Appendix 5-HMI Recognition Awards Notifications

Appendix 4_HMI Recognition Awards Notifications
Notification: Confirmation for Application Submission
OMB BURDEN STATEMENT: The Food and Nutrition Service (FNS) is collecting this information to help
track School Food Authorities’ (SFAs) application progress for the Healthy Meals Incentives Recognition
Awards. The application is a voluntary collection and FNS will use the information to recognize SFAs for
their significant improvements to the nutritional quality of school meals by exceeding the transitional
school meal pattern requirements for sodium and whole grains and by taking steps to reduce added
sugars. This collection does not request personally identifiable information that is subject to the privacy
requirements outlined at 5 U.S.C. §552a(e)3 of the Privacy Act of 1974. According to the Paperwork
Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond
to, a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0584-XXX. The time required to complete this information
collection is estimated to average 30 minutes (0.5 hour) per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information.
Thank you for applying for the Healthy Meals Incentives Recognition Awards. We have received your
application.
For questions regarding your application, please contact us at XXX.
Sincerely,
The Healthy Meals Incentives Team
In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights
regulations and policies, this institution is prohibited from discriminating on the basis of race, color,
national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or
retaliation for prior civil rights activity.
Program information may be made available in languages other than English. Persons with disabilities
who require alternative means of communication to obtain program information (e.g., Braille, large
print, audiotape, American Sign Language), should contact the responsible state or local agency that
administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA
through the Federal Relay Service at (800) 877-8339.
To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA
Program Discrimination Complaint Form which can be obtained online
at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-05080002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter
addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a
written description of the alleged discriminatory action in sufficient detail to inform the Assistant
Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The
completed AD-3027 form or letter must be submitted to USDA by:
1. mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights

Appendix 4_HMI Recognition Awards Notifications
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
2. fax:
(833) 256-1665 or (202) 690-7442; or
3. email:
Program.Intake@usda.gov
This institution is an equal opportunity provider.
___________________________________________________________________________________
Notification: Incomplete Application
OMB BURDEN STATEMENT: The Food and Nutrition Service (FNS) is collecting this information to help
track School Food Authorities’ (SFAs) application progress for the Healthy Meals Incentives Recognition
Awards. The application is a voluntary collection and FNS will use the information to recognize SFAs for
their significant improvements to the nutritional quality of school meals by exceeding the transitional
school meal pattern requirements for sodium and whole grains and by taking steps to reduce added
sugars. This collection does not request personally identifiable information that is subject to the privacy
requirements outlined at 5 U.S.C. §552a(e)3 of the Privacy Act of 1974. According to the Paperwork
Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond
to, a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0584-XXX. The time required to complete this information
collection is estimated to average 30 minutes (0.5 hour) per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information.
After reviewing your application, we have found the following item(s) which requires further action to
complete your application:
 Missing documentation
 Incorrect documentation
 Further clarification needed
For questions regarding your application, please contact us at XXX.
Sincerely,
The Healthy Meals Incentives Team
In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights
regulations and policies, this institution is prohibited from discriminating on the basis of race, color,
national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or
retaliation for prior civil rights activity.
Program information may be made available in languages other than English. Persons with disabilities
who require alternative means of communication to obtain program information (e.g., Braille, large
print, audiotape, American Sign Language), should contact the responsible state or local agency that

Appendix 4_HMI Recognition Awards Notifications
administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA
through the Federal Relay Service at (800) 877-8339.
To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA
Program Discrimination Complaint Form which can be obtained online
at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-05080002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter
addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a
written description of the alleged discriminatory action in sufficient detail to inform the Assistant
Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The
completed AD-3027 form or letter must be submitted to USDA by:
1. mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
2. fax:
(833) 256-1665 or (202) 690-7442; or
3. email:
Program.Intake@usda.gov
This institution is an equal opportunity provider.
_______________________________________________________________________________
Notification: Final Award Status
OMB BURDEN STATEMENT: The Food and Nutrition Service (FNS) is collecting this information to help
track School Food Authorities’ (SFAs) application progress for the Healthy Meals Incentives Recognition
Awards. The application is a voluntary collection and FNS will use the information to recognize SFAs for
their significant improvements to the nutritional quality of school meals by exceeding the transitional
school meal pattern requirements for sodium and whole grains and by taking steps to reduce added
sugars. This collection does not request personally identifiable information that is subject to the privacy
requirements outlined at 5 U.S.C. §552a(e)3 of the Privacy Act of 1974. According to the Paperwork
Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond
to, a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0584-XXX. The time required to complete this information
collection is estimated to average 30 minutes (0.5 hour) per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information.
Template #1: Congratulations! You have received a Healthy Meals Incentives Recognition Award for the
XXX award. Our team reviewed your application and found that all required criteria was met
successfully. Attached please find your recognition awards including a digital badge, XXX, XXX.
Our team will send two follow-up emails to:

Appendix 4_HMI Recognition Awards Notifications
1. Request the names and contact information for two of your team members that would like to
attend the Healthy Meals Summits. During the summits, award recipients will be recognized and
attendees will share best practices and strategies for accomplishing and sustaining your
achievement.
1. Gather more information from you about your achievement, lessons learned and/or best
practices used to apply for Healthy Meals Incentives Recognition Award(s).
We look forward to learning more about your program.
Template #2:
Our team reviewed your application and we regret to inform you that you did not receive the XXX
Award. Please contact our customer service team at XXX for assistance in resubmitting your application.
Sincerely,
The Healthy Meals Incentives Team
In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights
regulations and policies, this institution is prohibited from discriminating on the basis of race, color,
national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or
retaliation for prior civil rights activity.
Program information may be made available in languages other than English. Persons with disabilities
who require alternative means of communication to obtain program information (e.g., Braille, large
print, audiotape, American Sign Language), should contact the responsible state or local agency that
administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA
through the Federal Relay Service at (800) 877-8339.
To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA
Program Discrimination Complaint Form which can be obtained online
at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-05080002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter
addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a
written description of the alleged discriminatory action in sufficient detail to inform the Assistant
Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The
completed AD-3027 form or letter must be submitted to USDA by:
1. mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
2. fax:
(833) 256-1665 or (202) 690-7442; or
3. email:
Program.Intake@usda.gov
This institution is an equal opportunity provider.

Appendix 4_HMI Recognition Awards Notifications
Feedback: Customer Service and Technical Assistance
OMB BURDEN STATEMENT: The Food and Nutrition Service (FNS) is collecting this information to help
obtain feedback from School Food Authorities (SFA) of their application experience for the Healthy
Meals Incentives Recognition Awards. The application is a voluntary collection and FNS will use the
information to recognize SFAs for their significant improvements to the nutritional quality of school
meals by exceeding the transitional school meal pattern requirements for sodium and whole grains and
by taking steps to reduce added sugars. This collection does not request personally identifiable
information that is subject to the privacy requirements outlined at 5 U.S.C. §552a(e)3 of the Privacy Act
of 1974. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and
a person is not required to respond to, a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0584-XXX. The time required to
complete this information collection is estimated to average 30 minutes (0.5 hour) per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information.
Please complete this brief survey to provide us with information about the application process for the
Healthy Meals Incentives Recognition Awards. We appreciate your feedback.
1. Did you utilize the customer service team when completing your application?
Yes
No
Comments:

If so, did you find the customer service team to be helpful?
Yes

No

2. Were the technical assistance and training resources helpful when completing your application?
Yes
No
Comments:

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights
regulations and policies, this institution is prohibited from discriminating on the basis of race, color,
national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or
retaliation for prior civil rights activity.

Appendix 4_HMI Recognition Awards Notifications
Program information may be made available in languages other than English. Persons with disabilities
who require alternative means of communication to obtain program information (e.g., Braille, large
print, audiotape, American Sign Language), should contact the responsible state or local agency that
administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA
through the Federal Relay Service at (800) 877-8339.
To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA
Program Discrimination Complaint Form which can be obtained online
at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-05080002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter
addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a
written description of the alleged discriminatory action in sufficient detail to inform the Assistant
Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The
completed AD-3027 form or letter must be submitted to USDA by:
1. mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
2. fax:
(833) 256-1665 or (202) 690-7442; or
3. email:
Program.Intake@usda.gov
This institution is an equal opportunity provider.

Feedback: Survey for Healthy Meals Summits
OMB BURDEN STATEMENT: The Food and Nutrition Service (FNS) is collecting this information to help
obtain feedback from School Food Authorities (SFA) of their application experience for the Healthy
Meals Incentives Recognition Awards. The application is a voluntary collection and FNS will use the
information to recognize SFAs for their significant improvements to the nutritional quality of school
meals by exceeding the transitional school meal pattern requirements for sodium and whole grains and
by taking steps to reduce added sugars. This collection does not request personally identifiable
information that is subject to the privacy requirements outlined at 5 U.S.C. §552a(e)3 of the Privacy Act
of 1974. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and
a person is not required to respond to, a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0584-XXX. The time required to
complete this information collection is estimated to average 30 minutes (0.5 hour) per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information.
1. Your School Food Authority name and contact information
2. List the Healthy Meals Incentives Recognition Award(s) you received

Appendix 4_HMI Recognition Awards Notifications
3. List two members from your team that will attend the Healthy Meals Summits. During the summits,
award recipients will be recognized and attendees will share best practices and strategies for
accomplishing and sustaining your achievement.
Name:
Title:
Email:
Phone:

Name:
Title:
Email:
Phone:

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights
regulations and policies, this institution is prohibited from discriminating on the basis of race, color,
national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or
retaliation for prior civil rights activity.
Program information may be made available in languages other than English. Persons with disabilities
who require alternative means of communication to obtain program information (e.g., Braille, large
print, audiotape, American Sign Language), should contact the responsible state or local agency that
administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA
through the Federal Relay Service at (800) 877-8339.
To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA
Program Discrimination Complaint Form which can be obtained online
at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-05080002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter
addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a
written description of the alleged discriminatory action in sufficient detail to inform the Assistant
Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The
completed AD-3027 form or letter must be submitted to USDA by:
1. mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
2. fax:
(833) 256-1665 or (202) 690-7442; or
3. email:
Program.Intake@usda.gov
This institution is an equal opportunity provider.

Appendix 4_HMI Recognition Awards Notifications

Feedback: Success Stories
OMB BURDEN STATEMENT: The Food and Nutrition Service (FNS) is collecting this information to help
obtain feedback from School Food Authorities (SFA) of their application experience for the Healthy
Meals Incentives Recognition Awards. The application is a voluntary collection and FNS will use the
information to recognize SFAs for their significant improvements to the nutritional quality of school
meals by exceeding the transitional school meal pattern requirements for sodium and whole grains and
by taking steps to reduce added sugars. This collection does not request personally identifiable
information that is subject to the privacy requirements outlined at 5 U.S.C. §552a(e)3 of the Privacy Act
of 1974. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and
a person is not required to respond to, a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0584-XXX. The time required to
complete this information collection is estimated to average 30 minutes (0.5 hour) per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information.
1.
2.
3.
4.

List the Healthy Meals Incentives Recognition Award(s) you received
How did the Healthy Meals Incentives Recognition Award(s) affect your school meals program?
Did you create new practices in order to apply for an award?
How did you promote your achievement of receiving the Healthy Meals Incentives Recognition
Award(s)?
a. A sample of social media posts, such as a tweet – if applicable.
5. Provide a brief description (1-3 paragraphs) that summarizes highlights of your success story
including:
a. Lessons learned, or best practices used to apply for the Healthy Meals Incentives
Recognition Award(s)?
b. Any pertinent statistics or measurable outcomes you want to highlight?

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights
regulations and policies, this institution is prohibited from discriminating on the basis of race, color,
national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or
retaliation for prior civil rights activity.
Program information may be made available in languages other than English. Persons with disabilities
who require alternative means of communication to obtain program information (e.g., Braille, large
print, audiotape, American Sign Language), should contact the responsible state or local agency that
administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA
through the Federal Relay Service at (800) 877-8339.
To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA
Program Discrimination Complaint Form which can be obtained online
at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-0508-

Appendix 4_HMI Recognition Awards Notifications
0002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter
addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a
written description of the alleged discriminatory action in sufficient detail to inform the Assistant
Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The
completed AD-3027 form or letter must be submitted to USDA by:
1. mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
2. fax:
(833) 256-1665 or (202) 690-7442; or
3. email:
Program.Intake@usda.gov
This institution is an equal opportunity provider.