Official State of Nebraska website - Return to Nebraska.gov

National School Lunch Program - NSLP

Forms & Resource Center

National School Lunch and Breakfast Programs

Permanent Agreement and Attachments A-L

Attachment

Name/Description Adobe Format Microsoft Word Format
NDE 01-010 Permanent Agreement and Free/Reduced Price Policy Statement pdf  
Attachment A  Income Eligibility Guidelines pdf  
Attachment B Letter to Households pdf doc
Attachment B-1 Letter to Household for Milk Only Schools pdf doc
Attachment C Application for Free and Reduced Price Meals pdf doc
Attachment C-1 Application for Free Milk for Milk Only Schools pdf doc
Attachment D Notice of Approval/Denial Letter pdf doc
Attachment D-1 Notice of Approval/Denial Letter for Milk Only Schools pdf doc
Attachment D-3 Notice of Change in Benefits Letter pdf doc
Attachment E Computing Income for Self-Employed Persons pdf doc
Attachment F Verification Selection Letter and Enclosures pdf doc
Attachment G Verification Results Letter pdf doc
Attachment H Verification Procedures Questionnaire pdf  
Attachment H-1 Civil Rights Summary pdf doc
Attachment H-2 Verification Tracker pdf doc
Attachment I On-Site Review Summary pdf doc
Attachment J Edit Check Worksheet pdf doc
Attachment J-R Edit Check Worksheet for RCCIs only pdf doc
Attachment K-1 Breakfast Food-Based Production Record pdf doc
Attachment K-2 Lunch Food Based Production Record pdf doc
Attachment K-3 Multi-Day Food/Condiment Bar Production Record pdf doc
Attachment K-4 Single-Day Food Bar Production Record pdf doc
Attachment K-5 Multi-Day Food/Condiment Bar Production Record for RCCI with a 7 Day week pdf doc
Attachment K-6 After School Snack Program Weekly Production Record pdf doc
  After School Snack - On-Site Review Summary (2 required each year) pdf doc
Attachment L Sharing Information Waiver – Optional pdf doc
Attachment L-1 Sharing Information with Medicaid/SCHIP - Optional pdf doc

NUTRITION SERVICES > FORMS AND RESOURCE CENTER > NATIONAL SCHOOL LUNCH AND BREAKFAST PROGRAM >ATTACHMENTS