Texas Department of Agriculture - Food and Nutrition Division
                                                                               Worksheet to Determine Verification Sample Size
                                         Verification is to be completed as a Contracting Entity (CE) wide activity by November 15th each year. Households can provide documentation of 
                                         one month's income for any point in time between the month prior to the application and the time the household is required to provide income 
                                         documentation. 
                                  1      General Information                                                                                                                                                               2019-2020
                                                                                                                                                                                                                           2020-2021
                                         CE Name:
                                                                                                                                                                                                                           2021-2022
                                         CE ID:
                                                                                                                                                                                                                           2022-2023
                                         Program Year:
                                                                                                                                                                                                                           2023-2024
                                         Verifying Official:
                                         Date direct verification was conducted:
                                         Date of additional direct verification:
                                         Date households that were not directly verified 
                                         were notified of selection:
                                         Date verification was completed:
                                  2      Enter the total number of approved applications as of October 1st:
                                         Total applications refers to actual approved application documents/pieces of paper on file October 1. CEs must only complete verification activities based on 
                                         applications received and certified and must not include directly certified students in their calculations. 
                                         ENTER NUMBER OF APPROVED APPLICATONS:                                                             Standard Sample Size Method:
                                                                                                                                           Standard Sample Size Method:
                                                                                                                                           Those CEs that do not qualify for an alternate sample size will use 
                                         Categorically-eligible                                                                            Those CEs that do not qualify for an alternate sample size will use 
                                                                                                                                           the Standard Sample Size method. For this method, error-prone 
                                                                                                                                           the Standard Sample Size method. For this method, error-prone 
                                         Income-based free                                                                                 household applications are verified first, non error-prone 
                                                                                                                                           household applications are verified first, non error-prone 
                                                                                                                                           household applications are used to complete the sample size if 
                                         Income-based reduced-price                                                                        household applications are used to complete the sample size if 
                                                                                                                                           there are not enough error-prone household applications.
                                                                                                                                    0      there are not enough error-prone household applications.
                                         Total approved applications
                                                                                                                                           See ARM Section 6: Verification
                                                                                                                                           See ARM Section 6: Verification
                                         Number of error-prone applications
                                          (Enter 0 if there are none)                                                                                                                                                      Standard
                                                                                                                                                                                                                           Alternate
                                                                                                                                           The ability to use an alternate sample method must be determined 
                                                                                                                                            The ability to use an alternate sample method must be determined 
                                                                                                                                           annually. Those CEs that qualify for an alternate sample size must 
                                         Select the allowable sampling method based on the                                                  annually. Those CEs that qualify for an alternate sample size must 
                                                                                                                                           meet one of the following conditions: 
                                                                                                                                            meet one of the following conditions: 
                                         response rate from the SFA Verification Report from 
                                         the previous year.                                                                                Low Non-Response Rate. CEs that have less than a twenty 
                                                                                                                                            Low Non-Response Rate. CEs that have less than a twenty 
                                          *Check with regional ESC if you don't know                                                       percent non-response rate for verification requests for the 
                                                                                                                                            percent non-response rate for verification requests for the 
                                                                                                                                           preceding school year.
                                                                                                                                            preceding school year.
                                                                                                                                           Improved Non-Response Rate. CEs that
                                                                                                                                            Improved Non-Response Rate. CEs that
                                                                                                                                                   1. have more than 20,000 students approved by 
                                                                                                                                                    1. have more than 20,000 students approved by 
                                                                                                                                                   household application as eligible for free or reduced-price 
                                                                                                                                                    household application as eligible for free or reduced-price 
                                                                                                                                                   meals as of October 1
                                                                                                                                                    meals as of October 1
                                                                                                                                                   and
                                                                                                                                                    and
                                                                                                                                                   2. have at least a 10 percent decrease in the non-response 
                                                                                                                                                    2. have at least a 10 percent decrease in the non-response 
                                     Indicate the method you have selected by entering "x" in                                                      percentage between Year 1 and Year 2 qualify to use an 
                                                                                                                                                    percentage between Year 1 and Year 2 qualify to use an 
                                                                                                                                                   alternate sample size method in Year 3. 
                                     the box:                                                                                                       alternate sample size method in Year 3. 
                                                                                                                                                                                                                           x
                                         SELECT METHOD OF VERIFICATION:
                                         Standard
                                         Calculated as 3% of total applications. Randomly selected from 
                                         error-prone applications first.                                                                                                                                               ###
                                                                                                                                           For the Standard and Alternate 1 methods, verify 3% or 3000, 
                                         Alternate 1                                                                                        For the Standard and Alternate 1 methods, verify 3% or 3000, 
                                                                                                                                           whichever is less. 
                                                                                                                                            whichever is less. 
                                         Calculated as 3% of total applications. Randomly selected from 
                                         approved applications.                                                                            For Alternate 2 method, verify the lesser of 1% or 1000 total               ###
                                                                                                                                            For Alternate 2 method, verify the lesser of 1% or 1000 total 
                                                                                                                                           applications PLUS the lesser of one-half percent of 
                                                                                                                                            applications PLUS the lesser of one-half percent of 
                                                                                                                                           categorically eligible applications (applications with an EDG 
                                         Alternate 2                                                                                        categorically eligible applications (applications with an EDG 
                                                                                                                                           number)
                                                                                                                                            number)
                                         Calculated as 1% of total approved applications plus 0.5% of 
                                         Categorically Eligible applications. Randomly select the error-
                                         prone and categlorically eligible applications.
                                         The interval for selecting household applications for verification is 
                                         determined by dividing the total number of household 
                                         applications by the sample size.
                              3     Results of Direct Verification
                                    For each benefit program, enter the number of applications and students that were directly verified. This information will be reported in the 
                                    Preliminary Verification Report that opens Nov. 1 and is due Nov. 15. 
                                                                                       A. Number of applications      B. Number of students
                                    Directly verified as SNAP
                                    Directly verified as TANF
                                    Directly verified as Medicaid Free
                                    Directly verified as Medicaid Reduced-Price
                                    Directly verified as CHIP Free
                                    Directly verified as CHIP Reduced-Price
                                                                               TOTAL:
                                           (this will be entered on 5-7 A and B on the SFA                       0                                  0
                                                        Verification Report in TX-UNPS)
                              4     Results of Verification by Original Benefit Type
                                    Enter the number of applications and students that were verified by household submitted documentation. This information will be reported in the SFA 
                                    Verification Report (field 5-8) in TX-UNPS that opens December 1st.  
                                    Do not include results of direct verification. 
                                    Do include the results of any applications verified for cause. 
                                    A. FREE Categorically Eligible                     a. Applications                b. Students
                                    1. Responded, NO CHANGE:
                                    2. Responded, Changed to REDUCED PRICE:
                                    3. Responded, Changed to PAID
                                    4. Not Responded, Changed to PAID
                                    A. FREE-Income                                     a. Applications                b. Students
                                    1. Responded, NO CHANGE:
                                    2. Responded, Changed to REDUCED PRICE:
                                    3. Responded, Changed to PAID
                                    4. Not Responded, Changed to PAID
                                    A. REDUCED PRICE-Income                            a. Applications                b. Students
                                    1. Responded, NO CHANGE:
                                    2. Responded, Changed to FREE:
                                    3. Responded, Changed to PAID
                                    4. Not Responded, Changed to PAID
                                    VC-1: Total questionable applications verified for 
                                    Update to sample size:
                                    cause:
                                    Calculated sample plus applications verified for 
                                    cause.                                                                        0
                                    Total Applications Verified:                                                  0   ERROR: The number of 
                                                                                                                      applications verified does not 
                                                                                                                      equal the number of applications 
                                                                                                                      in the sample.
                                    TEXAS DEPARTMENT OF AGRICULTURE
                                    COMMISSIONER SID MILLER                                                                         This institution is an equal opportunity provider.