DSS Form 3306 "Site Information Application - Summer Food Service Program for Children (Sfsp)" - South Carolina

What Is DSS Form 3306?

This is a legal form that was released by the South Carolina Department of Social Services - a government authority operating within South Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2001;
  • The latest edition provided by the South Carolina Department of Social Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of DSS Form 3306 by clicking the link below or browse more documents and templates provided by the South Carolina Department of Social Services.

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Download DSS Form 3306 "Site Information Application - Summer Food Service Program for Children (Sfsp)" - South Carolina

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South Carolina Department of Social Services
Summer Food Service Program for Children (SFSP)
SITE INFORMATION APPLICATION
Instructions: Complete in duplicate for each feeding site which will be administered by the applicant. Attach one copy to DSS Form
1625, “Sponsor Application for Participation.” Retain a copy for your file. If more space is needed, continue on a plain sheet of paper,
numbering each item and attach to the Site Application. A Site Information Application must be submitted and approved before meals
served at the site are eligible for reimbursement.
1. Name of Sponsor:
Agreement Number:
Site Number:
Is the site located in a
Is the site located in a rural
standard metropolitan
pocket within SMSA?
statistical area (SMSA)?
Yes
No
Yes
No
2. Name and Address of Food Service Site:
Name of Site Supervisor:
(Include Zip Code)
(If unknown at this time, provide
to SCDSS Office prior to beginning of operation.)
County in Which Site is Located:
Telephone:
Select County ...
3. Did this site participate in any prior year’s Summer Food Service Program?
Yes
No
If yes, list name of sponsor and year of participation:
4. Indicate other USDA programs in which the site participates.
(Sites in the Special Milk Program (SMP) are not eligible for the SFSP.)
None
National School Lunch
School Breakfast
Child/Adult Care Food
Food Distribution
SMP
5. Type of Site:
(Check all that apply.)
A.
Open Site
C.
Migrant Site
E.
Enrolled Site
G.
Homeless Site
B.
Residential Camp
D.
Nonresidential Camp
F.
NYSP Site
H.
Licensed Day Care Center/Home
6. If the answer to item 5 is “A” or “C” please check one of the following to document that the local areas from which the site
draws its attendance are areas in which poor economic conditions exist, as defined by the program regulations.
Documentation from public or nonprofit private schools located nearest the site.
Name of School:
Documentation from departments of welfare, education or zoning commissions.
Documentation from organization determined by the state agency as a migrant organization.
Census tract information.
Documentation attached or indicate the year the above documentation was submitted:
7. If the answer to item 5 is “B”, “D” or “E”:
(a) Attach a copy of the form that is or will be used to document each enrolled child’s eligibility for reduced-price school meals.
(b) For camps only, indicate the number of children eligible for reduced-price meals and the total number of children partici -
pating at this site for each session.
(If this information is unavailable at this time, it must be provided to the SCDSS prior to the
submission of the Claim for Reimbursement for each session.)
Total No. of Children Participating:
Total No. of Eligible Children Participating:
(Estimate)
(Estimate)
8. A. Period of Operation of Food Service:
B. Operating Days of the Week:
(Check each day that this site will operate, and if a
Beginning
Closing
Number of Operating Days
camp, attach a copy of your camping schedule.)
Date
Date
Total
May
Jun
July
Aug
Sep
(MM/DD/YY)
(MM/DD/YY)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
C. Indicate date(s) this site will be closed:
DSS Form 3306 (JAN 01) Edition of FEB 00 is obsolete.
Reset
South Carolina Department of Social Services
Summer Food Service Program for Children (SFSP)
SITE INFORMATION APPLICATION
Instructions: Complete in duplicate for each feeding site which will be administered by the applicant. Attach one copy to DSS Form
1625, “Sponsor Application for Participation.” Retain a copy for your file. If more space is needed, continue on a plain sheet of paper,
numbering each item and attach to the Site Application. A Site Information Application must be submitted and approved before meals
served at the site are eligible for reimbursement.
1. Name of Sponsor:
Agreement Number:
Site Number:
Is the site located in a
Is the site located in a rural
standard metropolitan
pocket within SMSA?
statistical area (SMSA)?
Yes
No
Yes
No
2. Name and Address of Food Service Site:
Name of Site Supervisor:
(Include Zip Code)
(If unknown at this time, provide
to SCDSS Office prior to beginning of operation.)
County in Which Site is Located:
Telephone:
Select County ...
3. Did this site participate in any prior year’s Summer Food Service Program?
Yes
No
If yes, list name of sponsor and year of participation:
4. Indicate other USDA programs in which the site participates.
(Sites in the Special Milk Program (SMP) are not eligible for the SFSP.)
None
National School Lunch
School Breakfast
Child/Adult Care Food
Food Distribution
SMP
5. Type of Site:
(Check all that apply.)
A.
Open Site
C.
Migrant Site
E.
Enrolled Site
G.
Homeless Site
B.
Residential Camp
D.
Nonresidential Camp
F.
NYSP Site
H.
Licensed Day Care Center/Home
6. If the answer to item 5 is “A” or “C” please check one of the following to document that the local areas from which the site
draws its attendance are areas in which poor economic conditions exist, as defined by the program regulations.
Documentation from public or nonprofit private schools located nearest the site.
Name of School:
Documentation from departments of welfare, education or zoning commissions.
Documentation from organization determined by the state agency as a migrant organization.
Census tract information.
Documentation attached or indicate the year the above documentation was submitted:
7. If the answer to item 5 is “B”, “D” or “E”:
(a) Attach a copy of the form that is or will be used to document each enrolled child’s eligibility for reduced-price school meals.
(b) For camps only, indicate the number of children eligible for reduced-price meals and the total number of children partici -
pating at this site for each session.
(If this information is unavailable at this time, it must be provided to the SCDSS prior to the
submission of the Claim for Reimbursement for each session.)
Total No. of Children Participating:
Total No. of Eligible Children Participating:
(Estimate)
(Estimate)
8. A. Period of Operation of Food Service:
B. Operating Days of the Week:
(Check each day that this site will operate, and if a
Beginning
Closing
Number of Operating Days
camp, attach a copy of your camping schedule.)
Date
Date
Total
May
Jun
July
Aug
Sep
(MM/DD/YY)
(MM/DD/YY)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
C. Indicate date(s) this site will be closed:
DSS Form 3306 (JAN 01) Edition of FEB 00 is obsolete.
Sponsor:
Site:
Approval Status:
Initials:
9. A. Describe the Meal Service Area:
How many children can eat at this site at one time?
Is there shift feeding?
Yes
No
B. Describe the Meal Service:
Time of
Types of Meals
Estimated Total
Estimate Number
For SCDSS Use:
Meal Service
to be Served
of Children
of Eligible Children
Approved Level of
Instructions:
Meal Service
(Camps Only)
to be Served
Begins
Ends
All applicants should complete
this section. All Sponsors
Breakfast
applying for camps should only
list the number of eligible children
AM
to be served daily for which
Snack:
reimbursement for meals will be
PM
claimed under the Summer
Food Service Program.
Lunch
Supper
C. Monitoring Schedule:
Pre-Operational Visit
First Week Review
Site Review
Dates:
10. A. How will meals be prepared for this site?
(Check One)
Self-Preparation on Site
Agreement with School Food Service Authority
Sponsor Preparation at Central Kitchen Facility
Contract with Food Service Management Company
Sponsor Preparation at a School Food Service Facility
Other:
B. The Holding of Meals Until the Time of Meal Service: (Check One)
Served at Time of Delivery
Held in Refrigerator on Site
Served Within One Hour of Delivery
Other:
C. The Storage and Refrigeration of Excess Meals Until the Next Day or the Return of Excess Meals to the Vendor:
(If Applicable)
Refrigerate Until the Next Day
Return to Sponsor
Other:
11. A. Is this site an indoor or outdoor site?
Indoor
Outdoor
(Check Appropriate Box)
B. If an outdoor site, what is your policy for serving meals when weather prevents the outdoor service of meals?
Meal service will be cancelled.
Meals will be served at the following location:
Address:
Description:
Note: Leaving meals with the children is not an option.
C. Is there a regularly scheduled activity?
Yes
No
If yes, list the types of activities provided or attach a schedule of daily activities.
I certify that this site has been visited and that the information on this form and subsequent attachments is true and correct to the
best of my knowledge. I understand that this information is being given in connection with the receipt of federal funds and that
deliberate misrepresentation may subject me to prosecution under applicable state and federal criminal statutes. The Program
must be made available to all children regardless of sex, age, disability, race, color, religion or national origin.
Name and Title of Authorized Sponsor Representative (Please Print)
Signature of Authorized Sponsor Representative
Date
DSS Form 3306 (JAN 01) Edition of FEB 00 is obsolete.
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