Administrative and operating advance under the summer food service program for children




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Wisconsin Department of Public Instruction

CERTIFICATION FOR SECOND MONTH’S

ADMINISTRATIVE AND OPERATING ADVANCE

UNDER THE SUMMER FOOD SERVICE PROGRAM

FOR CHILDREN

PI-1491 (Rev. 2-11)



INSTRUCTIONS: Complete and return only after conducting training of site and administrative personnel. A second advance payment will not be vouchered until this form is received at the following address:

WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION

FEDERAL AIDS AND AUDIT SECTION

P.O. BOX 7841

MADISON, WI 53707-7841




Agency Code

     











GENERAL INFORMATION







Sponsor Name

     


In accordance with Section 225.9(c) of the Summer Food Service Program for Children regulations, the following certifications are made in order to receive the second advance payment:

a. that training on the Summer Food Service Program for Children was held for all administrative and site personnel regarding their program duties and responsibilities;



Date(s) Training Held

     


And,

b. that the sites represented on the Summer Food Service Program Application/Agreement/Policy Statement (PI 1482) submitted by your agency are operating and that there has been no significant change in the expected number of meals to be served to eligible children.







CERTIFICATION STATEMENT




I CERTIFY that, to the best of my knowledge, statements a and b above are true and correct. I understand that the information on this form 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.

Signature of Authorized Representative



Date Signed Mo./Day/Yr.

     





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