Food Distribution Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FNS-57 Report of Shipment Received Over, Short, and/or Damaged	Form and Instruction	New	Available
Form FNS-152 Monthly Distribution of Donated Foods to Famil Units	Form and Instruction	New	Available
Form FNS-667 Report of the Emergency Food Assistance Program (TEFAP) Administrative Costs	Form and Instruction	New	Available
Form FNS-52 Food Requisition	Form and Instruction	New	Available
Form FNS-53 Multi-Food Requisition	Form and Instruction	New	Available
Form FNS-52 Food Requisition	Form and Instruction	New	Available
Form FNS-155 Inventory Management Register	Form and Instruction	New	Available
Form FNS-663 Food Distribution Commodity Acceptability Progress (CAP) Report	Form and Instruction	New	Available
Form FNS-57 Report of Shipment Recieved, Over, Short and/or Damaged	Form and Instruction	New	Available
Form FNS-7 Destination Data for Delivery of Donated Foods	Form and Instruction	New	Available
Form FNS-153 Monthly Report of the Commodity Supplemental Food Program and Quarterly Administrative Financial Status Report	Form	New	Available
#0584-0293 Supporting Statement-PR Processing of Donated Food.doc	Supporting Statement A	Uploaded 2006-08-18	Available
#0584-0293 Summary of Burden Table.xls	Supplementary Document	Uploaded 2006-08-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
44825	250.13(a)(5) - Distributing Agency Documentation of Method Used to Determine Commodity Value - Recordkeeping		New
44824	253.11(b) & 254.3(a) - Managment of Administrative Funds		New
44823	253.7(h) & 254.3(a) - Fair Hearings - Recordkeeping		New
44795	253.5(j) & 254.3(a) - Investigations and Complaints - Recordkeeping		New
44794	253.5(i) & 254.3(a) - Monitoring and review of program operations - Recordkeeping		New
44793	253.5(h) & 254.3(a) - Records and Reports: Financial Status Reports - Recordkeeping		New
44792	253.5(h) & 254.3(a) - Records and Reports: Damaged or Out of Condition Commoditites - Recordkeeping		New
44791	253.5(h) & 254.3(a) - Reports and Records: Commodity Inventories - Recordkeeping		New
44789	253.5(h) & 254.3(a) - Records and Reports: ITO Applications - Recordkeeping		New
44788	253.5(h) & 254.3(a) - Records and Reports: Disposal of Out of Condition Commodities - Recordkeeping		New
44787	253.5(h) & 254.3(a) - Records and Reports: Reporting Changes - Recordkeeping		New
44786	253.5(h) & 254.3(a) - Records and Reports: Household Applications - Recordkeeping		New
44785	253.5(h) & 254.3(a) - Records and Reports: Plans of Operation - Recordkeeping		New
44784	253.8(f) & 254.3(a) - Damaged, or Out of Condition Commodities	Form and Instruction	New	Report of Shipment Received Over, Short, and/or Damaged
44783	253.8(b) & 254.3(a) - Commodity Inventories	Form and Instruction	New	Monthly Distribution of Donated Foods to Famil Units
44782	253.3(c) - Prime Vendor Pilot		New
44781	253.7 & 254.3(a) - Certification of Household to Participate		New
44780	253.5(a) & 254.3(a) - Plans of Operation		New
44779	251.10(a)(3) - Eligibility determination and collection of participating household information - Recordkeeping		New
44778	251.4(a)(2) - Funds paid to eligible recipient agencies for storage and distribution - Recordkeeping		New
44777	251.10(a)(1) - Receipt, disposal, and inventory of commodities - Recordkeeping		New
44776	251.4(l)(5) - Claims and adjustments - Recordkeeping		New
44775	251.4(h) - Inter-Agency Agreements - Recordkeeping		New
44774	251.4(g) - Documentation of transfer of Section 32 Commoditites - Recordkeeping		New
44773	251.2(c)(2) & 251.5(a) - State Agency-Eligible Recipient Agency Agreement - Recordkeeping		New
44772	251.2(c)(1) - Federal-State Agreement - Recordkeeping		New
44765	251.10(e) - Monitoring eligible recipient agencies		New
44764	251.9(e) & 251.10(d)(1) - Report of State Administratvie Cost Matching Requirements	Form and Instruction	New	Report of the Emergency Food Assistance Program (TEFAP) Administrative Costs
44763	251.6(b) - State Agency Distribution Plan		New
44762	251.4(l) - Commodity Losses and Claims		New
44761	251.4(j) - Inter-Agency Agreements		New
44760	251.4(g) - Availability and Control of Commodities		New
44759	250.69(a) & 250.70(a) - Records for Disaster Organizations maintain applications - Recordkeeping		New
44758	250.67(a)(2)(ii) - Correctional Institutions - Recordkeeping		New
44757	250.64(f) - Records and reports in the Pacific Islands - Recordkeeping		New
44756	250.55 - RA recordkeeping and reviews of Food Service Management Companies - Recordkeeping		New
44755	250.30(c)(4) - Recordkeeping requirements for all processors - Recordkeeping		New
44754	250.22 - Distributing agency complaint records - Recordkeeping		New
44753	250.19(b) - Maintain management evaluation & review records - Recordkeeping		New
44752	250.18(b) - Processor CPA Audits - Recordkeeping		New
44751	250.16, 250.30, 250.37(e) & (f) - Maintenance of records/types of processing agreements/records of processor performance - Recordkeeping		New
44750	250.15(f) - Segregation of Operating Funds - Recordkeeping		New
44749	250.14(e) - Physical inventory records - Recordkeeping		New
44748	250.14(c) - Storage facility review - Recordkeeping		New
44747	250.13(a)(1)(v) - Distributing agency documentation for the transfer of donated food		New
44746	250.12(f) & 250.30(c) - Processing Agreements with Distributing Agencies/Recipient Agencies - Recordkeeping		New
44745	250.12(e) & 250.14(d) - Storage Facility Agreements - Recordkeeping		New
44743	250.12(b) - Distributing Agency Agreement with Recipient Agencies - Recordkeeping		New
44742	250.58 - Ordering donated foods and thier provisions to School Food Authorities	Form and Instruction	New	Food Requisition
44740	250.17(e) - Other Reporting - Multi-Commodity Food Requisition	Form and Instruction	New	Multi-Food Requisition
44739	250.17(e) - Other Reporting - State Option Contract Program		New
44738	250.17(e) - Other Reporting - Food Requisition Form	Form and Instruction	New	Food Requisition
44737	250.17(a) - Commodity Inventory Report	Form and Instruction	New	Inventory Management Register
44736	250.13(k) & 250.17(d) - Commodity Acceptability Reports	Form and Instruction	New	Food Distribution Commodity Acceptability Progress (CAP) Report
44735	250.13(f) - Report of Shipment Received, Over, Short and/or Damaged	Form and Instruction	New	Report of Shipment Recieved, Over, Short and/or Damaged
44734	250.13(a)(6) - Destination Data for Delivery of Donated Foods	Form and Instruction	New	Destination Data for Delivery of Donated Foods
44733	250.69(g) - State written request for replacement		New
44732	250.69(a) & 250.70(a) - Emergency organization feeding application to state for disasters and situations of distress		New
44731	250.54 - Contract provisions between RAs and Food Service Management Companies		New
44729	250.43(a) & 250.44(a) - EFO Application to State in disasters and situations of distress		New
44728	250.41(a) - Reporting number of needy persons served by charitable institutions		New
44727	250.37(c) & 250.30(m) - Monthly Processor's Performance Reports		New
44726	250.36(b) - End product sales and crediting value of donated foods		New
44725	250.22 - Reporting irregularities found through complaints		New
44724	250.19(b) - Distributing Agency's Management Evaluation System		New
44723	250.18(c) - Audits for DAs/RAs/Processors		New
44722	250.15(f)(4) - Excess funds justification		New
44721	250.15(a) - Distribution charges		New
44720	250.14(f) - Recipient agency excessive inventories		New
44719	250.14(e) - Distributing agency's physical inventory report		New
44718	250.14(a)(4)(iv) - Cost comparison of existing warehouse system with commercial system		New
44717	250.14(a)(2) - Noncommercial Warehouse Evaluation		New
44716	250.13(i) - Notification of Suspected Embezzlement, Misuse, Theft, etc.		New
44715	250.12(f) & 250.30(b) - Processing Agreements with FNS/Distributing Agencies/Recipient Agencies		New
44704	250.12(e) & 250.14(d) - Storage facility agreements		New
44703	250.12(b) - Distributing agancy agreements with recipient agencies		New
44702	247.30(d)(3) - Records of participant claims - Recordkeeping		New
44701	247.29(a) - Records of Fair Hearing Proceedings - Recordkeeping		New
44700	247.28(b) - Records of receipt, disposal & inventory of donated food - Recordkeeping		New
44699	247.22 - Record of use of funds - Recordkeeping		New
44698	247.34 - Management Reviews		New
44697	247.31(c) - Audit responses		New
44696	247.29(a) & (b)(2)(iii) - Receipt, disposal, and inventory of donated foods	Form	New	Monthly Report of the Commodity Supplemental Food Program and Quarterly Administrative Financial Status Report
44695	247.26 - Closeout procedures		New
44694	247.23(b) - State provisions of administrative funds		New
44693	247.19(a) - Agreement to prevent dual participation		New
44692	247.8 & 247.16(a) - Applications/Recertifications		New
44686	247.7(a) - Applications of Local Agencies		New
44685	247.6(d) - State Plan Amendments		New
44684	247.6(a-c) - State Plan		New
44683	247.4(a)(2), (b), (c) - State/Local Agreements		New
44682	240.6 - Funds for States that have phased out facilities - Recordkeeping		New
44681	240.5 - Case in lieu of donated foods for commodity schools - Recordkeeping		New
43552	240.4 - Cash in Lieu of Donated Foods for Nonresidential Child Care Institutions - Recordkeeping		Modified

ICR Details

OMB Control No: 0584-0293	ICR Reference No: 200608-0584-007
Status: Historical Inactive	Previous ICR Reference No: 200606-0584-001
Agency/Subagency: USDA/FNS	Agency Tracking No:
Title: Food Distribution Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 12/06/2006
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/25/2006
Terms of Clearance: This ICR has been withdrawn, as requested by FNS.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2009	36 Months From Approved	08/31/2009
Responses	1,642,762	0	1,642,762
Time Burden (Hours)	1,085,814	0	1,085,814
Cost Burden (Dollars)	0	0	0

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Abstract: Changes in the burden hours to reflect the proposed commodity program proposed rule, "Revisions and Clarification in Requirements for the Processing Donated Foods," under 7 CFR 250.

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Authorizing Statute(s): US Code: 7 USC 2013(b) Name of Law: Food Stamp Act of 1977
   US Code: 42 USC 1755, 1762a, 1766 Name of Law: National School Lunch Act
   US Code: 42 USC 1733 Name of Law: Child Nutrition Act of 1955
   US Code: 7 USC 7501 et seq. Name of Law: Emergency Food Assistance Act of 1983
   PL: Pub.L. 81 - 739 416, 439, 202 Name of Law: Agricultural Act of 1939
   PL: Pub.L. 100 - 237 1-2, 3(a)-(i), 3(k), 7 Name of Law: Commodity Distribution Reform Act & WIC Amendments of 1987
   PL: Pub.L. 100 - 435 110-111,130, 220, 502-503, 701 Name of Law: Hunger Prevention Act of 1988
   US Code: 7 USC 612
   PL: Pub.L. 97 - 98 1114(a) Name of Law: Agriculture and food Act of 1981
   PL: Pub.L. 89 - 321 1446a-1 Name of Law: Food and Agriculture Act of 1965
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0584-AD76	Proposed rulemaking	71 FR 164	08/24/2006

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 50250	08/24/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 94

table that charts list of burden

IC Title	Form No.	Form Name
240.4 - Cash in Lieu of Donated Foods for Nonresidential Child Care Institutions - Recordkeeping
240.5 - Case in lieu of donated foods for commodity schools - Recordkeeping
240.6 - Funds for States that have phased out facilities - Recordkeeping
247.19(a) - Agreement to prevent dual participation
247.22 - Record of use of funds - Recordkeeping
247.23(b) - State provisions of administrative funds
247.26 - Closeout procedures
247.28(b) - Records of receipt, disposal & inventory of donated food - Recordkeeping
247.29(a) & (b)(2)(iii) - Receipt, disposal, and inventory of donated foods	FNS-153	Monthly Report of the Commodity Supplemental Food Program and Quarterly Administrative Financial Status Report
247.29(a) - Records of Fair Hearing Proceedings - Recordkeeping
247.30(d)(3) - Records of participant claims - Recordkeeping
247.31(c) - Audit responses
247.34 - Management Reviews
247.4(a)(2), (b), (c) - State/Local Agreements
247.6(a-c) - State Plan
247.6(d) - State Plan Amendments
247.7(a) - Applications of Local Agencies
247.8 & 247.16(a) - Applications/Recertifications
250.12(b) - Distributing Agency Agreement with Recipient Agencies - Recordkeeping
250.12(b) - Distributing agancy agreements with recipient agencies
250.12(e) & 250.14(d) - Storage Facility Agreements - Recordkeeping
250.12(e) & 250.14(d) - Storage facility agreements
250.12(f) & 250.30(b) - Processing Agreements with FNS/Distributing Agencies/Recipient Agencies
250.12(f) & 250.30(c) - Processing Agreements with Distributing Agencies/Recipient Agencies - Recordkeeping
250.13(a)(1)(v) - Distributing agency documentation for the transfer of donated food
250.13(a)(5) - Distributing Agency Documentation of Method Used to Determine Commodity Value - Recordkeeping
250.13(a)(6) - Destination Data for Delivery of Donated Foods	FNS-7	Destination Data for Delivery of Donated Foods
250.13(f) - Report of Shipment Received, Over, Short and/or Damaged	FNS-57	Report of Shipment Recieved, Over, Short and/or Damaged
250.13(i) - Notification of Suspected Embezzlement, Misuse, Theft, etc.
250.13(k) & 250.17(d) - Commodity Acceptability Reports	FNS-663	Food Distribution Commodity Acceptability Progress (CAP) Report
250.14(a)(2) - Noncommercial Warehouse Evaluation
250.14(a)(4)(iv) - Cost comparison of existing warehouse system with commercial system
250.14(c) - Storage facility review - Recordkeeping
250.14(e) - Distributing agency's physical inventory report
250.14(e) - Physical inventory records - Recordkeeping
250.14(f) - Recipient agency excessive inventories
250.15(a) - Distribution charges
250.15(f) - Segregation of Operating Funds - Recordkeeping
250.15(f)(4) - Excess funds justification
250.16, 250.30, 250.37(e) & (f) - Maintenance of records/types of processing agreements/records of processor performance - Recordkeeping
250.17(a) - Commodity Inventory Report	FNS-155	Inventory Management Register
250.17(e) - Other Reporting - Food Requisition Form	FNS-52	Food Requisition
250.17(e) - Other Reporting - Multi-Commodity Food Requisition	FNS-53	Multi-Food Requisition
250.17(e) - Other Reporting - State Option Contract Program
250.18(b) - Processor CPA Audits - Recordkeeping
250.18(c) - Audits for DAs/RAs/Processors
250.19(b) - Distributing Agency's Management Evaluation System
250.19(b) - Maintain management evaluation & review records - Recordkeeping
250.22 - Distributing agency complaint records - Recordkeeping
250.22 - Reporting irregularities found through complaints
250.30(c)(4) - Recordkeeping requirements for all processors - Recordkeeping
250.36(b) - End product sales and crediting value of donated foods
250.37(c) & 250.30(m) - Monthly Processor's Performance Reports
250.41(a) - Reporting number of needy persons served by charitable institutions
250.43(a) & 250.44(a) - EFO Application to State in disasters and situations of distress
250.54 - Contract provisions between RAs and Food Service Management Companies
250.55 - RA recordkeeping and reviews of Food Service Management Companies - Recordkeeping
250.58 - Ordering donated foods and thier provisions to School Food Authorities	FNS-52	Food Requisition
250.64(f) - Records and reports in the Pacific Islands - Recordkeeping
250.67(a)(2)(ii) - Correctional Institutions - Recordkeeping
250.69(a) & 250.70(a) - Emergency organization feeding application to state for disasters and situations of distress
250.69(a) & 250.70(a) - Records for Disaster Organizations maintain applications - Recordkeeping
250.69(g) - State written request for replacement
251.10(a)(1) - Receipt, disposal, and inventory of commodities - Recordkeeping
251.10(a)(3) - Eligibility determination and collection of participating household information - Recordkeeping
251.10(e) - Monitoring eligible recipient agencies
251.2(c)(1) - Federal-State Agreement - Recordkeeping
251.2(c)(2) & 251.5(a) - State Agency-Eligible Recipient Agency Agreement - Recordkeeping
251.4(a)(2) - Funds paid to eligible recipient agencies for storage and distribution - Recordkeeping
251.4(g) - Availability and Control of Commodities
251.4(g) - Documentation of transfer of Section 32 Commoditites - Recordkeeping
251.4(h) - Inter-Agency Agreements - Recordkeeping
251.4(j) - Inter-Agency Agreements
251.4(l) - Commodity Losses and Claims
251.4(l)(5) - Claims and adjustments - Recordkeeping
251.6(b) - State Agency Distribution Plan
251.9(e) & 251.10(d)(1) - Report of State Administratvie Cost Matching Requirements	FNS-667	Report of the Emergency Food Assistance Program (TEFAP) Administrative Costs
253.11(b) & 254.3(a) - Managment of Administrative Funds
253.3(c) - Prime Vendor Pilot
253.5(a) & 254.3(a) - Plans of Operation
253.5(h) & 254.3(a) - Records and Reports: Damaged or Out of Condition Commoditites - Recordkeeping
253.5(h) & 254.3(a) - Records and Reports: Disposal of Out of Condition Commodities - Recordkeeping
253.5(h) & 254.3(a) - Records and Reports: Financial Status Reports - Recordkeeping
253.5(h) & 254.3(a) - Records and Reports: Household Applications - Recordkeeping
253.5(h) & 254.3(a) - Records and Reports: ITO Applications - Recordkeeping
253.5(h) & 254.3(a) - Records and Reports: Plans of Operation - Recordkeeping
253.5(h) & 254.3(a) - Records and Reports: Reporting Changes - Recordkeeping
253.5(h) & 254.3(a) - Reports and Records: Commodity Inventories - Recordkeeping
253.5(i) & 254.3(a) - Monitoring and review of program operations - Recordkeeping
253.5(j) & 254.3(a) - Investigations and Complaints - Recordkeeping
253.7 & 254.3(a) - Certification of Household to Participate
253.7(h) & 254.3(a) - Fair Hearings - Recordkeeping
253.8(b) & 254.3(a) - Commodity Inventories	FNS-152	Monthly Distribution of Donated Foods to Famil Units
253.8(f) & 254.3(a) - Damaged, or Out of Condition Commodities	FNS-57	Report of Shipment Received Over, Short, and/or Damaged

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: The change in burden with this submission is a total of 18,694 hours (1,595 is attributed to Program change and 17,099 is associated with adjustments due to errors in calculations in previous submissions). Because all burden was migrated under one single IC, the total burden is shown as program/adjustment change instead of only the actual hours affected by this submission.

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Annual Cost to Federal Government: $320,400

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/25/2006

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