TECHNICAL ASSISTANCE NOTE
No. 04-21
Contact:
Nick Baldwin
School Support Services
FOOD AND NUTRITION MANAGEMENT
(850) 245-9330
?
Jim Horne, Commissioner
(800) 504-6609
?
DATE:
?
June 9, 2004
TO:
?
District School Food Service Directors
FROM:
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Diane Santoro, Administrator
Food and Nutrition Management (FNM)
SUBJECT:
ESE-080 Breakfast Program Supplement Report
Attached is the Breakfast Program Supplement Report used to report the number of free and
reduced price breakfast meals that your district claims for reimbursement in elementary schools
for the period July 1, 2003 through June 30, 2004. Only the total free and reduced price
elementary breakfast meals claimed in the School Breakfast Program may be reported. If you
have elementary schools that serve students beyond grade 6, you are only permitted to claim
those meals served to students in grades K-6.
The information submitted in these reports will be used to calculate your district’s portion of the
FY 05 State General Revenue Breakfast Supplement Appropriation. Since the distribution
cannot be calculated until all reports have been received, the deadline for submitting this report is
July 23, 2004.
Your district’s portion of the General Revenue allocation will be distributed in four equal
quarterly installments during FY 05. Please be advised that the final quarterly payment may be
adjusted to ensure that the total amount distributed for the year equals the number of free and
reduced price breakfasts reported multiplied by the calculated difference between per meal
average cost and average reimbursement.
DS/NB/set
Attachment
Please return completed form by
July 23,
2004,
to: Nick Baldwin
Food and Nutrition Management
Florida Department of Education
325 West Gaines Street, Room 1032
Tallahassee, Florida 32399-0400
(850) 245-9330, SunCom 245-9330
FLORIDA DEPARTMENT OF EDUCATION
FOOD AND NUTRITION MANAGEMENT
BREAKFAST PROGRAM
SUPPLEMENT REPORT
1. Name and Address of School District:
2. Number of free and reduced price breakfasts claimed for
reimbursement under the School Breakfast Program (7 CFR
Part 220) during the period of July 1, 2003, through June 30,
2004, in elementary schools*
3. I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THIS REPORT IS
TRUE AND CORRECT IN ALL RESPECTS, THAT RECORDS ARE AVAILABLE TO
SUPPORT THIS REPORT AND THAT MEALS REPORTED QUALIFY FOR PARTICIPATION
IN THIS INCENTIVE GRANT IN ACCORDANCE WITH SECTION 1006.06(5), FLORIDA
STATUTES.
Date of Preparation
Title
Signature of Superintendent or Sponsor
* Elementary schools are those schools with grades kindergarten (KG) through grade six unless the
school goes only through grade five. Kindergarten includes prekindergarten (PK). For this report,
in schools where grades KG through twelve exist, free and reduced price breakfasts must be
reported for grades PK/KG through six only.
NO BREAKFAST MEALS
may be claimed in middle
schools.
ESE 080
Jim Horne, Commissioner
Exp. 05/30/05
Florida Department of Education
