Dear Program Sponsor:
Your application to partic
Please keep in mind that ap]
ing milk consumption by cl
this program are for the pi
to serve children.
Importance of Following Yoi
Under the terms of your
serve milk to children in ac
tion form. Failure to follow
the necessity to recover thi
you to deviate from the plan
tion Division, immediately.
Effective Date of Agreemen1
Check Item 4 of the Agri
claiming incentive payment
children on and after that da
ipate in the Special Milk Program has been approved.
proval has been based, in part, on your plan for increas-
hildren. The incentive payments you will receive under
purpose of helping to pay for the additional milk you plan.
ur Plan for Increasing Milk Consumption
Special Milk Program Agreement, you have agred t
cordance with the plan shown in Item 15 of the Applica"
the plan may result in a violation of the Agreement>a i.
e incentive payments made to you. If it -is necessaryor
, be sure to notify the Area Office of the Food Distr,"ib
cement form. This item shows the date you may start
ts. You may report and claim for all milk servedto>,
Rate of Incentive Payment
The rate of incentive payment is 2 cents per half pint for all milk served to children.
EXCEPTION: Schools that also participate in the National School Lunch Program
may not claim reimbursement for the first half pint of milk served as part of the
Type A lunch.
Milk Sales to Children
Your milk service is
of the milk is sold to
2 cents per half pint
If the milk cost you
considered primarily a nonpricingprogram. However, if some
children, you must reduce the price of the milk being sold by
or as near to the 2 cent reduction as possible. For example:
7 cents per half pint, the selling price to the child should be 5
Why You Must Retain Records
According to the terms of the Special Milk Program Agreement, you have agreed
to retain certain records for a period of three years after the close of the fiscal
year to which they pertain. These records are for the purpose of substantiating
your claims for incentive uavments and must be available for review and audit by
What Records Are to be Kept
Invoices Either the daily milk delivery tickets or the monthly statement
by the milk supplier must be kept to substantiate milk purchases. If only
the monthly statement is retained for record purposes, the statement must
show the number of fluid whole milk units purchased, and the price per
unit after discount.
2. Claims for Reimbursement Copies of all claims for reimbursement.
3. Application and Agreement
- Copy of the approved Application, and Agreement.
4. Agreement Extensions and Amendments, and Correspondence Copies of any
extensions of and amendments to the Agreement, and any other correspond-
ence relating to the program.
5. Flavored Milk Certification Statement by the milk supplier certifying that the
flavored milk served is made from fluid whole milk meeting the State's
minimum requirements for butterfat and sanitation. If no flavored milk is
served, you may disregard this item.
6. Adult Consumption Reimbursement cannot
adults. For the purposes of this program
age or over. You have the option of:
be claimed for milk served to
, adults are persons 21 years of
Maintaining a daily record of the number of half pints of milk served to
adults (if you do so, a count must be made daily and the records must
be retained for review and audit purposes), or
percent of total milk purchases as an estimate of adult
EXCEPTION: Schools deduct 5 percent.
camps and institutions maintain a m
milk consumption is almost imposes
rs, at tables where children and adults
service is of this type, you should use
estimate of adult consumption.
lilk service where a count of
;ible, such as service from
are served together. If your
10 percent of total purchases
the method that best fits your particular situation. After one method
has been selected, you may not change unless your request is approved in
writing by the Area Office of the Food Distribution Division.
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How to Speed Payment 3 1262 08860 6651
by following these
simple rules before mailing
that the names
of the sponsor, and school,
on the Application and Agreement forms.
the Special Milk Program Agreement Number is the same
shown on the Application and Agreement forms.
should cover all program operations during a month or other period
of time covered by the claim,
for example: July,
purchases are reported in half-pint units in Item 5 of the
form. For your convenience, the following table shows the number of half
pints contained in the different
Number of Half Pints
items other than fluid whole milk,
either unflavored or flavored. For example: Do not show buttermilk, skim milk,
The total amount of milk
reported in Item 5 must be supported by milk invoices.
on the Claim form are filled out and that all
computations are correct.
form is signed and dated by the authorized repre-
on the form must be
initialed in ink or indelible pencil by the person signing the Claim.