an agency may not conduct or monthly distribution of ... nj lunchmeat p 24. pork nj ... beans b lima...

MONTHLY DISTRIBUTION OF DONATED FOODS TO FAMILY UNITS

U.S. DEPARTMENT OF AGRICULTURE FOOD AND NUTRITION SERVICE

16151413121110987654321

8. USDA COMMODITY 9. RECEIPTS 10. WITHDRAWALS 11. INVENTORY

5. NAME OF SDA/ITO

1

1615141312111098765432

2. HOUSEHOLDS PARTICIPATING

3. NUMBER OF PARTICIPANTS

LIN

E N

O. LIN

E N

O.

FORM FNS-152 (07/08) Previous editions obsolete Electronic Form Version Designed in Adobe 8.1 Version

(9a) (9b) (9c) (9d) (10a) (10b) (10c) (10d) (10e) (11a) (11b) (11c)

COMMODITY CODE REPORTING UNIT

AMOUNT ON HAND FIRST OF MONTH

AMOUNT RECEIVED

AMOUNT RE-DONATED

IN

TOTAL AMOUNT

AVAILABLE DURING MONTH

AMOUNT ISSUED

AMOUT RE-DONATED

OUT


FOOD LOSS

TOTAL WITHDRAWALS

BOOK INVENTORY

END OF MONTHPHYSICAL

INVENTORY END OF MONTH

ADJUSTMENTS POSITIVE/ NEGATIVE

(9a) + (9b) + (9c)(10a) + (10b)

+ (10c) + (10d) (9d) - (10e) (11a) +/- (11b)

BEANS GREEN 30

BEANS GREEN 303

BEANS VEG/ 300

CARROTS

CARROTS 300

CORN KERNEL 300

CORN CREAM

CORN KERNEL

CORN CREAM 300

LENTILS

PEAS 300

PEAS 303

PUMPKIN

PUMPKIN 30012. SIGNATURE OF APPROVING OFFICIAL

REMARKS

FORM APPROVED OMB NO. 0584-0594 Expiration Date:11/30/2019

A059

A060

A090

A095

A098

A119

A120

A121

A122

A135

A144

A145

A163

A16413. TITLEI certify that this report is true and correct to the best of my

knowledge and belief.

1. HOUSEHOLDS CERTIFIED

4. STATE

#300 can

#303 can

#300 can

#303 can

#300 can

#300 can

#303 can

#303 can

#300 can

2# pkg.

#300 can

#303 can

#303 can

#300 can14. DATE

u

6. DA CODE

7. REPORT MONTH

SBU

Public reporting burden for this collection of information is estimated to average 2.5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Research and Analysis (0584-0594), Alexandria, VA 22302. Do not return the completed form to this address.

434241403938373635343332313029282726252423222120191817


SDA/ITO

17

4342414039383736353433323130292827262524232221201918

DA CODE REPORT MONTHLI

NE

NO

. LINE

NO

.

FORM FNS-152 (07/08) Previous editions obsolete

(9a) (9b) (9c) (9d) (10a) (10b) (10c) (10d) (10e) (11a) (11b) (11c)



AMOUNT RECEIVED

AMOUNT RE-DONATED

IN

TOTAL AMOUNT


AMOUNT ISSUED

AMOUT RE-DONATED

OUT


FOOD LOSS

TOTAL WITHDRAWALS

BOOK INVENTORY




(9a) + (9b) + (9c)(10a) + (10b)

+ (10c) + (10d) (9d) - (10e) (11a) +/- (11b)

SPINACH

SPINACH 300

POTATOES 303

POTATOES SLC 300

POTATOES DHY 12

SWT POTATOES 303

SWT POTATOES 300

TOMATOES 300

TOM SAUCE 300

TOMATOES 303

SYRUP P

SYRUP P 12/24

GRAPEFRUIT J

APPLE J

GRAPE J

PINEAPPLE J

TOMATO J

ORANGE J

APPLESAUCE 303

F COCKTAIL 303

F COCKTAIL 300

PEACHES CLG 300

PEACHES CLG 303

A166

A167

A169

A170

A196

A221

A223

A240

A244

A248

A251

A258

A280

A282

A285

A286

A290

A300

A355

A401

A403

A411

A412

24#303 can

24#300 can

24#300-303

24#300 can

12/1 # pkg

24#303 can

24#300 can

24#300 can

24#300-303

24#303 can

12/24 oz

12/24 oz

12/46 oz

12/46 oz

12/46 oz

12/46 oz

12/46 oz

12/46 oz

24#303 can

24#303 can

24#300 can

24#300 can

24#303 can

706968676665646362616059585756555453525150494847464544


SDA/ITO DA CODE REPORT MONTHLI

NE

NO

. LINE

NO

.


(9a) (9b) (9c) (9d) (10a) (10b) (10c) (10d) (10e) (11a) (11b) (11c)



AMOUNT RECEIVED

AMOUNT RE-DONATED

IN

TOTAL AMOUNT


AMOUNT ISSUED

AMOUT RE-DONATED

OUT


FOOD LOSS

TOTAL WITHDRAWALS

BOOK INVENTORY




(9a) + (9b) + (9c)(10a) + (10b)

+ (10c) + (10d) (9d) - (10e) (11a) +/- (11b)

PEARS 300

PEARS 303

PINEAPPLE 2

PLUMS 303

PRUNES 1

RAISINS 48

CARROTS 5

CARROTS 1

ONIONS 3

POTATOES RUS BIN

POTATOES RUS 5

POTATOES RED

SQUASH YEL

TURIPS 3

APPLES FRESH

GRAPEFRUIT 5

ORANGE FRESH

CHICKEN CND

EGG MIX 6

STEW CND

A437

A439

A446

A461

A480

A502

F111

F113

F120

F130

F131

F140

F151

F171

F511

F521

F530

A562

A570

A587

24#300 can

24#303 can

24/#2 can

24#303 can

24/#1 can

48/#1 can

10/5 lb.

48/1 lb.

16/3 lb.

200/5 lb.

8/5 lb.

16/3 lb.

1/24 lb.

16/3 lb.

8/5 lb.

8/5 lb.

8/5 lb.

24/29 oz.

48/6 oz.

24/24 oz. 706968676665646362616059585756555453525150494847464544

979695949392919089888786858483828180797877767574737271



NE

NO

. LINE

NO

.


(9a) (9b) (9c) (9d) (10a) (10b) (10c) (10d) (10e) (11a) (11b) (11c)



AMOUNT RECEIVED

AMOUNT RE-DONATED

IN

TOTAL AMOUNT


AMOUNT ISSUED

AMOUT RE-DONATED

OUT


FOOD LOSS

TOTAL WITHDRAWALS

BOOK INVENTORY




(9a) + (9b) + (9c)(10a) + (10b)

+ (10c) + (10d) (9d) - (10e) (11a) +/- (11b)

STEW 24/15

BEEF 1

BEEF NJ

LUNCHMEAT P 24

PORK NJ

TUNA 12.5

TUNA 12.25

SALMON PINK

SALMON 24

BEANS DK R KIDNEY

BEANS BLKEYE 2

BEANS B LIMA 2

BEANS PINTO

BEANS R KIDNEY 2

BEANS Grt NORTH 2

BEANS NAVY PEA 2

BEANS LT KIDNEY 2

PEAS SPLIT 2

BUTTER 36

CHEESE 30

EVAP 12

INSTAT 24

EVAP 24

CORNMEAL 5 DEG

A589

A598

A610

A617

A630

A640

A741

A800

A803

A906

A910

A912

A914

A915

A917

A918

A920

A922

B050

B060

B081

B090

B117

B137

24/15 oz.

36/#1

24/29 oz.

24/30 oz.

24/29 oz.

24/12.5 oz.

24/12.25 oz.

48/14.75 oz.

24/14.75 oz.

12/#2

12/#2

12/#2

12/#2

12/#2

12/#2

12/#2

12/#2

12/#2

36/1 lb.

6/5 lb.

48/12 fl oz.

6/4 lb.

24/12 fl oz.

10/5 lb. 979695949392919089888786858483828180797877767574737271

1241231221211201191181171161151141131121111101091081071061051041031021011009998



NE

NO

. LINE

NO

.


(9a) (9b) (9c) (9d) (10a) (10b) (10c) (10d) (10e) (11a) (11b) (11c)



AMOUNT RECEIVED

AMOUNT RE-DONATED

IN

TOTAL AMOUNT


AMOUNT ISSUED

AMOUT RE-DONATED

OUT


FOOD LOSS

TOTAL WITHDRAWALS

BOOK INVENTORY




(9a) + (9b) + (9c)(10a) + (10b)

+ (10c) + (10d) (9d) - (10e) (11a) +/- (11b)

CORNMEAL 8/5 DEG

CORNMEAL 10 DEG

CORNMEAL 40 DEG

FORMULA PWD 14.1

FARINA

CEREAL INFANT R8

FORM SOY DRY 6/14

FORMULA 12

FORMULA

FORMULA SOY

FORMULA POWDER

FORMULA PWDR 6

FORMULA SOY 12

FORM SOY PWDR 6

FLOUR AP 5

FLOUR AP 10

FLOUR AP 10 UNBL

FLOUR AP 8/5

FLOUR AP 40

FLOUR AP 40 UNBL

FLOUR B 10

FLOUR B 8/5

FLOUR B 40

FLOUR WW 10

B138

B141

B142

B158

B160

B161

B162

B163

B164

B165

B166

B167

B168

B169

B179

B180

B181

B182

B183

B188

B230

B232

B233

B350

8/5 lb.

5/10 lb.

4/10 lb.

24/14 oz.

24/14 oz.

12/8 oz.

6/14 oz.

12/13 fl oz.

12/13 fl oz.

24/13 fl oz.

24/13 fl oz.

12/1 lb.

6/1 lb.

6/1 lb.

10/5 lb.

5/10 lb.

5/10 lb.

8/5 lb.

4/10 lb.

4/10 lb.

5/10 lb.

8/5 lb.

4/10 lb.

5/10 lb. 1241231221211201191181171161151141131121111101091081071061051041031021011009998

151150149148147146145144143142141140139138137136135134133132131130129128127126125



NE

NO

. LINE

NO

.


(9a) (9b) (9c) (9d) (10a) (10b) (10c) (10d) (10e) (11a) (11b) (11c)



AMOUNT RECEIVED

AMOUNT RE-DONATED

IN

TOTAL AMOUNT


AMOUNT ISSUED

AMOUT RE-DONATED

OUT


FOOD LOSS

TOTAL WITHDRAWALS

BOOK INVENTORY




(9a) + (9b) + (9c)(10a) + (10b)

+ (10c) + (10d) (9d) - (10e) (11a) +/- (11b)

FLOUR WW 40

FLOUR MIX

FLOUR MIX LOFAT

GRITS CW 5

GRITS CW 40

HONEY 24

MACARONI 1

MAC N CHEESE

OATS 3

PB 2

PB RDI-FAT 2

CHUNKY RDU-FAT 2

ROASTED 12

RICE 2

VEG OIL 48

SHORT S

SPAGHETTI 2

CER CORN RTE 17.5

CEREAL RICE 15

CEREAL CORN 18

CEREAL OATS 16

CEREAL CORN 17.5

B351

B367

B368

B381

B382

B403

B425

B436

B445

B470

B471

B488

B501

B510

B666

B720

B835

B847

B848

B849

B851

B852

4/10 lb.

6/5 lb.

6/5 lb.

10/5 lb.

8/5 lb.

24/24 oz.

24/1 lb.

12/26 oz.

12/3 lb.

24/2 lb.

24/2 lb.

24/2 lb.

24/12 oz.

24/2 lb.

8/48 oz.

12/3 lb.

12/2 lb.

14/17.5 oz.

12/15 oz.

12/18 oz.

14/16 oz.

12/17.5 oz. 151150149148147146145144143142141140139138137136135134133132131130129128127126125

178177176175174173172171170169168167166165164163162161160159158157156155154153152



NE

NO

. LINE

NO

.


(9a) (9b) (9c) (9d) (10a) (10b) (10c) (10d) (10e) (11a) (11b) (11c)



AMOUNT RECEIVED

AMOUNT RE-DONATED

IN

TOTAL AMOUNT


AMOUNT ISSUED

AMOUT RE-DONATED

OUT


FOOD LOSS

TOTAL WITHDRAWALS

BOOK INVENTORY




(9a) + (9b) + (9c)(10a) + (10b)

+ (10c) + (10d) (9d) - (10e) (11a) +/- (11b)

CEREAL OATS 15.5

CEREAL OATS

CEREAL OATS 16

CEREAL RICE 12

CEREAL RICE 17.5

CER RICE RTE 17.5

CEREAL WHEAT 16

CER WHEAT RTE 16

B854

B860

B861

B866

B867

B868

B871

B872

12/15.5 oz.

12/15 oz.

12/16 oz.

12/13 oz.

12/17.5 oz.

12/17.5 oz.

12/16 oz.

14/16 oz.

178177176175174173172171170169168167166165164163162161160159158157156155154153152

FORM FNS-152 INSTRUCTIONS

SUBMISSION: Forward the original of this document to the appropriate Food and Nutrition Service (FNS) office no later than 30 calendar days following the last day of the month being reported. SDAs do not complete items 1, 2, 3, or Column 10c. SDAs are those facilities which hold FDPIR inventory but do not issue commodities to program participants.

(9c) Amount redonated in. Indicate the quantity of individual units redonated from another SDA, program or ITO.

(9d) Total amount available during month. Enter the total of columns: (9a) amount on hand first of

month, (9b) amount received, and (9c) amount redonated out. (10a) Amount issued. ITOs enter the total number of commodity units actually issued to and accepted

by participants during the report month as specified below . This figure should exclude (1) those commodities not accepted by the participant at the time of food pick-up, and (2) any commodities returned to the ITO by participants during the report month. If a participant has refused a commodity at pick-up, it should not be considered issued. SDAs enter commodity units delivered to ITOs for distribution to program participants.

(10b) Amount redonated out. When a commodity is redonated to another SDA, program or ITO,

indicate the amount redonated. (10c) Amount used for nutrition education. When a commodity is used for food demonstrations or

taste testing as part of t he SDA' s or ITO' s nutrition education program, indicate the amount (in units) used for this purpose.

(10d) Food loss. Provide the appropriate explanation code for all lost food. Enter the number of

commodities that are actual food losses. These would include foods that : (A) after consignee receipt were found to have concealed damage; (B) were damaged in the warehouse or during transit from the State warehouse to the local site; (C) were found to be out of condition or unfit for human consumption; or (D) were known to have been stolen or lost due to fraud, misuse or embezzlement . Additional details may be provided in the REMARKS section. (Attach additional pages if necessary.)

(10e) Total withdrawals. Enter the total of columns: (10a) issued to participant s, (10b) redonated out,

(10C) used for nutrition program, and (10d) lost. (11a) Book inventory end of month. Column (9d) minus Column (10e). (11b) Physical inventory end of month. Report total number of individual units for each commodity

which a physical inventory determines to be in warehouse. (11c) Inventory Adjustments - Positive/Negative. Column (11a) minus/plus equal Column (11c). 12. Signature. The approving official signs the form here to certify that a physical inventory w as taken

and that the report is true and accurate. 13. Title. Enter the approving official's title. 14. Date. Enter the date the report is signed.

ITEM

1. Number of Households Certified. Enter the number of households (not individual persons) which have been certified eligible to receive commodities from this Distribution Center during the report month.

2. Number of Households Participating. Enter the total number of households (not individual

persons) which actually received commodities from this Distribution Center during the report month. 3. Number of Participants. Enter the total number of persons in households which actually received

commodities from this Distribution Center during the report month. 4. State. Enter the name of the State in which the SDA or ITO is located. 5. Name of State Distributing Agency (SDA) or Indian Tribal Organization (ITO). Enter the name of

the SDA or the reporting ITO acting as the SDA. 6. Distributing Agency Code. Enter the 4 digit SNPIIS code for the reporting SDA or ITO. 7. Report for the Month of. Enter the month and year for which data is reported.

(8a) (8b) & (8c) Preprinted. All commodities being reported must agree with the commodity title and commodity code as preprinted

on the form. If a specific commodity is not preprinted, it must be written in along with the correct commodity short title, commodity code and reporting unit (e.g., #300 can, 16 oz. box, 2 lb. bag). Blank spaces are provided for this purpose. For all commodities, report the number of individual units, such as bags, boxes, cans, foils, etc., not the number of containers in which multiple units are packed.

(9a) Amount on hand first of month. This amount must be the same as the previous month's

"Physical inventory end of month (11b)." Include all foods held in storage by the SDA or reporting ITO. (9b) Amount received. Indicate in this column the quantity of individual units received in good

condition from USDA during the month.

COLUMNS

an agency may not conduct or monthly distribution of ... nj lunchmeat p 24. pork nj ... beans b lima...

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