Monthly Reimbursement Calculation Worksheet - Nutrition Services (CA Dept of Education)

California Department of Education

Child Nutrition Fiscal Services

Revised (07/2015)

Summer Food Service Program

Monthly Reimbursement Calculation Worksheet

Reimbursement rates change on an annual basis. Please consult the United States Department of Agriculture Web site at current Federal reimbursement rates. Transfer meal counts from the claim form to the appropriate sectionsof this worksheet and multiply the meals by the reimbursement rates.

Month _____ Year ______

Breakfast Operating Reimbursement

Total Reimbursable Meals / Breakfast Operating Rate / Operating Reimbursement Amount
x / =

Breakfast Administrative Reimbursement

Total Reimbursable Meals / Breakfast Self-Prep and/or Vended Rural Administrative Rate / Administrative Reimbursement Amount
x / =
Total Reimbursable Meals / Breakfast Vended-Urban Administrative Rate / Administrative Reimbursement Amount
x / =

(A) Total Breakfast Reimbursement $ ______

AM SnackOperating Reimbursement

Total Reimbursable Meals / AM Snack Operating Rate / Operating Reimbursement Amount
x / =

AM Snack Administrative Reimbursement

Total Reimbursable Meals / AM Snack Self-Prep and/or Vended Rural Administrative Rate / Administrative Reimbursement Amount
x / =
Total Reimbursable Meals / AM Snack Vended-Urban Administrative Rate / Administrative Reimbursement Amount
x / =

(B) Total AM Snack Reimbursement $ ______

LunchOperating Reimbursement

Total Reimbursable Meals / Lunch Operating Rate / Operating Reimbursement Amount
x / =

LunchAdministrative Reimbursement

Total Reimbursable Meals / Lunch Self-Prep and/or Vended Rural Administrative Rate / Administrative Reimbursement Amount
x / =
Total Reimbursable Meals / Lunch Vended-Urban Administrative Rate / Administrative Reimbursement Amount
x / =

(C) Total LunchReimbursement $ ______

PM SnackOperating Reimbursement

Total Reimbursable Meals / PM Snack Operating Rate / Operating Reimbursement Amount
x / =

PM Snack Administrative Reimbursement

Total Reimbursable Meals / PM Snack Self-Prep and/or Vended Rural Administrative Rate / Administrative Reimbursement Amount
x / =
Total Reimbursable Meals / PM Snack Vended-Urban Administrative Rate / Administrative Reimbursement Amount
x / =

(D) Total PMSnack Reimbursement $ ______

SupperOperating Reimbursement

Total Reimbursable Meals / Supper Operating Rate / Operating Reimbursement Amount
x / =

SupperAdministrative Reimbursement

Total Reimbursable Meals / Supper Self-Prep and/or Vended Rural Administrative Rate / Administrative Reimbursement Amount
x / =
Total Reimbursable Meals / Supper Vended-Urban Administrative Rate / Administrative Reimbursement Amount
x / =

(E) Total SupperReimbursement $ ______

Community Child Nutrition Snack Pilot(CCNSP)Operating Reimbursement

Total Reimbursable Meals / CCNSP Operating Rate / Operating Reimbursement Amount
x / =

CCNSP Administrative Reimbursement

Total Reimbursable Meals / CCNSP Self-Prep and/or Vended Rural Administrative Rate / Administrative Reimbursement Amount
x / =
Total Reimbursable Meals / CCNSP Vended-Urban Administrative Rate / Administrative Reimbursement Amount
x / =

(F) Total CCNSP Reimbursement $ ______

Total Reimbursement for this Month (A) + (B) + (C) + (D) + (E) + (F) =$ ______