported a total of {totalSchoolsrccis} schools and/or RCCIs in Section 1 and a total of {totalSchoolsrccis102} schools and/or RCCIs in Section 2. Please review the numbers reported in Section 1 and Section 2.
! The total number of students reported as enrolled at special provision schools and/or institutions cannot be greater than the total number of students reported in Section 1.

You reported a total of {totalStudents116} students in Section 1 and a total of {totalStudents} students in Section 2. Please review the numbers reported in Section 1 and Section 2.
! You reported ALL schools and/or RCCIs are operating special provisions. However, the number of schools and/or RCCIs reported as special provision does not equal the total number of schools reported in Section 1.

You reported a total of {totalSchoolsrccis} schools and/or RCCIs in Section 1 and a total of {totalSchoolsrccis102} schools and/or RCCIs in Section 2. Please review the numbers reported in Section 1 and Section 2.
! You reported ALL schools and/or RCCIs are operating special provisions. However, the number of students reported as special provision does not equal the total number of students reported in Section 1.

You reported a total of {totalStudents116} students in Section 1 and a total of {totalStudents} students in Section 2. Please review the numbers reported in Section 1 and Section 2.

TDA is required to report the specific program eligibility of directly certifiied students attending special provision sites to USDA.

This section is intended to collect more detail on the total number of students already reported in Section 2, which includes students enrolled in:
- schools and/or RCCIs operating Provision 2 in a NON-BASE year
- schools operating CEP
NOTE: Program eligibility for directly certified students enrolled at Provision 2 BASE year schools [2-1A, 2-1B] will be reported in Supplementary Section 3.

To be directly certified, a student must appear on a State list pulled from Texas ELMS or on a Local List. *

Rows	Number of students directly certified as of October 31
SNAP [S2-1]
TANF [S2-2]
MEDICAID FREE [S2-3]
MEDICAID REDUCED PRICE [S2-4]
FDPIR [S2-5]
FOSTER [S2-6]
MIGRANT [S2-7]
HOMELESS [S2-8]
RUNAWAY [S2-9]
HEADSTART/EARLY HEADSTART [S2-10]

Supplementary Section 2 Student Check
! The total number of directly certified Provision 2 NON BASE year and CEP students cannot be greater than the total number of students reported in Section 1.

You reported a total of {totalStudents116} students in Section 1 and a total of {supplementarySection158} students in this section. Please review the numbers reported in Section 1 and Supplementary Section 2.

Supplementary Section 2 is intended to collect additional information about the students already reported in Section 2.
! The total number of directly certified Provision 2 NON BASE year and CEP students cannot be greater than the total number of Provision 2 NON-BASE YEAR and CEP students reported in Section 2.

You reported a total of {nonbaseYear} Provision 2 NON BASE year and CEP students in Section 2 and a total of {supplementarySection158} students in this section. Please review the numbers reported in Section 2 and Supplementary Section 2.

Supplementary Section 2 is intended to collect additional information about the students already reported in Section 2.

All CEs must report Section 3.
Are ALL schools and/or RCCIs in the CE exempt from direct certification?*

NoYes
CEs that meet ANY of the following criteria should select YES above:
- All sites participate in CEP or Provision 2 in a NON BASE year.
- All sites are RCCIs with no day students.
- All sites are RCCIs with day students that remain enrolled at the home district.
* Based on your responses in Section 1 and Section 2, you have reported:
- at least one school NOT operating under Provision 2 in a Non-BASE year or CEP or
- at least one RCCI with day students
Please review the criteria above and the numbers reported in Sections 1 and 2.
3-1. Check the box only if ALL schools and/or RCCIs are not required to perform direct certification.*

Checked: I confirm that all schools and/or RCCIs are not required to perform direct certification.Not Checked
* You are reporting all schools and/or RCCIs were not required to perform direct certification. If this is accurate, the remaining fields in Section 3 are not required.

Please proceed to Section 4.
! Please select CHECKED to confirm direct certification was not required for your SFA.
Direct certification is the process by which the student is certified eligible based on documentation received directly from the applicable program (e.g. SNAP or TANF agency) through Texas ELMS. This process eliminates the need for the household to submit an application.

Report students approved FREE eligible through direct certification as of October 31 for all schools and/or RCCIs that are:
- operating Provision 2 in a BASE YEAR
- NOT operating under special provisions.
As of October 31, how many students were directly certified as FREE through SNAP (Supplemental Nutrition Assistance Program)? [3-2]*
NOTE: If a student is directly certified with SNAP as well as with another program, report the student in the SNAP count. Also include in this count any student deemed eligible based on extended categorical eligibility via an eligible student in the primary household who has been directly certified with SNAP.
! The number of students directly certified through SNAP cannot be greater than the total number of students reported in Section 1.

You reported a total of {totalStudents116} students in Section 1. Please review the numbers reported in Section 1 and Section 3.
As of October 31, how many students were directly certified as FREE through a program other than SNAP? [3-3]*
NOTE: DO NOT include SNAP students already reported. Include students directly certified through Temporary Assistance for Needy Families (TANF), Food Distribution Program on Indian Reservations (FDPIR), or Medicaid FREE (if applicable) and those documented as homeless, migrant, runaway, foster, or Head Start/Pre-K Even Start. Also include students in the CE deemed eligible due to extended categorical eligibility via an eligible student in the primary household directly certified with TANF, FDPIR, or Medicaid-FREE.
! The number of students directly certified through programs other than SNAP cannot be greater than the total number of students reported in Section 1.

You reported a total of {totalStudents116} in Section 1. Please review the numbers reported Section 1 and Section 3.
As of October 31, how many students approved as FREE were directly certified via the SNAP letter method? [3-4]*
Direct Certification Check
! The total number of students reported as directly certified cannot be greater than the total number of students reported in Section 1.

You reported a total of {totalStudents116} in Section 1. Please review the numbers reported Section 1 and Section 3.

TDA is required to report the specific program eligibility of directly certifiied students to USDA.

This section is intended to collect more detail on the total number of students already reported in Field 3-3 as directly certified through programs other than SNAP as well as students directly certified through Medicaid Reduced Price.

Only include students enrolled in schools and/or RCCIs:
- operating Provision 2 in a BASE YEAR
- NOT operating special provisions
NOTE: All students reported in 3-3 should be reported below.

To be directly certified, a student must appear on a State list pulled from Texas ELMS or on a Local List. *

Rows	Number of students directly certified as of October 31
TANF [S3-1]
MEDICAID FREE [S3-2]
MEDICAID REDUCED PRICE [S3-3]
FDPIR [S3-4]
FOSTER [S3-5]
MIGRANT [S3-6]
HOMELESS [S3-7]
RUNAWAY [S3-8]
HEADSTART/EARLY HEADSTART [S3-9]

Supplementary 3 DC Other Check
Supplementary 3 DC Other FREE Check
Supplementary 3 DC Other + SNAP Check
! The total number of students reported as directly certified as FREE through other programs (all fields except Medicaid Reduced Price) in this section does not equal the number of students reported as directly certified as FREE through other programs in Section 3.

You reported a total of {asOf167} students directly certified as FREE through other programs in Section 3 and a total of {supplementary3197} students directly certified as FREE in this section. Please review the numbers reported Section 3 and Supplementary Section 3.

Supplementary Section 3 is intended to collect additional information about those students already reported in Section 3.
! The total number of students reported as directly certified through other programs cannot be greater than the total number of student reported in Section 1.

You reported a total of {totalStudents116} students in Section 1 and a total of {supplementary3} students in this section. Please review the numbers reported Section 1 and Supplementary Section 3.
! The total number of students reported as directly certified through SNAP and other programs cannot be greater than the total number of students reported in Section 1.

You reported a total of {totalStudents116} students in Section 1, a total of {asOf163} SNAP students in Section 3, and a total of {supplementary3} directly certified students in this section. Please review the numbers reported in Section 1, Section 3, and Supplementary Section 3.

All CEs collecting applications must report Section 4.
* In Section 3, you reported all schools and/or RCCIs are operating CEP or Provision 2 in a NON BASE year.

If this is accurate, select NO.
Did any schools and/or RCCIs collect household applications to determine FREE and REDUCED PRICE eligibility?*

NoYes
* You are reporting NO schools and/or RCCIs collected household applications. If this is accurate, the remaining fields in Section 4 are not required.

Please proceed to Section 5.
Report the number of
- APPLICATIONS approved as of October 1
- STUDENTS approved as of October 31
REMINDER: The reported number of APPLICATIONS as of October 1st does not change if the students' eligibility changes prior to the last day of October.

For example, if a student on a categorically eligible application is directly certified during the month of October, the number of applications reported will remain the same, but the number of students reported will be only those that are still eligible by application as of October 31st.
Approved as categorically FREE eligible

Based on those providing documentation (e.g. a case number for SNAP, TANF, FDPIR on an application)
As of October 1, how many APPLICATIONS were approved as categorically FREE eligible? [4-1 A]*
As of October 31, how many STUDENTS were approved as categorically FREE eligible? [4-1 B]*
NOTE: Include students in the SFA deemed eligible due to extended categorical eligibility via an eligible student in the primary household categorically FREE eligible with SNAP, TANF, or FDPIR through a household application.
CAT FREE Students per Application
> You have reported one or more approved students on zero applications. Please review the numbers reported. Do not report the same students in both Section 3 and Section 4.
Categorically Free Enrollment Confirmation

I confirm students enrolled after October 1 and submitted an application approved as categorically free.
> The number of applications approved as categorically FREE eligible exceeds the number of students on those applications. Only in rare circumstances would there be more approved applications than students, even when considering the difference in reporting dates for the two fields. Please review the numbers reported.
> You are reporting an unexpectedly high average number of students per application. Please review the numbers reported.

Do not report the same students in both Section 3 and Section 4.
> The number of students is equal to the number of applications. This is unusual. Please review the numbers reported.
> The number of students reported as approved as categorically FREE eligible based on an application and the number of students reported as directly certified through SNAP are the same. This is highly unusual. Please review the numbers reported in Section 3 and Section 4.

Do not report the same students in both Section 3 and Section 4.
> The number of students reported as approved as categorically FREE eligible based on an application and the number of students reported as directly certified through programs other than SNAP are the same. This is highly unusual. Please review the numbers reported in Section 3 and Section 4.

Do not report the same students in both Section 3 and Section 4.
Approved as FREE eligible based on income

Based on household size and income information
As of October 1, how many APPLICATIONS were approved as FREE eligible based on income information? [4-2 A]*
As of October 31, how many STUDENTS were approved as FREE eligible based on income information? [4-2 B]*
FREE Students per Application
> You have reported one or more approved students on zero applications. Please review the numbers reported. Do not report the same students in both Section 3 and Section 4.
FREE Income Enrollment Confirmation

I confirm students enrolled after October 1 and submitted an application approved as free eligible based on income information.
> The number of applications approved as FREE eligible should not exceed the number of students on those applications. Only in rare circumstances would there be more approved applications than students, even when considering the difference in reporting dates for the two fields. Please review the numbers reported.
> You are reporting an unexpectedly high average number of students per application. Please review the numbers reported.
> The number of students is equal to the number of applications. This is unusual. Please review the numbers reported.
Approved as REDUCED PRICE eligible based on income

Based on household size and income information
As of October 1, how many APPLICATIONS were approved as REDUCED PRICE eligible based on income information? [4-3 A]*
As of October 31, how many STUDENTS were approved as REDUCED PRICE eligible based on income information? [4-3 B]*
REDUCED PRICE Students per Application
> You have reported one or more approved students on zero applications. Please review the numbers reported. Do not report the same students in both Section 3 and Section 4.
REDUCED PRICE Income Enrollment Confirmation

I confirm students enrolled after October 1 and submitted an application approved as reduced price eligible based on income information.
> The number of applications approved as REDUCED PRICE eligible should not exceed the number of students on those applications. Only rare circumstances would there be more applications than students, even when considering the difference in reporting dates for the two fields. Please review the numbers reported.
> You are reporting an unexpectedly high average number of students per application. Please review the numbers reported.
> The number of students is equal to the number of applications. This is unusual. Please review the numbers reported.
> Total free and reduced price students reported in Section 3 and Section 4 should be greater than zero when reporting Provision 2 schools in a BASE year in Section 2. This may not be the case only if renewing with data in lieu of applications. Please review the numbers reported in Section 2, Section 3, and Section 4.
! You reported collecting applications but have reported zero approved applications and zero students. Please review the numbers reported.
! The number of approved applications cannot be greater than the total number of students reported in Section 1.

You reported a total of {totalStudents116} students in Section 1 and a total of {totalApproved} approved applications in this section. Please review the numbers reported in Section 1 and Section 4.
! The number of students in CEP and Provision 2 NON BASE year schools and/or RCCIs, plus the number of students approved through direct certification, plus the number of students approved by application cannot be greater than the total number of students reported in Section 1.

You reported a total of {totalStudents116} students in Section 1, {nonbaseYear} CEP and Provision 2 NON BASE year students in Section 2, {directCertification} directly certified students in Section 3, and {totalApproved221} application approved students in this section.

Please review the numbers reported in Section 1, Section 2, Section 3, and Section 4.

If you reported students in special provision schools, only those students in Provision 2 BASE YEAR schools need to be reported in Section 3 and Section 4.
! The total number of FREE and REDUCED PRICE students cannot be greater than the total number of students reported in Section 1.

You reported a total of {totalStudents116} in Section 1, and a total of {t1Total} FREE eligible students and {t2Total} REDUCED PRICE students in Sections 2, 3, and 4.

Please review the numbers reported in Section 1, Section 2, Section 3, and Section 4.

If you reported students in special provision schools, only those students in Provision 2 BASE YEAR schools need to be reported in Section 3 and Section 4.
Total Income Applications
Total Approved Applications
Total Approved Students
T1 Total FREE Eligible (2-2aB + 3-2B + 3-3B + 3-4B + 4-1B + 4-2B)
T2 Total REDUCED PRICE Eligible (2-2bB + 4-3B)
T1 + T2
T1 + T2 - P2
Total Students Check 2 (Special Provision + DC + Applications)

All CEs must report Section 5.
Verification activities are NOT required for:
• schools/RCCIs in which all children have been certified under direct certification procedures including children documented as eligible foster, migrant, runaway or homeless children;
• RCCIs which do not have day students;
• schools electing the Community Eligibility Option;
• schools in which all children are served with no separate charge for food service and no special cash assistance is claimed, (i.e., nonpricing programs claiming only the paid rate of reimbursement);
• all schools are Provision 2 schools in a NON BASE year;
• schools which do not have any free or reduced price eligible students
Based on the above, are ALL schools and/or RCCIs in your CE exempt from verification?*

NoYes
* In Section 3, you reported ALL schools and/or RCCIs are operating CEP or Provision 2 in a NON BASE year. If this is accurate, please select YES.
* In Section 4, you reported that no schools and/or RCCIs collected household applications for verification. If this is accurate, please select YES.
! You reported at least one household application was collected but are also reporting all schools are exempt from verification. Please review the responses reported in Section 4 and Section 5.
5-1. Check the box if ALL schools and/or RCCIs are exempt from verification.*

Checked: I confirm that ALL schools and/or RCCIs are exempt from verification.Not Checked
* You are reporting that ALL schools and/or RCCIs are exempt from verification.

If this is accurate, the remaining fields in Section 5 are not required. Please proceed to Review My Responses.
! Please select CHECKED to confirm verification activity was not required for your SFA.
Was verification performed and completed? [5-2]*

Yes, completed by November 15thYes, completed after November 15thNo, verification was NOT performed or the process was not completed
! You reported at least one approved household application but are also reporting you did NOT complete the verification process. If this is accurate, no further reporting in Section 5 is required. Please proceed to Review My Responses.
! You reported zero approved household applications in Section 4 but are also reporting verification was performed. Please review the numbers reported in Section 4.

If no household applications were approved as of October 1st, you are exempt from verification and should select "Checked" for question 5-1 above.
Which verification sampling method did you use? [5-3]*

Standard - Lesser of 3% or 3,000 error-prone applicationsAlternate 1 - Lesser of 3% or 3,000 randomly selected applicationsAlternate 2 - Lesser of 1% or 1,000 error-prone applications + lesser of 0.5% or 500 categorically eligible applications (SNAP/TANF/FDPIR case number provided)
! You reported zero approved household applications in Section 4 but are also reporting a verification sampling method. Please review the numbers reported in Section 4.

If no household applications were approved as of October 1st, you are exempt from verification and should select checkbox 5-1.
! You reported you did NOT complete the verification process but are also reporting a verification sampling method. Please review your responses.
How many error-prone applications were approved as of October 1? [5-4]*
Report ALL approved applications considered error-prone as of October 1
! The number of error-prone applications reported equals the total number of income eligible household applications. This is highly unlikely. Please review the number of error-prone applications reported and the numbers reported in Section 4.
! The number of error-prone applications reported is greater than the total number of income eligible household applications. Please review the number of error-prone applications reported and the numbers reported in Section 4.
How many applications were selected for the verification sample? [5-5]*
! The number of applications selected for the verification sample is greater than the total number of approved household applications. Please review the numbers reported in Section 4 and the sample size reported.
! You reported at least one approved application in Section 4 but reported a sample size of 0. If verification was completed, a minimum sample size of 1 is required. Please review the numbers reported in Section 4, answers provided in Section 5, and the sample size reported.
! You reported the verification process was completed but reported a sample size of 0. If verification is completed, a minimum sample size of 1 is required. Please review the numbers reported in Section 4, answers provided in Section 5, and the sample size reported.
! You reported a sampling method but reported a sample size of 0. If verification is completed, a minimum sample size of 1 is required. Please review the numbers reported in Section 4, answers provided in Section 5, and the sample size reported.
> The sample size reported may be incorrect based on the number of approved household applications reported in Section 4 and the sampling method reported in Section 5. Please review the numbers reported in Section 4 and answers provided in Section 5.
Standard Sampling Method - Correct Sample Size (Calculated)
Standard Sampling Method - Correct Sample Size (Max)
Alternate 1 Sampling Method - Correct Sample Size (Calculated)
Alternate 1 Sampling Method - Correct Sample Size (Max)
Pt1 Alternate 2 Check - 1%
Pt2 Alternate 2 Check - 0.05%
Alternate 2 Sampling Method - Correct Sample Size (Calculated)
Applications verified for cause
Were there any questionable applications verified for cause that were NOT included in the verification sample and were verified as of November 15th?*

NoYes
How many applications were verified for cause in addition to the verification sample? [VC-1]*
! The number of applications reported as being verified for cause is greater than the total number of approved applications. Please review the numbers reported in Section 4 and Section 5.
Sample + VC Applications
In the results sections that follow include the verification results of applications
- selected for the verification sample
- verified for cause.
Applications confirmed through DIRECT VERIFICATION
Was direct verification (Texas ELMS) used in an attempt to confirm eligibility for any applications in your verification sample or any applications verified for cause?*

NoYes
5-6. If direct verification was NOT used, select "Checked" to confirm.*

Checked: I confirm that the CE DID NOT use direct verification.Not Checked
* You are reporting that direct verification was not used. If this is correct, please continue to the next field.
! Please select CHECKED to confirm direct verification was not used.
* Be careful not to confuse direct verification with direct certification. Only applications that were selected for verification AND THEN confirmed as eligible through direct verification should be reported here.
How many APPLICATIONS were confirmed as FREE or REDUCED PRICE eligibility through direct verification as of November 15th? [5-7 A]*
SNAP, TANF, FDPIR, MEDICAID
How many STUDENTS were confirmed as FREE or REDUCED PRICE eligibility through direct verification as of November 15th? [5-7 B]*
> You reported direct verification was performed but reported zero directly verified applications. Please confirm your answer and review the numbers reported.
> You reported direct verification was performed but reported zero directly verified students. Please confirm your answer and review the numbers reported.
! You reported at least one directly verified student on zero applications. Please review the numbers reported.
! The number of directly verified applications cannot exceed the number of directly verified students. Please review the numbers reported.
! The number of applications reported as being directly verified is greater than the total number of approved applications reported in Section 4. Please review the numbers reported in Section 4 and Section 5.
! The number of applications reported as being directly verified is equal to the total number of applications selected for verification (sample size + verified for cause). This is highly unlikely. Please review the numbers reported.
! The number of applications reported as being directly verified is greater than the total number of applications selected for verification (sample size + verified for cause). Please review the numbers reported.
> The number of directly verified students is equal to the number of directly verified applications. This is unusual. Please review the numbers reported.
TDA is required to report the specific program eligibility of directly verified students to USDA.

This section is intended to collect more detail on applications and students already reported as directly verified above.

DV Breakout Total Applications
DV Breakout Total Students
! You reported {howMany291} directly verified applications in Field 5-7A. The number of directly verified applications reported in this section does not equal the number of directly verified applications reported above. Please review the numbers reported.

This section is intended to collect additional information about those students already reported as directly verified in Field 5-7A.
! You reported {number292} directly verified students in Field 5-7B. The number of directly verified students reported in this section does not equal the number of directly verified students reported above. Please review the numbers reported.

This section is intended to collect additional information about those students already reported as directly verified in Field 5-7B.
Results of application verification by Original Benefit Type
* Report the results of verification (sample and verified for cause) by original benefit type for each result category as of November 15th .

Do NOT include any applications and students already reported as confirmed through direct verification.
A. Applications originally approved as FREE-Categorically Eligible

CAT FREE R No Change Apps
CAT FREE R No Change Students
CAT FREE R Reduced Apps
CAT FREE R Reduced Students
CAT FREE R Paid Apps
CAT FREE R Paid Students
CAT FREE NR Paid Apps
CAT FREE NR Paid Students
CAT FREE Total Applications
CAT FREE Total Students
! In Section 4, you reported (0) zero categorically free applications, but you are also reporting results from verifying categorically free eligible applications in this section. Please review the numbers reported in Section 4 and Section 5-8 A.
! The number of applications cannot be greater than the number of students for the FREE- Categorically Eligible fields 1. Responded, NO CHANGE. Please review the numbers reported in Section 5-8 A.
! The number of applications cannot be greater than the number of students for the FREE- Categorically Eligible fields 2. Responded, Changed to REDUCED PRICE. Please review the numbers reported in Section 5-8 A.
! The number of applications cannot be greater than the number of students for the FREE- Categorically Eligible fields 3. Responded, Changed to PAID. Please review the numbers reported in Section 5-8 A.
! The number of applications cannot be greater than the number of students for the FREE- Categorically Eligible fields 4. NOT Responded, Changed to PAID. Please review the numbers reported in Section 5-8 A.
B. Applications originally approved as FREE-Income

FREE Income R No Change Apps
FREE Income R No Change Students
FREE Income R Reduced Apps
FREE Income R Reduced Students
FREE Income R Paid Apps
FREE Income R Paid Students
FREE Income NR Paid Apps
FREE Income NR Paid Students
FREE Income Total Applications
FREE Income Total Students
! In Section 4, you reported (0) zero free income applications, but you are also reporting results from verifying free income applications in this section. Please review the numbers reported in Section 4 and Section 5-8 B.
! The number of applications cannot be greater than the number of students for the FREE- Income fields 1. Responded, NO CHANGE. Please review the numbers reported in Section 5-8 B.
! The number of applications cannot be greater than the number of students for the FREE- Income fields 2. Responded, Changed to REDUCED PRICE. Please review the numbers reported in Section 5-8 B.
! The number of applications cannot be greater than the number of students for the FREE- Income fields 3. Responded, Changed to PAID. Please review the numbers reported in Section 5-8 B.
! The number of applications cannot be greater than the number of students for the FREE- Income fields 4. NOT Responded, Changed to PAID. Please review the numbers reported in Section 5-8 B.
C. Applications originally approved as REDUCED PRICE-Income

RP Income R NO CHANGE Apps
RP Income R NO CHANGE Students
RP Income R Free Apps
RP Income R Free Students
RP Income R Paid Apps
RP Income R Paid Students
RP Income NR Paid Apps
RP Income NR Paid Students
RP Income Total Applications
RP Income Total Students
! In Section 4, you reported (0) zero reduced price income applications, but you are also reporting results from verifying reduced price income applications in this section. Please review the numbers reported in Section 4 and Section 5-8 C.
! The number of applications cannot be greater than the number of students for the REDUCED PRICE- Income fields 1. Responded, NO CHANGE. Please review the numbers reported in Section 5-8 C.
! The number of applications cannot be greater than the number of students for the REDUCED PRICE- Income fields 2. Responded, Changed to FREE. Please review the numbers reported in Section 5-8 C.
! The number of applications cannot be greater than the number of students for the REDUCED PRICE- Income fields 3. Responded, Changed to PAID. Please review the numbers reported in Section 5-8 C.
! The number of applications cannot be greater than the number of students for the REDUCED PRICE- Income fields 4. NOT Responded, Changed to PAID. Please review the numbers reported in Section 5-8 C.
Verified Applications Total: DV + Verified
Verified Students Total: DV + Verified
! You indicated you completed verification but the total number of applications reported in the results of direct verification and verification by original benefit type does not equal the reported sample size.

All applications selected for the verification sample should be reported in the results sections. Please review the numbers reported.
! You indicated you completed verification but the total number of applications reported in the results of direct verification and verification by original benefit type does not equal the reported sample size plus any applications verified for cause. Please review the numbers reported.

The only exception would be for applications that were verified for cause after October 1st, and for which there are no results yet to report. In this case, the difference must not be more than the number of applications verified for cause.
! The number of applications reported in the results of direct verification and verification by original benefit type is greater than the total number of approved applications reported in Section 4. Please review the numbers reported in Section 4 and Section 5.

PLEASE REVIEW YOUR RESPONSES

Continue to the next page to SUBMIT
GENERAL INFORMATION
CE ID
CE Name
Type of CE - Public
Type of CE - Private
School Year From
School Year To
CE City
CE Zip Code
SECTION 1

Total Schools, Residential Child Care Institutions (RCCIs) and Enrolled Students
1-1: Total Schools (Do not include RCCIs):
1-1 A. Number of Schools OR Institutions
1-1 B. Number of Students
1-2: Total RCCIs (Do not include schools counted in 1-1):
1-2 A. Number of Schools OR Institutions
1-2 B. Number of Students
1-2a: RCCIs with day students (Report ONLY day students in 1-2aB):
1-2a A. Number of Schools OR Institutions
1-2a B. Number of Students
1-2b: RCCIs with NO day students:
1-2b A. Number of Schools OR Institutions
1-2b B. Number of Students
SECTION 2

CEs with schools operating special provisions
2-1: Operating Provision 2/3 in a BASE year for NSLP and SBP:
2-1 A. Number of Schools OR Institutions
2-1 B. Number of Students
2-2: Operating Provision 2/3 in a NON BASE year for NSLP and SBP:
2-2 A. Number of Schools OR Institutions
2-2 B. Number of Students
2-2a B. Number of Students reported as FREE
2-2b B. Number of Students reported as REDUCED PRICE
2-3: Operating the Community Eligibility Provision (CEP):
2-3 A. Number of Schools OR Institutions
2-3 B. Number of Students
2-4: Operating other special provisions for NSLP and SBP:
2-4 A. Number of Schools OR Institutions
2-4 B. Number of Students
2-5: Operating a special provision(s) for only SBP or only NSLP:
2-5 A. Number of Schools OR Institutions
2-5 B. Number of Students
SUPPLEMENTARY SECTION 2

Breakout of directly certified students in CEP and NON-BASE YEAR special provision schools
S2-1 SNAP
S2-2 TANF
S2-3 MEDICAID-FREE
S2-4 MEDICAID-REDUCED PRICE
S2-5 FDPIR
S2-6 FOSTER
S2-7 MIGRANT
S2-8 HOMELESS
S2-9 RUNAWAY
S2-10 HEADSTART/EARLY HEADSTART
SECTION 3

Students approved as FREE eligible NOT subject to verification
3-1: Check the box only if all schools and/or RCCIs in the CE were not required to perform direct certification with SNAP (i.e. NON BASE year Provision 2/3 for all schools).
3-1
3-2: Students directly certified through Supplemental Nutrition Assistance Program (SNAP):
3-2 B. Number of Students
3-3: Students directly certified through other programs:
3-3 B. Number of Students
3-4: Students certified categorically FREE eligible through SNAP letter method:
3-4 B. Number of Students
SUPPLEMENTARY SECTION 3

Breakout of students directly certified at schools/RCCIs NOT operating special provisions or operating Provision 2 in a BASE YEAR
S3-1 TANF
S3-2 MEDICAID-FREE
S3-3 MEDICAID-REDUCED PRICE
S3-4 FDPIR
S3-5 FOSTER
S3-6 MIGRANT
S3-7 HOMELESS
S3-8 RUNAWAY
S3-9 HEADSTART/EARLY HEADSTART
SECTION 4

Students approved as FREE or REDUCED PRICE eligible through a household application
4-1: Approved as categorically FREE Eligible:
4-1 A. Number of Applications
4-1 B. Number of Students
4-2: Approved as FREE Eligible:
4-2 A. Number of Applications
4-2 B. Number of Students
4-3: Approved as REDUCED PRICE Eligible:
4-3 A. Number of Applications
4-3 B. Number of Students
T-1
T-2
SECTION 5

Results of household application verification
5-1. Check the box if ALL schools and/or RCCIs are exempt from verification
5-1
5-2: Was verification performed and completed?
5-2 Yes, by November 15th
5-2 Yes, after November 15th
5-2 No, not performed or completed
5-3: Type of verification process used:
5-3 Standard
5-3 Alternate One
5-3 Alternate Two
5-4: Total ERROR PRONE applications:
5-5: Number of applications selected for verification sample:
5-6. Check the box if direct verification was not conducted in the CE, (i.e. not one of the schools and/or RCCIs in the CE performed direct verification).
5-6
5-7: Confirmed through direct verification:
5-7 A. Number of Applications
5-7 B. Number of Students
5-8: Results of Verification by Original Benefit Type
5-8 A. FREE-Categorically Eligible:
5-8 A1. Responded, NO CHANGE
5-8 A1a. Number of Applications
5-8 A1b. Number of Students
5-8 A2. Responded, Changed to REDUCED PRICE
5-8 A2a. Number of Applications
5-8 A2b. Number of Students
5-8 A3. Responded, Changed to PAID
5-8 A3a. Number of Applications
5-8 A3b. Number of Students
5-8 A4. Not Responded, Changed to PAID
5-8 A4a. Number of Applications
5-8 A4b. Number of Students
5-8 B. FREE Income:
5-8 B1. Responded, NO CHANGE
5-8 B1a. Number of Applications
5-8 B1b. Number of Students
5-8 B2. Responded, Changed to REDUCED PRICE
5-8 B2a. Number of Applications
5-8 B2b. Number of Students
5-8 B3. Responded, Changed to PAID
5-8 B3a. Number of Applications
5-8 B3b. Number of Students
5-8 B4. Not Responded, Changed to PAID
5-8 B4a. Number of Applications
5-8 B4b. Number of Students
5-8 C. REDUCED PRICE Income:
5-8 C1. Responded, NO CHANGE
5-8 C1a. Number of Applications
5-8 C1b. Number of Students
5-8 C2. Responded, Changed to FREE
5-8 C2a. Number of Applications
5-8 C2b. Number of Students
5-8 C3. Responded, Changed to PAID
5-8 C3a. Number of Applications
5-8 C3b. Number of Students
5-8 C4. Not Responded, Changed to PAID
5-8 C4a. Number of Applications
5-8 C4b. Number of Students
VC-1: Total questionable applications verified for cause
SUPPLEMENTARY SECTION 5

Breakout of directly verified applications
S5-1 A. SNAP - Applications
S5-1 B. SNAP - Students
S5-2 A. TANF - Applications
S5-2 B. TANF - Students
S5-3 A. MEDICAID-FREE - Applications
S5-3 B. MEDICAID-FREE - Students
S5-4 A. MEDICAID-REDUCED PRICE - Applications
S5-4 B. MEDICAID-REDUCED PRICE - Students
S5-5 A. CHIP-FREE - Applications
S5-5 B. CHIP-FREE - Students
S5-6 A. CHIP-REDUCED PRICE - Applications
S5-6 B. CHIP-REDUCED PRICE - Students

Attestation Statements

Confirm the following statements are true prior to submitting.
Reported Information*

I confirm I understand it is the CE’s responsibility to accurately complete this report by the submission deadline and that non-compliance may result in adverse action.
Documentation*

I confirm that the CE has retained documentation related to the information submitted in this report.
Should be Empty:

Rows	Number of Applications	Number of Students
SNAP [S5-1]
TANF [S5-2]
Medicaid Free [S5-3]
Medicaid Reduced Price [S5-4]
CHIP Free [S5-5]
CHIP Reduced Price [S5-6]

Rows	Number of Applications	Number of Students
Responded - NO CHANGE [5-8 A1]
Responded - Changed to REDUCED PRICE [5-8 A2]
Responded - Changed to PAID [5-8 A3]
NOT Responded - Changed to PAID [5-8 A4]

Rows	Number of Applications	Number of Students
Responded - NO CHANGE [5-8 B1]
Responded - Changed to REDUCED PRICE [5-8 B2]
Responded - Changed to PAID [5-8 B3]
NOT Responded - Changed to PAID [5-8 B4]

Rows	Number of Applications	Number of Students
Responded - NO CHANGE [5-8 C1]
Responded - Changed to FREE [5-8 C2]
Responded - Changed to PAID [5-8 C3]
NOT Responded - Changed to PAID [5-8 C4]