1 SNAP-Agency NDNH Match Results Performance Reporting Too

SNAP Agency NDNH Matching Program Performance Reporting Tool
	Federal Fiscal Year:		Quarter:		Amended:	Y ( ) N ( )
	State:
			1.	2.	3.	4.
Match Type	Quarter	Month	Unduplicated Individuals Verified as Employed	Unduplicated SNAP Cases Closed Due to Earnings	Unduplicated SNAP Cases with Benefits Reduced	Unduplicated First-Month Avoided SNAP Costs
W-4 Data Match	Quarter 1	Oct
		Nov
		Dec
	Quarter 2	Jan
		Feb
		Mar
	Quarter 3	Apr
		May
		Jun
	Quarter 4	Jul
		Aug
		Sep
QW Data Match	Quarter 1	Oct
	Quarter 2	Jan
	Quarter 3	Apr
	Quarter 4	Jul
UI Data Match	Quarter 1	Oct
	Quarter 2	Jan
	Quarter 3	Apr
	Quarter 4	Jul
Unduplicated Annual Total			0	0	0	$-
“Unduplicated” means counting the same person no more than once per federal fiscal year. Individuals should only be counted in one of the three data sources.
Please see instructions below for an explanation of the four performance measures.
For detailed instructions, please see accompanying document: "Explanation and Detailed Instructions on How to Complete and Submit the SNAP Agency NDNH Matching Program Performance Reporting Tool"
General Instructions
Report all outcomes in the month the match was conducted, not the month of state verification or case action. State agencies will report data by December 31, which is 90 days after the end of the federal fiscal year (October 1- September 30).
Previously Unknown Employment
Item 1.	Unduplicated Individuals Verified as Employed (receiving SNAP benefits): The number of unduplicated individuals with previously unknown employment that had an NDNH match and were verified as being employed while receiving SNAP benefits in your state.
Actions Taken
Item 2.	Unduplicated SNAP Cases Closed Due to Earnings: The number of unduplicated individuals reported in item 1 whose SNAP benefits were terminated as a result of employment verified from an NDNH match.
Item 3.	Unduplicated SNAP Cases with Benefits Reduced: The number of unduplicated individuals reported in item 1 whose SNAP benefits were reduced as a result of employment verified from an NDNH match.
Avoided Costs
Item 4.	Unduplicated First-Month Avoided SNAP Costs: The total first-month SNAP costs avoided from items 2 and 3.
Unduplicated Annual Total
The unduplicated annual total equals the sum of each column. The total for item 4 represents the annual unduplicated first-month avoided SNAP costs resulting from use of the NDNH.
The Paperwork Reduction Act of 1995(Pub.L. 104-13) Public reporting burden for this collection of information is estimated to average 1.625 hours, per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless it displays a currently valid OMB control number.