Pretesting for Direct Certification with Medicaid Demonstrations

FNS Generic Clearance For Pre-Testing, Pilot, And Field Test Studies

DCM-FRP Generic OMB Appendix B

Pretesting for Direct Certification with Medicaid Demonstrations

OMB: 0584-0606

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APPENDIX B

ADMINISTRATIVE RECORDS DATA REQUEST

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ADMINISTRATIVE RECORDS DATA REQUEST

Evaluation of Demonstrations of Direct Certification with Medicaid for Free and Reduced-Price Meals (DCM-F/RP)

A key component of the DCM-F/RP demonstration evaluation is an assessment of outcomes related to student certification and participation in the National School Lunch Program (NSLP) and School Breakfast Program (SBP). Therefore, we are asking each State to provide district-level administration records data on certification and participation for two school years (SY): 2015–2016 and 2016–2017.

Certification data

Certification data should be provided depending upon the date of the first DCM-F/RP match:

  1. For states that implemented DCM-F/RP prior to the last operating day in October 2016, data should be provided (a) as of the last operating day in October 2016 AND (b) as of the last operating day in October 2015.

  2. For states that implemented DCM-F/RP after the last operating day in October 2016, data should be provided (a) as of a date chosen shortly after the first DCM-F/RP match in SY 2016–17, AND (b) for the same or closest date in SY 2015–16.

Table 1 lists the data elements that should be included for each district in the certification data files. Districts report most of these data elements, as of the last operating day in October, to the State as part of the process for completing Form FNS-742.

Table 1. Data elements requested in certification file, for each district in the State

Data element

Item number on FNS-742

Total number of SFA’s schools that operate the NSLP or SBP

1-1A

Total number of SFA’s Residential Child Care Institutions (RCCIs) that operate the NSLP or SBP

1-2A

Total number of students enrolled in the SFA’s schools that operate the NSLP or SBP

1-1B

Total number of students enrolled in the SFA’s RCCIs that operate the NSLP or SBP

1-2B

Number of schools or institutions:


  • Operating Provision 2/3 in a base year for NSLP and SBP

2-1A

  • Operating Provision 2/3 in a non-base year for NSLP and SBP

2-2A

  • Operating the Community Eligibility Provision (CEP)

2-3A

  • Operating other alternatives for NSLP and SBP

2-4A

  • Operating an alternative provision for only NSLP or SBP

2-5A

Number of students enrolled in schools or institutions:


  • Operating Provision 2/3 in a base year for NSLP and SBP

2-1B

  • Operating Provision 2/3 in a non-base year for NSLP and SBP

2-2B

  • Operating CEP

2-3B

  • Operating other alternatives for NSLP and SBP

2-4B

  • Operating an alternative provision for only NSLP or SBP

2-5B

Number of students certified for free meals:


  • By application, based on income and household size

4-2B

  • By application, based on categorical eligibility

4-1B

  • By direct certification, based on:a


  • Medicaid

Not reported on FNS-742 (included in 3-3B)

  • Supplemental Nutrition Assistance Program (SNAP)

3-2B

  • Temporary Assistance for Needy Families (TANF)

Not reported on FNS-742 (included in 3-3B)

  • Food Distribution Program on Indian Reservations (FDPIR)

Not reported on FNS-742 (included in 3-3B)

  • Other

Not reported on FNS-742 (included in 3-3B)

  • Both Medicaid and another program

Not reported on FNS-742

  • By SNAP letter method

3-4B

Total number of students certified for free meals

T-1

Number of students certified for reduced-price meals:


  • By application, based on income and household size

4-3B

  • Based on DCM-F/RP

Not reported on FNS-742

Total number of students certified for reduced-price meals

T-2

Average daily attendance in the district

Not reported on FNS-742

School district name

SFA Name

Unique school district ID number

SFA ID#

aWe would like as much detail on the basis of direct certification as is available. If your data system does not include all the categories listed here, please provide any that are available. At a minimum, please provide the numbers for Medicaid, SNAP, and a combined number for other programs. If your data system includes other categories not listed here, please provide that information as well.

bIf your data system does not include all the categories listed here, please provide any that are available. If your data system includes other categories not listed here, please provide that information as well.



In addition, in States where administrative data are available on the complete results of the DCM-F/RP match and the distribution of matched students’ prior certification status and basis, that information should be included. These data should be provided as of the same point in time during SY 2016–2017 as the other certification data elements. They can be included in the same data file or in separate data files (including a common SFA identification number), if that is more convenient for the State.

Participation data

Participation data should be provided for each operating month in SY 2015–2016 and SY 2016–2017. Table 2 lists the data elements that should be included for each district in the monthly participation data files. Districts report most of these data elements to the State as part of the process for generating the State-level information reported on Form FNS-10.

Table 2. Data elements requested in monthly participation files, for each district in the State

Data element

Item number on FNS-10

Number of schools and institutions participating in the NSLP

12a-F, 13a-F, 14a-Fa

Number of students enrolled in these schools and institutions

12b-F, 13b-F, 14b-Fa

Number of reimbursable lunches served, by reimbursement category:


  • Paid

5a-A

  • Free

5a-B

  • Reduced-price

5a-C

  • Total

5a-D

  • Average daily reimbursable lunches served

5a-E

Number of NSLP operating days

Not reported on FNS-10

Number of reimbursable lunches served that qualify district for additional payment

5b1-D

Number of reimbursable lunches served in districts certified for performance-based reimbursement

5b2-D

Number of schools or institutions participating in the SBPb

12a-I, 13a-I, 14a-Ia

Number of students enrolled in these institutions

12b-I, 13b-I, 14b-Ia

Number of severe need schools or institutions

12a-J, 13a-J, 14a-Ja

Number of students enrolled in severe need institutions

12b-J, 13b-J, 14b-Ja

Number of reimbursable breakfasts served, by reimbursement category:


  • Paid

6-A

  • Free

6-B

  • Reduced-price

6-C

  • Total

6-D

  • Average daily reimbursable breakfasts served

6-E

Number of severe need reimbursable breakfasts served, by reimbursement category:


  • Paid

7-A

  • Free

7-B

  • Reduced-price

7-C

  • Total

7-D

  • Average daily severe need reimbursable breakfasts served

7-E

Number of SBP operating days

Not reported on FNS-10

School district name

Not reported on FNS-10

Unique school district ID number

Not reported on FNS-10

aThis data element corresponds to more than one FNS-10 item. States can provide the items separately or report as a sum across the items.

bInclude severe need.



Data delivery timeline

The data files for SY 2015–2016 and the first few months of SY 2016–2017 should be provided as soon as possible after the beginning of data collection. Data for the remaining months of SY 2016–2017 should be provided as they become available.

Data delivery methods

Mathematica can accept the requested data in any standard format, but we prefer Microsoft Excel or SAS file formats. Because these files will contain only aggregate data, with no personally identifiable information on individuals, they may be transmitted via email. However, we recommend encrypting the files before sending.


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleDCM - APPENDIX A-D
SubjectOMB Attachments
AuthorLara Hulsey
File Modified0000-00-00
File Created2021-01-25

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