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Attachments A-L – Permanent Agreement

Forms & Resource Center

National School Lunch and Breakfast Programs

Permanent Agreement and Attachments A-L


Name/DescriptionAdobe FormatMicrosoft Word Format
NDE 01-010Permanent Agreement and Free/Reduced Price Policy Statementpdf 
Attachment A Income Eligibility Guidelinespdf 
Attachment BLetter to Householdspdfdoc
Attachment B-1Letter to Household for Milk Only Schoolspdfdoc
Attachment CApplication for Free and Reduced Price Mealspdfdoc
Attachment C-1Application for Free Milk for Milk Only Schoolspdfdoc
Attachment DNotice of Approval/Denial Letterpdfdoc
Attachment D-1Notice of Approval/Denial Letter for Milk Only Schools pdfdoc
Attachment D-3Notice of Change in Benefits Letterpdfdoc
Attachment EComputing Income for Self-Employed Personspdfdoc
Attachment FVerification Selection Letter and Enclosurespdfdoc
Attachment GVerification Results Letterpdfdoc
Attachment HVerification Procedures Questionnairepdf 
Attachment H-1Civil Rights Summarypdfdoc
Attachment H-2Verification Trackerpdfdoc
Attachment IOn-Site Review Summarypdfdoc
Attachment JEdit Check Worksheetpdfdocxls
Attachment J-REdit Check Worksheet for RCCIs onlypdfdoc
Attachment K-1Breakfast Food-Based Production Recordpdfdoc
Attachment K-2Lunch Food Based Production Recordpdfdoc
Attachment K-3Multi-Day Food/Condiment Bar Production Recordpdfdoc
Attachment K-4Single-Day Food Bar Production Recordpdfdoc
Attachment K-5Multi-Day Food/Condiment Bar Production Record for RCCI with a 7 Day weekpdfdoc
Attachment K-6After School Snack Program Weekly Production Recordpdfdoc
 Attachment MAfter School Snack – On-Site Review Summary (2 required each year)pdfdoc
Attachment LSharing Information Waiver – Optionalpdfdoc
Attachment L-1Sharing Information with Medicaid/SCHIP – Optionalpdfdoc