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Resource | Forms

FNS-152: Monthly Distribution of Donated Foods to Family Units

The ITO/state agency must submit Form FNS-152, Monthly Distribution of Donated Foods to Family Units,  that documents the data obtained in the physical inventory with the perpetual inventory record. Shortages must be reported to the appropriate FNS regional office.

FNS-152
Resource | Forms

FNS-292a: Report of Commodity Distribution for Disaster Relief

FNS Form 292A is to be used to report Commodity Distribution for Disaster Relief. 

FNS-292A
Resource | Forms

FNS-101: Participation in Food Programs - by Race

Form FNS-101: Participation in Food Programs - by Race 

FNS-101
Resource | Forms

FNS-667: Report of The Emergency Food Assistance Program (TEFAP) Administrative Costs

Form FNS-667 is used by state agencies to report use of TEFAP administrative funds.  

FNS-667
Resource | Forms

FNS-57: Report of Shipment Received Over, Short and/or Damaged

Form FNS-57 is used by consignees to report overages and shortages in a shipment and commodities damaged in transit.

FNS-57
Resource | Forms

AD-1049: USDA Certification Regarding Drug-Free Work Place Requirements Alternative I - For Grantees Other than Individuals

FNS Form AD-1049 is the USDA Certification Regarding Drug-Free Work Place Requirements (GRANTS) Alternative I - For Grantees Other than Individuals

AD-1049
Resource | Forms

FSA-21: Public Voucher - Commodity Programs

State agencies apply for reimbursement using Form FSA-21, submitted to the appropriate FNS regional office for approval. 

FSA-21