SFSP 12l Waiver Request - heat and air quality

SFSP 12l Waiver Request - heat and air quality

Child Nutrition Programs are expected to be administered according to all statutory and regulatory requirements; waivers to the requirements are exceptions. However, Section 12(l) of the Richard B. Russell National School Lunch Act, 42 U.S.C. 1760(l), provides USDA authority to waive requirements under certain circumstances.

Summer Food Service sponsors, in good standing, may apply waivers to serve non-congregate meals, allow parent pick up and have flexible meals times when there is excessive heat or poor air quality on a case-by-case basis. Note: if meal times are changed, they cannot be changed less than 24 hours in advance of the previously scheduled meal time. For questions, contact your CDE point of contact.

Contact Name*

Sponsor Name/ID*

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If other, please enter sponsor name

Contact Email*

Name of site(s) that will use the waiver*

Which waivers are being requested?

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Which flexibilities are needed to serve the community in excessive heat.

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Select flexibilities needed to serve the community when there are air quality concerns.

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Describe air quality concerns.

Air quality index confirmation

Air quality waivers may only be used on days when the area is experiencing an Air Quality Index (AQI) “purple” flag or higher. Please check the box to confirm the meal site location meets this requirement. Sponsors must maintain documentation of the AQI per recordkeeping requirements.

Describe heat conditions.

Excessive heat confirmation

Excessive heat waivers may only be used on days when the National Weather Service (NWS) has issued a Heat Advisory, an Excessive Heat Warning, or an Excessive Heat Watch. Please check the box to confirm the meal site location meets this requirement. Sponsors must maintain documentation of excessive heat per recordkeeping requirements.

What challenges would sponsors face without these waivers? Choose all that apply.

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Describe the other challenges

If approved, what benefits will these flexibilities provide?

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Describe other benefits

If parents or guardians will pick up meals, please describe how the sponsor will maintain program integrity and accountability.*

This includes processes to ensure that meals are only distributed to parents or guardians of eligible children, and that duplicate meals are not distributed to any child.

Please describe how food safety requirements will be maintained when serving non-congregate meals.*

Examples: storage and reheating instructions, shelf stable meals, special packaging, or other.

Please describe how the sponsor will maintain program integrity and accountability.*

All SFSP program requirements must be maintained, including but not limited to meal patterns, civil rights, and special dietary needs. Sponsors must ensure that only the allowable number of approved meals are served and that duplicate meals are not distributed to any child.

Serving Start Date*

Serving End Date*

I certify that the information completed in this form is accurate and true, and I acknowledge that if approved, program integrity will be upheld as described in the completion of this form. I acknowledge that this approval is only for this circumstance and a new request must be submitted if needed again. I acknowledge that I will not receive any additional reimbursement for offering non-congregate meals.*

Date of Submission*

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