Form FNS 366A FNS 366A PROGRAM AND BUDGET SUMMARY STATEMENT

OMB Control Number 0584-0083
Expiration Date xx/xx/xxxx

Appendix D FNS 366A

1. STATE AND STATE CODE

U.S. DEPARTMENT OF AGRICULTURE
FOOD AND NUTRITION SERVICE

2. LETTER OF CREDIT NO.

PROGRAM AND BUDGET SUMMARY STATEMENT

3. UNIVERSAL IDENTIFIER NUMBER
4. FEDERAL FISCAL YEAR

PART A - BUDGET PROJECTION
4A.

FROM

MONTH

FUNCTION

01

CERTIFICATION

02

COUPON ISSUANCE

03

QUALITY CONTROL

04

MANAGEMENT
EVALUATION

05

50% FUNDING
FRAUD CONTROL

06

75% FUNDING
FRAUD CONTROL

07

ADP OPERATIONS

08

FAIR HEARINGS

09

OTHER ACTIVITIES
(20 + 30)

10

TOTAL (1 - 9)

4B.
YEAR

FEDERAL FISCAL QUARTER ENDING
DECEMBER

MARCH

JUNE

SEPTEMBER

TO

MONTH

YEAR

PROJECTION
TOTALS

5. REMARKS

6. SIGNATURE OF AUTHORIZED OFFICIAL

FORM FNS-366A (12-08) Previous Editions Obsolete

7. NAME AND TITLE

8. DATE

Electronic Form Version Designed in Adobe 10.0 Version

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a Collection of Information unless it
displays a valid OMB control number. The valid OMB control number for this information is 0584-0083. The time required to
complete this information collection is estimated to average 13 hours per response, including the time to review instructions, search
existing data resources, gather the data needed, and complete and review the information collection. If you have any comments
concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to Department of Agriculture,
Clearance Officer, Stop 7602, 1400 Independence Avenue S.W., Washington D.C. 20250-7602.

1. STATE AND STATE CODE

U.S. DEPARTMENT OF AGRICULTURE
FOOD AND NUTRITION SERVICE

2. LETTER OF CREDIT NO.

PROGRAM AND BUDGET SUMMARY STATEMENT

3. UNIVERSAL IDENTIFIER NUMBER
4. FEDERAL FISCAL YEAR

PART A - BUDGET PROJECTION
4A.

FROM

MONTH

FUNCTION

11

E & T 100% GRANT

12

E & T 50% MATCHING

13

E & T DEPENDENT CARE

14

E & T TRANSPORTATION
AND OTHER

15

OPTIONAL WORKFARE

16

OUTREACH

17

NUTRITION EDUCATION

18

REINVESTMENT

19

SAVE

20

PAGE 2 SUBTOTAL

4B.
YEAR

FEDERAL FISCAL QUARTER ENDING
DECEMBER

MARCH

JUNE

SEPTEMBER

TO

MONTH

YEAR

PROJECTION
TOTALS

5. REMARKS

6. SIGNATURE OF AUTHORIZED OFFICIAL

7. NAME AND TITLE

8. DATE

Page 2

1. STATE AND STATE CODE

U.S. DEPARTMENT OF AGRICULTURE
FOOD AND NUTRITION SERVICE

2. LETTER OF CREDIT NO.

PROGRAM AND BUDGET SUMMARY STATEMENT

3. UNIVERSAL IDENTIFIER NUMBER
4. FEDERAL FISCAL YEAR

PART A - BUDGET PROJECTION
4A.

FROM

MONTH

FUNCTION

21

50% FUNDING ADP
DEVELOPMENT

22

63% FUNDING ADP
DEVELOPMENT

23

75% FUNDING ADP
DEVELOPMENT

24

EBT ISSUANCE

25

ISSUANCE INDIRECT

26

EBT STARTUP

27

UNSPECIFIED PORTION
OF OTHER

28

E & T ABAWD GRANT

4B.
YEAR

FEDERAL FISCAL QUARTER ENDING
DECEMBER

MARCH

JUNE

SEPTEMBER

TO

MONTH

YEAR

PROJECTION
TOTALS

29
30

PAGE 3 SUBTOTAL

5. REMARKS

6. SIGNATURE OF AUTHORIZED OFFICIAL

7. NAME AND TITLE

8. DATE

Page 3

PROGRAM AND BUDGET SUMMARY STATEMENT
(Supplemental Nutrition Assistance Program) (SNAP)
PART A - BUDGET PROJECTION
GENERAL. Part A of the Program and Budget
Summary Statement is used to report projections of
Federal funding needs for the upcoming Federal Fiscal
Year. The quarterly budget projections should be
developed in the same functional categories as those
found on the FNS-778 (Financial Status Report). The
budget projections represent the best estimate of
anticipated expenditures to be funded at the
appropriate rate of Federal financial participation for
that category. This report should be updated as
needed. Each update will serve to project anticipated
expenditures for the current year. Data for a category
which was previously submitted but has not changed
should be carried forward onto the updated report.

A narrative justification should be attached to each
Budget Projection Statement, documenting the
assumptions used to arrive at the figures reported.
The narrative should cover as many of the items listed
above, and any other deemed relevant as having a
significant impact on costs. The State agency is not
required to address every contributing factor in every
submission of a Budget Projection Statement. Rather,
the narrative should concentrate on items that account
for increases or decreases in costs from the
preceding submissions and having greatest impact.
Lengthy explanations are not necessary, but pertinent
figures used in the analysis (for example, the inflation
rate or salary rates and benefits) should be included.

DUE DATE: Part A is to be submitted annually, no
later than August 15 of each year. One copy each
should be retained by the respondent State Program
and Finance Directors and the remaining copies sent to
the appropriate FNS Regional Office for approval.

1. CERTIFICATION - Project salaries and fringe benefits
for full or part-time certification and multifunctional
workers for their estimated time actually engaged in
certification of households. Include salaries to be paid
during travel status, estimated travel expenses,
supervisory, clerical, or other support costs, including
related salaries and benefits.

A separate form FNS-366A is required for States to
report any FNS-approved demonstration costs
required to be reported separately. Specify the
project in the Remarks block. Do not include such
separate data in the Statewide FNS-366A for the
regular (coupon/electronic benefit transfer (EBT))
program unless specifically instructed to do so by
FNS.
PROJECTING FUNDING NEEDS: Those responsible for
the form's completion will evaluate any factors of
program activity that impact on program costs,
determine the projected dollar impact of those factors
and adjust the program budget accordingly.
Such analysis normally will take into account, but not
be limited to, the following factors:

2. COUPON ISSUANCE - Project salaries and fringe
benefits for full or part-time issuance and
multifunctional workers for their estimated time
actually engaged in coupon issuance transactions.
Include salaries estimated for travel time spent
traveling from work site to other issuance locations,
estimated travel expenses, fees estimated to be paid
or accrued under contracts which use a transaction
rate, supervisory, clerical, or other support worker
costs, including salaries and benefits. Include the direct
costs for coupon and non-EBT issuance activities.
Include any indirect costs charged as part of a public
assistance cost allocation plan related to coupon
issuance. Indirect costs assigned by cost rates are
reported in "Issuance Indirect" (Row 25).

The number and salary level of employees
Other factors affecting personnel costs including
(1) Anticipated Increases in pay rates or benefits,
and
(2) Reallocations of staff among units or functions,
insofar as these might result in cost increases or
decreases.

3. PERFORMANCE REPORTING - QUALITY CONTROL:
Project salaries and fringe benefits for full or
part-time Quality Control and multifunctional workers
for their estimated time to be actually engaged in
Quality Control activities. Include salaries estimated for
travel, estimated travel expenses, supervisory, clerical,
or other support worker costs, including salaries and
benefits.

Costs for purchasing, leasing, and maintaining
equipment and space, especially concerning
(1) Any upcoming one-time-only purchases of new
capital assets such as ADP equipment,
(2) Renegotiation of leases,
(3) Changes in depreciation rates or procedures,
(4) Relocation of offices,
(5) Maintenance and renovation work, and
(6) Inflation.

4. PERFORMANCE REPORTING - MANAGEMENT
EVALUATION: Project salaries and fringe benefits for
full or part-time Management Evaluation and
multifunctional workers for their estimated time to be
actually engaged in Management Evaluation activities.
Include salaries estimated for travel, estimated travel
expense, supervisory, clerical, or other support
worker costs, including salaries and benefits.

Issuance system costs including:
(1) Renegotiation of issuing agent fee, and
(2) Plans to change issuance systems.
Changes in case load and factors contributing to
increases or decreases in the numbers of
recipients and recertifications, including the
anticipated impact of economic conditions
(and in particular unemployment) and seasonality
Cost implications of corrective action plans
Anticipated changes in program regulations and
operating guides and instructions,
Training needs,
Travel costs, and
Adjustments in insurance premiums.

5. 50% FUNDING - FRAUD CONTROL: Project all
expenses for payroll, equipment, space, and other
support costs of qualified employees that will be
engaged specifically in the investigation and
prosecution of SNAP Fraud Activity. Include only
costs which are to be reimbursed at the 50 percent
Federal Financial Participation rate.
6. 75% FUNDING - FRAUD CONTROL: Project all
expenses for payroll, equipment, space, and other
support costs of qualified employees that will be
engaged specifically in the investigation and
prosecution of SNAP Fraud Activity. Costs for
fraud hearings will also be included, as well as costs
generated through formal agreements with agencies
other than the State agency. Training costs specifically
related to this job function will be reported in this

column. Include only costs which are to be reimbursed at
the 75 percent Federal Financial Participation rate.
7. ADP OPERATIONS: Include funding activity for
operational costs of computer systems which are
charged under an approved cost allocation plan.
Also include any special applicable indirect costs.
8. FAIR HEARINGS: Project salaries and fringe benefits
for full or part-time Fair Hearing or multifunctional workers
for their estimated time to be actually engaged in Fair
Hearing activities. Include salaries estimated for travel
time, estimated travel expenses, supervisory, clerical, or
other support costs.
9. OTHER ACTIVITIES (20+30): Include funding of costs
for all other activities. Include costs for the E & T program,
workfare, SAVE, ADP Development costs at the 50%,
63% or 75% rates, and outreach costs and also report
these costs in items 11-30 on Pages 2 and 3 of this form.
Include costs of any other activity in item 27 and attach a
detailed listing of these costs. These should include but
not be limited to the following where applicable: Indian
Administration costs (show reimbursement level), Wage
Matching, etc. The total of items 20 and 30 must be
reported in item 9.
10. TOTAL: For each quarter, enter the total cost
projection for items 1-9.
11. EMPLOYMENT AND TRAINING (E&T) PROGRAM
GRANT ALLOCATION (100% GRANT): Project for each
quarter of the next Federal fiscal year the amount of 100%
Federal E&T funding the State expects to spend. The
projected amount may not exceed the State's annual
E&T grant allocation. NOTE: If applicable, do not include
projections for line 28: E&T ABAWD GRANT in this
category. Do not include participant reimbursements

in this category.

12. E&T ADMINISTRATIVE COSTS (50% MATCHING):
Project for each quarter of the next fiscal year the amount
in excess of the E&T Program grant allocation (line 11)
and, if applicable, the additional E&T grant allocation for
"pledge" States (line 28), needed to operate the E&T
program in accordance with FNS-approved State E&T
plan. Do not include participant reimbursements in this
category.
13. E&T PARTICIPANT REIMBURSEMENT DEPENDENT CARE: Project for each quarter of the next
Federal fiscal year the funds needed to reimburse E&T
participants for the costs of dependent care incurred as a
result of E&T participation. NOTE: The Federal contribution
may not exceed one-half of the lesser amount of either the
actual cost of dependent care or the applicable payment
rate for child care established in accordance with the Child
Care and Development Block Grant provisions of 45 CFR
98.43.

14. E&T PARTICIPANT REIMBURSEMENT TRANSPORTATION AND OTHER COSTS: Project for
each quarter of the next Federal fiscal year the funds
needed to reimburse E&T participants for the costs of
transportation and other reasonable and necessary costs
(other than dependent care) incurred as a result of E&T
participation.
15. OPTIONAL WORKFARE: For each quarter of the next
Federal fiscal year, enter the operational costs for workfare
programs operated under

Section 20 of the Food and Nutrition Act. These are only
programs which are not included in Employment and
Training Programs. Include the cost when the participant
will be reimbursed for workfare-related expenses such as
transportation, child care, or the cost for personal safety
items or equipment required for performance of work if
these items are also purchased by regular employees.
(Do not include enhanced reimbursement which should be
reported on the SF-270.)
16. OUTREACH: Enter for each quarter of the next Federal
fiscal year the estimated outreach costs. Include as
outreach costs only those costs for Program informational
activities which are included in the State's outreach plan.
17. NUTRITION EDUCATION: Enter for each quarter of
the next Federal fiscal year the estimated nutrition
education costs. Include as nutrition education costs only
those costs for nutrition education activities which are
included in the State's nutrition education plan.
18. REINVESTMENT: No entry is required as there is no
Federal share for reinvestment costs.
19. SYSTEMATIC ALIEN VERIFICATION FOR
ENTITLEMENTS (SAVE): Project for each quarter of the
next Federal fiscal year, the administrative costs of
planning, implementing and operating a SAVE system.
20. PAGE 2 SUBTOTAL: Enter the total of items 11
through 19.
21. 50% FUNDING - ADP DEVELOPMENT: Enter the
computer system development costs which are to be
reimbursed at the Federal Financial Participation rate of
50%. On an attachment provide for each project, the
project name, project ceiling, and amount budgeted.
22. 63% FUNDING - ADP DEVELOPMENT: Enter the
computer system development costs which are to be
reimbursed at the Federal Financial Participation rate of
63%. On an attachment provide for each project, the
project name, project ceiling, and amount budgeted.
23. 75% FUNDING - ADP DEVELOPMENT: Enter the
computer system development costs which are to be
reimbursed at the Federal Financial Participation rate of
75%. On an attachment provide for each project, the
project name, project ceiling, and amount budgeted.
24. EBT ISSUANCE: Enter the salaries and fringe benefits
for full or part time workers engaged in Electronic Benefit
Transfer (EBT) issuance. Include costs to be paid for EBT
issuance under contracts. Enter direct costs and the
indirect costs charged through a public assistance cost
allocation plan. Report indirect EBT issuance costs
charged through an indirect cost rate in "Issuance indirect".
25. ISSUANCE INDIRECT: Enter the indirect costs for
coupon and EBT issuance that are approved for cost
charging through an indirect cost rate. Indirect issuance
costs charged through a public assistance cost allocation
plan are reported under "Coupon issuance" or "EBT
issuance" as appropriate.

26. EBT STARTUP: Enter the EBT system startup costs
incurred after the implementation APD is approved and
prior to issuance of benefits by the EBT system. Costs
approved for planning an EBT system are to be included
in the appropriate ADP Development category. Startup
costs are design, development, and implementation
costs excluding system planning approved by FNS.
Operational costs, including equipment costs, are
included in the "EBT issuance" row.
27. UNSPECIFIED PORTION OF OTHER: Enter that

portion of item 9 "Other Activities" not specifically
identified and recorded in items 11-26 and 28. Include
Wage Matching, etc.
28. E&T ABAWD GRANT: If applicable, project for each
quarter of the next Federal fiscal year the amount of the
unmatched additional Federal grant allocated under
section 16(h)(1)(E) of the Food and Nutrition Act needed to
provide qualifying education/training or workfare
opportunities to every able-bodied adult without
dependents (ABAWD) applicant and recipient subject to
the 3-month SNAP time limit. Since the $20 million
E&T ABAWD allocation will not be made before the
required due date of this form FNS-366A, a participating
pledge State must submit a revised FNS-366A when its
grant is allocated. NOTE: This projection is separate from and must not be included as part of - the EMPLOYMENT
AND TRAINING (E&T) PROGRAM GRANT ALLOCATION
(100% GRANT) on line 11. Do not include participant

reimbursements in this category.

30. PAGE 3 SUBTOTAL: Enter the total of items 21
through 28.
NOTE: The totals from item 30 must be reported in item 9.