Georgia Department of Education
School Nutrition Program
1662 Twin Towers East
Atlanta, Georgia 30334
FREE AND REDUCED-PRICE MEALS POLICY STATEMENT
SCHOOL YEAR 2011-2012
KEEP THIS BOOKLET ON FILE
In accordance with State and Federal law, the Georgia Department of Education prohibits discrimination on the basis of race, color, religion, national origin, sex, disability, or age in its educational and employment activities. Inquiries regarding the application of these practices may be addressed to the General Counsel of the Georgia Department of Education, 2052 Twin Towers East, Atlanta, Georgia, 30334, (404) 656-2800.
In accordance with Federal Law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write USDA, Director, Office of Adjudication, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call toll free (866) 632-9992 (Voice). Individuals who are hearing impaired or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer.

Georgia Department of Education

School Nutrition Program

FREE AND REDUCED–PRICE MEALS POLICY WORKSHEET SY 2011-2012

Free and Reduced-Price Meals Policy Statement

The governing body of this School Food Authority (SFA) accepts this Free and Reduced-Price MealsPolicy Statement, including the Family Income Eligibility Criteria and all required attachments, as referred to or indicated below:

Item 1: GENERAL INFORMATION

A. NAME OF SCHOOL FOOD AUTHORITY:______

B. NAME OF SCHOOL NUTRITION DIRECTOR/MANAGER:______

C. Check all that apply:

_____1. School Breakfast Program*

_____2. National School Lunch Program**

_____a. Meal Supplement for Afterschool Care Program

_____b. Seamless Summer Option

D. Indicate the Operation Methods of the School Nutrition Programs checked above:

(Check all that apply)

______Pricing______Provision 1, 2, 3PublicCharter

______Non-Pricing______RCCI Private Regular

**.40 Maximum Reduced-Price Lunch*.30 Maximum Reduced-Price Breakfast

Item 2: COLLECTION AND SERVICE PROCEDURES

Collection methods will be the same as used in the 2010-2011 School Year.

Yes _____ No _____ If no, complete section on next page.

Georgia Department of Education

Dr. John D. Barge, State School Superintendent

June 2011 • Page 1 of 124

“This institution is an equal opportunity provider.”

Item 2: Collection and Service Procedures

List collection and service procedures used by your school(s). (See Attachment J). If your procedure is not listed in Attachment J (Collection and Service Procedures) provide detailed description of the procedure on Attachment N (Alternate Collection Method) for pre-approval. Use multiple lines for schools with more than one collection procedure; indicate grade levels for each procedure.
School Name / Menu Planning
Option / Collection and Service Procedures / Offer vs. Serve
Breakfast / Lunch
Breakfast / Lunch
S / C / P / S / C / P / Yes/No / Yes/No

Menu Planning Option: T-Traditional, N-Nutrient Standard, A-Assisted Nutrient Standard, E-Enhanced
Collection Methods: S-School Counting Procedure, C-Code Procedure, P-Payment Methods
If additional lines are needed for school listing/procedure continue on the next page.

Item 2: Collection and Service Procedures

List collection and service procedures used by your school(s). (See Attachment J). If your procedure is not listed in Attachment J (Collection and Service Procedures) provide detailed description of the procedure on Attachment N (Alternate Collection Method) for pre-approval. Use multiple lines for schools with more than one collection procedure; indicate grade levels for each procedure.
School Name / Menu Planning
Option / Collection and Service Procedures / Offer vs. Serve
Breakfast / Lunch
Breakfast / Lunch
S / C / P / S / C / P / Yes/No / Yes/No

Menu Planning Option: T-Traditional, N-Nutrient Standard, A-Assisted Nutrient Standard, E-Enhanced
Collection Methods: S-School Counting Procedure, C-Code Procedure, P-Payment Methods

If needed make additional copies of this page and continue.

Item 2: Collection and Service Procedures

List collection and service procedure(s) used by your school(s). (See Attachment J). If your procedure is not listed in Attachment J (Collection and Service Procedures) provide detailed description of the procedure on Attachment N (Alternate Collection Method) for pre-approval. Use multiple lines for schools with more than one collection procedure; indicate grade levels for each procedure.
School Name / Meal Supplement for Afterschool Care Programs
School Counting Procedure / Code Procedure / Payment Method

Georgia Department of Education

Dr. John D. Barge, State School Superintendent

June 2011 • Page 1 of 124

“This institution is an equal opportunity provider.”

Item 3: TITLES OF DESIGNATED OFFICIALS

A. DETERMINING OFFICIAL: ______

Address & Telephone ______

B. HEARING OFFICIAL: ______

Address & Telephone ______

C. VERIFICATION OFFICIAL: ______

Address & Telephone ______

D. CONFIRMING OFFICIAL: ______

Address & Telephone ______

E. FOLLOW-UP OFFICIAL: ______

Address & Telephone ______

Item 4: MEAL ACCOUNTABILITY PROCEDURE (Check One)

I certify that my system is using at a minimum the STATE PROTOTYPE MEAL ACCOUNTABILITY PROCEDURE (Attachment K)

Enclosed is my system MEAL ACCOUNTABILITY PROCEDURE for approval by the State Department of Education

Item 5: FREE AND REDUCED PARENT LETTER/APPLICATION

(Select the application/parent letter you are using)

______Family instructions/application (Attachment B)

______Family parent letter (Attachment B)

______Special Assistance Certification and Reimbursement Alternatives II/III parent letter (Attachment F)

Alternate application

Alternate parent letter

Item 6: VERIFICATION (Refer to Attachment L) (Check Method Used)

__Basic Sample Alternate-Random Alternate-Focused ___ No Verification Performed

Item 7: ATTACHMENTS

The following attachments are adopted with and considered part of this policy statement:

Attachment A -Eligibility Standards for Free and Reduced-Price Meals

Attachment B -Free and Reduced-Price School Meals Household Application

Attachment C -Sharing Information Letter with Medicaid/PeachCare for Kids

Attachment D -Sharing Information Letter with Other Programs

Attachment E - Notification of Eligibility Determination

Attachment F -Special Assistance Certification and Reimbursement Alternatives II/III Parent Letter

Attachment G -Special Assistance Certification and Reimbursement Alternatives II/III List of Assurances

Attachment H -Statewide Direct Certification Plan and Procedures

Attachment I -Georgia Online (GO) Screen Instructions

Attachment J -Collection and Service Procedures

Attachment K -State Prototype Meal Accountability Procedure

Attachment L -General Guidelines for Verification

Attachment M -Public Release (Distributed by State)

Attachment N -Alternate Collection Method

Attachment O -RACF ID Application

Attachment P -On-Site Review

Attachment Q -Edit Checks

Attachment R -Prototype Disclosure of Free and Reduced-Price Information Agreement

Attachment S -Civil Rights Compliance Requirements

Attachment T -Spanish Version of Application and Verification Letters

Attachment U -Seamless Summer Option

Attachment V -Meal Supplement for Afterschool Care Program

THIS AGREEMENT IS HEREBY EXECUTED ON BEHALF OF THE:
SCHOOL FOOD AUTHORITY / GEORGIADEPARTMENT OF EDUCATION
(Original Signature)
BY: / (Original Signature)
BY:
Nancy Rice
Title: Superintendent, Local School Food Authority / Title: Director, School Nutrition Program
Date: / Date:

Georgia Department of Education

Dr. John D. Barge, State School Superintendent

June 2011 • Page 1 of 124

“This institution is an equal opportunity provider.”