Requestfor Flexibility to Use Enriched Grain Product(s)

Sponsor Name: / Agreement Number:
Enriched Product Description / Manufacturer Name / Manufacturer Number / Menu Item(s) Affected
Example: Enriched Macaroni / XYZ Foods / 55555 / Mac and Cheese, Beef-a-Roni, Macaroni Salad
Provideinformation regarding attempted use of whole grain-rich product(s).Describe efforts to use alternative products, recipesand/or cooking methods and the significant challenges experienced that demonstrate a negative impact. Include the number of portions of each item served previously and the number served when using whole grain-rich product(s).
Attach supporting documentation. Evidence of hardship(s) may include but is not limited to point-of-service data or production records showing a significant drop in meal counts as a result of using whole grain-rich product(s), financial information showing a significant cost increase of whole grain-rich product(s), communication records showing limited product availability and/ordocumentation such as complaints or pictures that demonstrate unacceptable product quality, poor student acceptability or increased plate waste.
Provide a plan to achieve compliance with the full whole grain-rich requirement before the exemption expires. Goals might include product testing, recipe alteration and seeking technical assistance from the Division of Food, Nutrition and Wellness.1, 2
State Agency Response*
(expires ______)
Approved By: / Denied By: / Date:
  1. Sponsors that are approved for an exemption from the current whole grain-rich requirement must work with the Division of Food, Nutrition and Wellness to search for acceptable products.While working with the division, sponsors that have been approved for an exemption should be considered compliant with the whole grain-rich requirements during an administrative review if their grain offerings are consistent with the exemption granted and at least half of the grains offered weekly are whole grain-rich.
  2. Waivers will be granted upon approval and expire semi-annually (December 31 or June 30). Sponsors seeking to renew the waiver must reapply every six months with an update on the progress made and a statement of continued need. The division will evaluate each request to determine that the circumstances statedin the request warrant an approval to use enriched grain products in accordance with USDA Memo SP 20-2015. This flexibility is available only until acceptable products are available and identified or if the sponsor can demonstrate a continued negative impact on participation or cost.
*Please allow two weeks for review.

Revised 5/4/15