West Virginia Department of Education
Office of Child Nutrition
Annual Agreement Information Update Instructions
Please review the information on the enclosed Annual Agreement Information Update
for accuracy pertaining to school year 2004-2005. If information is inaccurate, draw a
red line through the field and write legibly the correct information. If there are any blank
fields, enter current information or indicate that the information is not applicable by
writing “NA.”
1. Audit Requirement: If you expended more than $300,000 in federal funds on
the food service program last year, please indicate so by checking the
appropriate box. By exceeding the $300,000 threshold, your agency/school is
required to submit an organization wide, OMB Circular A-133 annual audit to the
Office of Child Nutrition.
2. Lobbying Activities: If your school/agency participates in lobbying activities,
please indicate so by checking the appropriate box. If you check “yes” regarding
the lobbying activities, the Certification Regarding Lobbying and the Disclosure of
Lobbying Activities forms will be mailed to you for completion.
3. Public Release: (Public and Private School Sponsors only) State the media
source(s) and the date(s) sent.
4. Program Participation: If not already indicated, state whether the SFA is a
public school, private school or RCCI and check all boxes for programs in which
the sponsor will participate.
SFAs sponsoring a Child and Adult Care Food Program:
Complete the Advanced Options and state whether the sponsor wants to
receive:
• Full Advance Payments
• Partial Advance Payments (Please attach explanation)
• No Advance
Complete the Commodity Option and state whether the sponsor wants to
receive:
• Cash In Lieu or
• Government Donated commodities
5. Point of Service: Check the box indicating the method the sponsor will use for
the Point of Service. Refer to the permanent Sponsor Agreement for method
definitions. If the sponsor has more than one site using different methods, check
all that apply:
• Method 1
Tickets
• Method 2
Coded Roster
• Method 3
Cards/Computer
• Method 4
ID Cards/Manual Recording
• Method 5
Other (Please attach detailed description.)
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6. Offer vs. Serve: If the Annual Agreement Update form does not indicate correct
information, state the offer vs. serve option the SFA will use for all sites
participating. The following chart indicates the offer vs. serve options by school
level for food-based lunch implementation options (Option A, Option B, and
USDA Enhanced Food Based):
Meal Service
Breakfast
Lunch
School Level
Elementary
Offer vs. Serve
3 out of 4 offered or
no offer vs. serve
Middle/Junior High
3 out of 4 offered or
no offer vs. serve
High School
3 out of 4 offered or
no offer vs. serve
Elementary
3 out of 5 offered or
4 out of 5 or
no offer vs. serve
Middle/Junior High
3 out of 5 offered or
4 out of 5 or
no offer vs. serve
Note: In accordance with Federal Regulations 210.10a(2)(e) high schools must
implement an offer vs. serve option for high school students at lunch.
Option for Lunch Implementation: The menu planning option approved last year for
the sponsor is listed. If another option (shown below) will be implemented, please call
the Office of Child Nutrition for guidance. The options for lunch implementation in order
to implement the Dietary Guidelines for Americans are as follows:
•
•
•
•
•
Option A
Option B
NuMenus
Assisted NuMenus
USDA Food Based Menus
7. Key Personnel: In each of the following areas, please indicate the employee
responsible, their title, and, if available, email address:
Edit Checks: Enter the name of the employee who will compare claims
against the school or institution’s average daily attendance or membership
data, and a factor that accurately accounts for the difference between
enrollment and attendance at any given time.
Monitoring NSLP:
Identify person responsible for completing site
monitoring. Each sponsor with more than one school/site shall perform no
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less than one on-site review of each school/site under it’s jurisdiction prior
to February 1 of each school year.
Hearing Official: (For sponsors that use free and reduced price meal
applications). Under the provision of the free and reduced price meal and
free milk policy, the school/institution principal or program director will
review applications and determine eligibility. If a parent, guardian, or adult
household member is dissatisfied with the decision, they can make a
formal complaint and request a hearing to appeal the decision. This
person must be someone not involved in the original eligibility
determinations. It is suggested that the designated hearing official hold a
position at a higher administrative level than the person who reviews the
applications.
Monthly Claim for Reimbursement: Person authorized by the sponsor to
prepare the Monthly Claim for Reimbursement.
F/R Complaint: Person identified to receive complaints regarding free and
reduced meal applications.
Food Service Director: Identify County Food Service Director. (Complete
this area only if you are a public school sponsor.)
Authorized Representative Signature: Signature of person who is authorized to
receive federal reimbursement. If the person indicated has changed, draw a red line
through the field and write the correct name.