Supply Chain Assistance (SCA) Funding Questionnaire and Attestation Statement

The following Questionnaire and Attestation Statement is for LEAs that contract with a Food Service Management Company (FSMC) ONLY! Do NOT complete if you are a self opt LEA.

The Authorized Representative of the Local Education Agency (LEA) should answer the following questions.
Do not send this survey or share with the FSMC.

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* 1. Local Education Agency (LEA) Name

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* 2. LEA Agreement Number

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* 3. LEA Authorized Representative Contact Name

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* 4. LEA Authorized Representative Contact Phone Number

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* 5. LEA Authorized Representative Contact E-Mail Address

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* 6. What amount of SCA funding have you spent?

Spent all of SCA Funds

Spent some of SCA funds

Have not spent funds

If you have spent some or none of SCA funding, please indicate the amount of funding liquidated or how much is remaining in your school food service account.

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* 7. How are the funds being utilized for the School Food Program?
Check all that apply.

Purchased local foods including beef or produce

Purchased food outside of the FSMC contract

Paid a portion of FSMC invoice for meals

Paid milk invoices received from the FSMC

Paid a portion of milk invoices

Other (please specify)

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* 8. If you have NOT spent funds please check all that apply.

Need to return funds

Still plan to spend funds

Not sure or undecided

Other (please specify)

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* 9. DESE, FNS has not yet disbursed Round 4 funds to schools that contract with an FSMC Company.
Please complete the following question.

Does the LEA want Round 4 SCA Funds?

Yes

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* 1. Local Education Agency (LEA) Name

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* 2. LEA Agreement Number

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* 3. LEA Authorized Representative Contact Name

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* 4. LEA Authorized Representative Contact Phone Number

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* 5. LEA Authorized Representative Contact E-Mail Address

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* 6. What amount of SCA funding have you spent?

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* 7. How are the funds being utilized for the School Food Program?Check all that apply.

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* 8. If you have NOT spent funds please check all that apply.

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* 9. DESE, FNS has not yet disbursed Round 4 funds to schools that contract with an FSMC Company. Please complete the following question.Does the LEA want Round 4 SCA Funds?

* 7. How are the funds being utilized for the School Food Program?
Check all that apply.

* 9. DESE, FNS has not yet disbursed Round 4 funds to schools that contract with an FSMC Company.
Please complete the following question.

Does the LEA want Round 4 SCA Funds?