Verification Tracking Form - Arizona Department Of Education printable pdf download

VERIFICATION TRACKING FORM

PHASE 3: VERIFY

Attach to each application selected for verification with a copy of all documents from household.

Number of Students on Application: _________

Error Prone:

 Yes

 No

Original Determination was (check one):

 Free Eligible Based on Categorical Eligibility (Case # SNAP/TANF/FDPIR or Foster)

 Free Eligible Based on Income/Household Size Information

 Reduced-Price Eligible

Step 1

 Identify your confirming official. This person will double check that the application was certified correctly. Cannot

be the same person who initially certified the application.

Results of Confirmation Review (Select ONE):

 Confirmed Original Determination, no change in benefits

Continue to Step 2.

 Changed from Reduced to Free

Notify household of increased benefits, change benefits within 3 days, continue to Step 2.

 Changed from Free to Reduced

Do not change benefits, do not contact household; continue to Step 2.

 Changed to PAID

Notify household of paid benefits, change benefits

after 10 calendar days of letter sent and

remove this application

from verification sample. Select new application for verification. (Start again with Step 1 with new application and

new tracking form.) Date eligibility status updated on BID: ___________

(after 10 calendar days of letter

sent)

Step 2

 Conduct Direct Verification, Results (Select ONE):

 Matched in MA, SNAP, TANF or FDPIR: Print off results and attach to this tracking form. Verification

is complete. STOP and do not contact the household. SFAs will report this application and all the

students listed as Directly Verified.

 Matched in FOSTER, MEP, or HOM: Print off results and attach to this tracking form. If any child

resulted in a Match in either the Foster or Migrant column– Verification is considered complete for only

the child who matched. If there are other children on the application, and the children did not match

through Direct Verification, the SFA must then contact the household to verify those children.

 No Match: Print off results, attach to tracking form. Continue with Step 3.

Now contact the household

Step 3

 Send First Verification Notice _______ (sent date)

Requesting Documentation returned by: ______________

 If no response by given due date, follow up with household. Second Verification Notice/called/email ______ (date)

 Follow-up official must sign and date household application

Step 4

 Results of Verification (Select ONE):

 Responded, no change in benefits

Send Letter of Verification Results (confirming no change) and attach to this tracking form. _______ (date)

 Responded, original determination changed to Free

Send Letter of Verification Results and attach to this tracking form __________ (date)

 Responded, original determination changed to Reduced

Send Letter of Verification Results and attach to this tracking form __________ (date)

 Responded, original determination changed to Paid

Send Letter of Verification Results and attach to this tracking form ) ________ (date)

 No response after follow up, original determination changed to Paid

Send Letter of Verification Results and attach to this tracking form __________ (date)

*Changes in meal benefits due to Verification: Increased benefits changed within 3 days, decreased benefits changed within

10 calendar days of letter sent.

Arizona Department of Education. Revised September 2017

Verification Tracking Form - Arizona Department Of Education

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