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Home > Data Center > Reporting Forms > Child Nutrition Services > Child Nutrition Applications / School Lunch/Breakfast Program Forms > LEA Verification Summary Report

Must be Submitted by November 20 Yearly

Local Educational Agency (LEA) Verification Summary Report

EFN90 Instructions

All fields MUST be filled in, if nothing to report place a "0" in the column.

Use the tab key to get to the next required field.

District (SAU) Name:

Email of Person Completing Form: (example: child.nutrition@maine.gov)
Contact Name:
Contact Telephone Number: (example: 123-4567)
Type of SAU: Public Private (Check one that applies)
School Year
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it contains a valid OMB control number. The valid OMB control number for this collection is 0584-0026. The time required to complete this information collection is 6 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

1. Type of Free/Reduced Priced Application Used Household

 

 

Report items 2 through 5 as of the first operating day in October

A. All Schools

(Maximum of 4 digits)

 

B. Provision 2 or 3 Schools WHICH ARE NOT OPERATING A BASE YEAR

(Maximum of 4 digits)

2. Number of schools and RCCIs Operating the NSLP and/or SBP

3. Number of enrolled students with access to the NSLP (or SBP for SBP only schools)

 

 

A. # of Students

(Maximum of 4 digits)

B. # of Approved Applications

(Maximum of 4 digits)

4. Total FREE ELIGIBLE reported

 

4-1. # approved as FREE ELIGIBLE who are not subject to verification (directly certified, homeless liaison list, income-eligible Head start, pre-K Even start, residential students in RCCIs, non-applicants approved by local officials)

 

4-2. # approved as FREE ELIGIBLE based on FS/TANF/FDPIR case number submitted on an application (Categorically Eligible)

4-3. #approved as FREE ELIGIBLE based on income/household size information submitted on an application

4-4. # FREE ELIGIBLES reported for Provision 2 or 3 Schools WHICH ARE NOT OPERATING A BASE YEAR

5. Total REDUCED PRICE ELIBIBLE reported

5-1. # reduced price eligibles reported for Provision 2 or 3 schools WHICH ARE NOT OPERATING A BASE YEAR

 

 

II. RESULTS OF VERIFICATION, BY APPLICATION TYPE

6. Type of Verification Used: Error Prone as Required or Alternate Method with State Agency Approval

 

Items 7 through 11 are required and are reported as of the date of completion of the verification process (see instructions). Item 12 is optional and is reported as of February 15.

 

A. FREE ELIGIBLE based on FS/TANF/FDPIR Application (Categorically Eligible)

(Maximum of 4 digits)

B. FREE ELIGIBLE based on Income/Household Size Application (Income Eligible)

(Maximum of 4 digits)

C. REDUCED PRICE ELIGIBLE

(Maximum of 4 digits)

7. No Change

# applications

 

# students

8. Responded, Changed to Free

# applications

 

# students

9. Responded, Changed to Reduced Price

# applications

 

# students

10. Respond, Changed to Paid

# applications

 

# students

11. Did Not Respond

# applications

 

# students

12. Reapplied and Reapproved on or Before Feb. 15

# applications

 

# students