Form FNS-153 Monthly Report of the Commodity Supplemental Food Progra

FORM APPROVED OMB NO. 0584-0293
U.S. DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION SERVICE

MONTHLY REPORT OF THE COMMODITY SUPPLEMENTAL FOOD PROGRAM AND QUARTERLY ADMINISTRATIVE FINANCIAL
STATUS REPORT
SEE INSTRUCTIONS ON REVERSE
1. REPORTING MONTH
AND YEAR

4. NUMBER OF PARTICIPANTS

3. TYPE OF SUBMISSION
(A) - INITIAL

INFANTS
(0-3) MONTHS
(A)

(B) - LATEST REV.

2A. ST AGENCY NAME

(C) - CLOSEOUT
INVENTORY

INFANTS
(4-12) MONTHS
(B)

CHILDREN
(1-6) YEARS
(C)

2B. DA CODE
6.
COMMODITY
NAME

PREGNANT/BREAST
FEEDING WOMEN
(D)

5. REPORTING MEASUREMENTS
POST PARTUM
WOMEN
(E)

TOTAL NO. PART.

TOTAL NO. OF

(4A+B+C+D+E=4F) ELDERELY PART.

(A) CASES

(B) UNITS

(G)

(F)

STATE AND LOCAL DATA
6A.

6B.

CODE

PACK
SIZE

8.

7.
STATE &
LOCAL
BEGINNING

10.

9.
REDONATIONS

RECEIPTS

INVENTORY

IN

TOTAL

11.
COMMODITY ISSUANCE

COMMODITY ACTIVITY

TOTAL

TOTAL NUMBER
ISSUED TO:

INVENTORY
AVAILABLE

13.

12.

W-I-C

ELDERLY

(A)

(B)

(7+8+9=10)

ACTIVITY
TOTAL
NUMBER
ISSUED

REDONATIONS
OUT

FOOD
LOSS

(A)

(B)

(C)

(11A+B=12)

AMT
USED
FOR
NUT
ED
(D)

14.
ADJUSTMENTS
POSITIVE

NEGATIVE

15.
STATE &
LOCAL
ENDING

(12A +B
C + D = 13)

(A)

(B)

INVENTORY

((10-13) + OR 14A & B = 15)

24/300can

GREEN BEANS 300

A059

GREEN BEANS 303

A060

24/303can

BEANS VEG 300
CARROTS

A090
A095

24/300can
24/303can

CARROTS 300

A098 24/300can

CORN KERNEL 300

A119

CORN CREAM

A120

24/303can

CORN KERNEL

A121

24/303can

CORN CREAM 300

A122

24/300can

LENTILS

A135

12/2 lb.

PEAS 300
PEAS 303

A144
A145

24/300can
24/303can

PUMKIN

A163

24/300can

SPINACH

A166

24/303can

24/300can

SPINACH 300

A167

24/300can

POTATOES 303

A169

24/303can

POTATOES SLC 300

A170

24/300can

POTATOES DEHY 12

A196

12/1 lb.

FORM FNS -153 (5/00) Previous Editions Are Obsolete

Electronic Form Version Designed in JetForm 5.1 version

PAGE 1 OF 8

MONTHLY REPORT OF COMMODITY SUPPLEMENTAL

REPORTING MONTH AND YEAR:

REPORTING MEARSUREMENT

STATE AGENCY NAME:

CASES (

FOOD PROGRAM STATE AND LOCAL INVENTORY

)

OR UNITS (

)

STATE AND LOCAL DATA
6.
COMMODITY
NAME

6A.

6B.

CODE

PACK
SIZE

8.

7.
STATE &
LOCAL
BEGINNING

REDONATIONS
RECEIPTS

INVENTORY

SWT POTATOES 303
SWT POTATOES 300

A240 24/300can

TOMATO SAUCE 300

A244 24/300can

TOMATOES 303

A248 24/303can

GRAPEFRUIT J
APPLE J

A280 12/46 oz.

TOMATO J
ORANGE J

IN

TOTAL

11.
COMMODITY ISSUANCE

COMMODITY ACTIVITY

TOTAL

TOTAL NUMBER
ISSUED TO:

INVENTORY
AVAILABLE

13.

12.

W-I-C

ELDERLY

(A)

(B)

(7+8+9=10)

ACTIVITY
TOTAL
NUMBER
ISSUED

REDONATIONS
OUT

FOOD
LOSS

(A)

(B)

(C)

(11A+B=12)

AMT
USED
FOR
NUT
ED
(D)

14.
ADJUSTMENTS
POSITIVE

NEGATIVE

15.
STATE &
LOCAL
ENDING

(12A +B
C + D = 13)

(A)

(B)

INVENTORY

((10-13) + OR 14A & B = 15)

A221 24/303can
A223 24/300can

TOMATOES 300

GRAPE J
PINEAPPLE J

10.

9.

A282 12/46 oz.
A285 12/46 oz.
A286 12/46 oz.
A290 12/46 oz.
A300 12/46 oz.

APPLESAUCE 303

A355 24/303can

F COCKTAIL 303
F COCKTAIL 300

A401 24/303can
A403 24/300can

PEACHES CLING 300

A411 24/300can

PEACHES CLING 300

A412 24/303can

PEARS 300

A437 24/300can

PEARS 303

A439 24/303can

PINEAPPLE 2

A446 24/2 can

PLUMS 303

A461 24/303can

PRUNES 24

A489 24/1 lb.

FORM FNS -153 (5/00) Previous Editions Are Obsolete

Electronic Form Version Designed in JetForm 5.1 version

PAGE 2 OF 8

MONTHLY REPORT OF COMMODITY SUPPLEMENTAL

REPORTING MONTH AND YEAR:

REPORTING MEARSUREMENT

STATE AGENCY NAME:

CASES (

FOOD PROGRAM STATE AND LOCAL INVENTORY

)

OR UNITS (

)

STATE AND LOCAL DATA
6.
COMMODITY
NAME

6A.

6B.

CODE

PACK
SIZE

7.

8.

STATE &
LOCAL
BEGINNING

REDONATIONS
RECEIPTS

INVENTORY

CHICKEN CND

A562 24/29 oz.

EGG MIX 6
STEW CND

A570 48/6 oz.
A587 24/24 oz.

STEW 24/15

A589 24/15 oz.

BEEF NJ

A610 24/29 oz.
A630 24/29 oz.
A740 24/12.25oz.
A803 24/14.75oz.

PORK NJ
TUNA 12.25
SALMON 24

BEANS DK R KIDNEY
BEANS BLKEYE 2
BEANS B LIMA 2

10.

9.

IN

TOTAL

11.
COMMODITY ISSUANCE

COMMODITY ACTIVITY

TOTAL

TOTAL NUMBER
ISSUED TO:

INVENTORY
AVAILABLE

13.

12.

W-I-C

ELDERLY

(A)

(B)

(7+8+9=10)

ACTIVITY
TOTAL
NUMBER
ISSUED

REDONATIONS
OUT

FOOD
LOSS

(A)

(B)

(C)

(11A+B=12)

AMT
USED
FOR
NUT
ED
(D)

14.
ADJUSTMENTS
POSITIVE

NEGATIVE

15.
STATE &
LOCAL
ENDING

(12A +B
C + D = 13)

(A)

(B)

INVENTORY

((10-13) + OR 14A & B = 15)

A906 12/2 lb.
A910 12/2 lb.
A912 12/2 lb.

BEANS PINTO 2

A914

12.2 lb.

BEANS R KIDNEY 2

A915

12.2 lb.

BEANS GRT NORTH 2

A917

12.2 lb.

BEANS NAVY PEA 2

A918

12.2 lb.

BEANS LT KIDNEY 2

A920

12.2 lb.

PEAS SPLIT 2

A922 12.2 lb.

FORM FNS -153 (5/00) Previous Editions Are Obsolete

Electronic Form Version Designed in JetForm 5.1 version

PAGE 3 OF 8

MONTHLY REPORT OF COMMODITY SUPPLEMENTAL

REPORTING MONTH AND YEAR:

REPORTING MEARSUREMENT

STATE AGENCY NAME:

CASES (

FOOD PROGRAM STATE AND LOCAL INVENTORY

)

OR UNITS (

)

STATE AND LOCAL DATA
6.
COMMODITY
NAME

6A.

6B.

CODE

PACK
SIZE

7.

8.

STATE &
LOCAL
BEGINNING

REDONATIONS
RECEIPTS

INVENTORY

EVAP 12
INSTANT 24

B081 48/12 Fl oz.
B090 6/4 lb.

EVAP 24

B117 24/12 Fl oz.

CORNMEAL 5 DEG

B137

CORNMEAL 8/5 DEG

B138 8/5 lb.
B141 5/10 lb.
B142 5/10 lb.

CORNMEAL 10 DEG
CORNMEAL 40 DEG

10.

9.

IN

TOTAL

11.
COMMODITY ISSUANCE

COMMODITY ACTIVITY

TOTAL

TOTAL NUMBER
ISSUED TO:

INVENTORY
AVAILABLE

13.

12.

W-I-C

ELDERLY

(A)

(B)

(7+8+9=10)

ACTIVITY
TOTAL
NUMBER
ISSUED

REDONATIONS
OUT

FOOD
LOSS

(A)

(B)

(C)

(11A+B=12)

AMT
USED
FOR
NUT
ED
(D)

14.
ADJUSTMENTS
POSITIVE

NEGATIVE

15.
STATE &
LOCAL
ENDING

(12A +B
C + D = 13)

(A)

(B)

INVENTORY

((10-13) + OR 14A & B = 15)

10/5 lb.

FORMULA POWDER 14.1 B158 24/14 oz.
FARINA

B160 24/14 oz.

CEREAL INFANT R8
B161 12/8 oz.
FORMULA SOY DRY 6/14 B162 6/14 oz.
B163 12/13 Fl oz.
FORMULA SOY 12
FORMULA 12

B164 12/13 Fl oz.

FORMULA

B165 24/13 Fl oz.

FORMULA SOY

B166 24/13 Fl oz.

FORMULA POWER
FORMULA POWDER 6

B167 12/1 lb.
6/1 lb.

B168

FORMULA SOY PWDR 6 B169 6/1 lb.

FORM FNS-153 (5/00) Previous Editions Are Obsolete

Electronic Form Version Designed in JetForm 5.1 version

PAGE 4 OF 8

MONTHLY REPORT OF COMMODITY SUPPLEMENTAL

REPORTING MONTH AND YEAR:

REPORTING MEARSUREMENT

STATE AGENCY NAME:

CASES (

FOOD PROGRAM STATE AND LOCAL INVENTORY

)

OR UNITS (

)

STATE AND LOCAL DATA
6.
COMMODITY
NAME

6A.

6B.

CODE

PACK

8.

7.
STATE &
LOCAL

SIZE

BEGINNING

REDONATIONS
RECEIPTS

INVENTORY

GRITS CW 5

B381

10/5 lb.

GRITS CW 40

B382

8/5 lb.

HONEY 24

B403 24/24 oz.

MACARONI 1

B425 24/1 lb.

OATS 3

B445 12/3 lb.

PB 2
PB RDU-FAT 2

B470

CHUNKY RDU-FAT 2
RICE 2

CEREAL CORN RTE 17.5
CEREAL RICE 15
CEREAL CORN 18
CEREAL CORN 16

10.

9.

IN

TOTAL

11.
COMMODITY ISSUANCE

COMMODITY ACTIVITY

TOTAL

TOTAL NUMBER
ISSUED TO:

INVENTORY
AVAILABLE

13.

12.

W-I-C

ELDERLY

(A)

(B)

(7+8+9=10)

ACTIVITY
TOTAL
NUMBER
ISSUED

REDONATIONS
OUT

FOOD
LOSS

(A)

(B)

(C)

(11A+B=12)

AMT
USED
FOR
NUT
ED
(D)

14.
ADJUSTMENTS
POSITIVE

NEGATIVE

15.
STATE &
LOCAL
ENDING

(12A +B
C + D = 13)

(A)

(B)

INVENTORY

((10-13) + OR 14A & B = 15)

24/2 lb.
B471 24/2 lb.
B488 24/2 lb.
B510 24.2 lb.

B847 14/17.5 oz.
B848 12/15 oz.
B849 12/18 oz.

CEREAL CORN 17.5

B851 14/16 oz.
B852 12/17.5 oz.

CEREAL OATS 15.5

B854 12/15.5 oz.

FORM FNS-153 (5/00) Previous Editions Are Obsolete

Electronic Form Version Designed in JetForm 5.1 version

PAGE 5 OF 8

MONTHLY REPORT OF COMMODITY SUPPLEMENTAL

REPORTING MONTH AND YEAR:

REPORTING MEARSUREMENT

STATE AGENCY NAME:

CASES (

FOOD PROGRAM STATE AND LOCAL INVENTORY

)

OR UNITS (

)

STATE AND LOCAL DATA
6.
COMMODITY
NAME

6A.

6B.

CODE

PACK

8.

7.
STATE &
LOCAL

SIZE

BEGINNING

REDONATIONS
RECEIPTS

INVENTORY

CEREAL OATS

B860 24/15 oz.

CEREAL OATS 16

B861

12/16 oz.

CEREAL RICE 12

B866

12/13 oz.

CEREAL RICE 17.5

B867

12/17 oz.

CEREAL RICE RTE 17.5
CEREAL WHEAT 16

B868 14/17.5 oz.
B871 12/16 oz.

10.

9.

IN

TOTAL

11.
COMMODITY ISSUANCE

COMMODITY ACTIVITY

TOTAL

TOTAL NUMBER
ISSUED TO:

INVENTORY
AVAILABLE

13.

12.

W-I-C

ELDERLY

(A)

(B)

(7+8+9=10)

ACTIVITY
TOTAL
NUMBER
ISSUED

REDONATIONS
OUT

FOOD
LOSS

(A)

(B)

(C)

(11A+B=12)

AMT
USED
FOR
NUT
ED
(D)

14.
ADJUSTMENTS
POSITIVE

NEGATIVE

15.
STATE &
LOCAL
ENDING

(12A +B
C + D = 13)

(A)

(B)

INVENTORY

((10-13) + OR 14A & B = 15)

CEREAL WHEAT RTE 16 B872 14/16 oz.

16. REMARKS (Provide Explanation as Requested by Instructions.) (Attach Additional Sheets as Deemed Necessary.)

17. SIGNATURE

18. TITLE

19. DATE

20.

OUTLAYS
CSFP

UNLIQ. OBLIGATION

(A)

(B)

TOTAL
(C)

UNLIQ. BAL. OF
ADVANCES
(D)

ADMINISTRATION

FORM FNS-153 (5/00) Previous Editions Are Obsolete

Electronic Form Version Designed in JetForm 5.1 version

PAGE 6 OF 8

FNS-153 REPORTING INSTRUCTIONS

Reporting Measurements - Data reported on ths FNS-153 form can be shown in either "case/remaining" or
"units." Reporting data in "cases/remaining units" for some columns and just "units"for other columns or
vice versa is prohibited on the same form. Prior FNS approval is required for a State agency to switch one
reporting measurement to another. The choice of the measurement "cases/remaining units" or "units" is left
to the discretion of the reporting State agency. Rounding the count is unacceptable.
"Cases" means the container size in which the commodity is shipped. For example, the pack size for
egg mix is 48/6 oz. foils. If reporting "cases/remaining units," 48 cases and 3 units would be shown on
the FNS-153 as "48/3." Any number appearing to the left of the slash will represent the number of cases.
In contrast, any number to the right of the slash will represent the actual number of units. When a number
appears with no slash, FNS will automatically assume it is whole casses when 5A is checked.

during the reported month. (This column should not reflect commodity movement between State and local
agencies.)
9. Redonations In - Enter the total number of redonated commodities received by the State from
another State agency or another USDA program from the CSFP. Specify in the remarks section the name of
the State and program those commodities were redonated from and their commodity code.
10. Total Inventory Available - Enter the total number of commodities available for issuance for the
CSFP. (The sum of items 7, 8, and 9 should equal item 10.)

11. CSFP Issuance - Enter the total number of commodities actually issued to and accepted by
participants during the reporting month as specified below. This figure should exclude those commodities not
"Unit" means individual cans, boxes, packages, etc., not cases. For example, 1 case of egg mix would accepted by the participant at the time of food pick-up. If a participant has refused a commodity at pick-up
be reported as "48," and 5A would be checked.
it should not be considered issued.
Submission - The CSFP State agency shall collect the necessary data for this report from the local
certification, State and local warehouse sites within its jurisdiction and combine the data so that only one
FNS-153 report would be submitted by the CSFP State agency to the appropriate FNS regional office no
later than 30 days after the end of the month being reported for. Financial status data (item 20) shall be
completed quarterly and submitted on the FNS-153 for December, March, June, and September. A final
closeout SF-269 for CSFP must be submitted to FNS within 90 days after the end of the fiscal year.
1. Reporting Month and year - Enter month and year for which data is reported.

(B) Reflect the total number of commodities actually issued and accepted by elderly during the
reporting month.
12. Commodity Activity.
12A. Total number issued - Self-explanatory (11A + 11B = 12A).

2A &2B. State Agency name & DA Code - Self-explanatory.
3. Type of Invent/Part Submission - Indicate type of submission for month being reported. The initial
submission of this report should be such by checking (A). Any subsequent revisions for the report month
should be indicated by checking 3(b). The submission of the annual physical inventory which is due for the
report month of September should be indicated by checking 3(c). If the September report is submitted with
3(c) checked, FNS will automatically consider it the final report for September.
4. Number of Participants - (A through E) Enter the toal number of participants

(A) Reflect the total number of commodities that were actually issued and accepted by Women,
Infants and Children (W-I-C).

by category, to

whom commodities were actually issed.
4(F). Self-explanatory.
4(G). Enter the total number of elderly participants to whom commodities were actually issued.
5. (A and B) - Reporting Measurement - (see above explanation) Check appropriate clock 5A or 5B.
6. (A and B) - Commodity name, code and shipping pack size - Where the code and name of a
commodity is not preprinted on this form, enter that information on the next available blank line.
7. State and Local Beginning Inventory - Enter the number appearing in item 15 in the previous
month's report. (This number must reflect all foods physically located at State and local storage and
distribtion site(s).
8. Receipts - Enter the total number of commodities actually accepted in good condition from USDA

12B. Redonations Out - Enter the total number of commodities shipped by the reporting State to
another State agency or to another USDA food program. Specify in the remarks section the name of the
State and program those commodities were redonated to and their commodity code.
12C. Food Loss - Enter the number of commodities that are actual food losses. These would
include foods that: (1) after consignee receipt were found to have concealed damaged; (2) were damaged in
the warehouse or during transit from the State warehouse to the local sites; (3) were found to be out-ofcondition or unfit for human consumption; or (4) were known to have been stolen or lost due to fraud, misuse
or embezzlement. (The reasons for food loss must be detailed in the REMARKS section. Attach additional
pages if necessary.)
12D. Food Used for Nutrition Education - Enter the number of commodities used for CSFP nutrition
education purposes.
13. Total Activity - Self-explanatory (sum 12A thru 12D = 13).
14. Inventory Adjustments - Enter the actual number of commodities adjusted. A partial list of
such adjustments are provided below as examples. (Note: the reasons for adjustments must be detailed in
"Remarks," item 16). This column should not reflect the movement of commodities between the State and
its local agencies.

Page 7 of 8

REPORTING INSTRUCTIONS - CONTINUED

(a) A "Positive" Commodity adjustments could be the result of a bookkeeping error or previous
inaccurate inventory count. Any commodity still in good condition which was returned to a distribution
site by a participant should be reflected as a positive adjustment.
(b) A "Negative" Commodity adjustment could be caused by a bookkeeping discrepancy.
15. State and Local Ending Inventory - Enter the combined total number of CSFP commodities in
inventory at the end of the reporting month at all State and local storage and distribution sites (10-13) plus
or minus 14A and 14B = 15.
16. Remarks - Self-explanatory.
17. Signature - Self-explanatory.
18. Title - Self-explanatory.
19. Date - Self-explanatory.
20. Complete item number 20 for CSFP as follows.

(b) Unliquidated Obligations - Show the unliquidated obligations for the State and local
agencies. Unliquidated administrative obligations are the cumulative year-to-date dollars which the
State agency expects to pay out for administrative cost incurred through the quarter being reported
for but not yet paid or certified for payment. (Only obligations to be paid with Federal funds should
be shown.)
(c) Total - Show the sums of (A) and (B).
(d) Unliquidated Balances of Advances - where applicable show the unliquidated balance of
advances as of the end of the report quarter. This should be calculated as follows:
(1) Determine the total amount of payments provided to local agencies and contract agents
for administration year-to-date.
(2) Determine the total amount of outlays made by local agencies and contract agents for
administration for the year-to-date.
(3) Subtract (2) from (1) and record the result as the unliquidated balances of advances.

Advances for Administration are actual payments made by the State agency to a local agency or
(a) Outlays - Show the administrative outlays for State and local agencies, administrative outlays are contract agent which are not administrative costs already paid or fees for goods/services already
the cumulative year-to-date payments, or invoices certified by the program for payment, for administrative costs provided.
incurred through the quarter being reported for. (Do not report advances as outlays.)

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Page 8 of 8