Form FNS-7 Destination Data for Delivery of Donated Foods

Food Distribution Forms

FNS-7

250.13(a)(6) - Destination Data for Delivery of Donated Foods

OMB: 0584-0293

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

TYPE OF ACTION

DESTINATION DATA FOR DELIVERY OF
DONATED FOODS

CHANGE

NEW

FNS Instruction 709-5
SEE INSTRUCTIONS ON REVERSE

DELETE

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it display a valid OMB
control number. The valid OMB control number for this information collection is 0584-0293. The time required to complete this information
collection is estimated to average .5 hour 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.
1. NAME OF STATE DISTRIBUTING AGENCY

2. DESTINATION (CITY) RECEIVING POINT

4. CONSIGN TO

5. CARE OF (Please provide Fax No. and E-mail address if available)

3. STATE IN WHICH DISTRIBUTING AGENCY
IS LOCATED

ENTITY NO.
6. DELIVER TO (Street address, team track, warehouse, etc.

Please provide Fax and E-Mail address if available)

A. FOR RAIL DELIVERY

LIMITATIONS

B. FOR TRUCK DELIVERY

LIMITATIONS

EXPLANATION OF NEED FOR THE RESTRICTION SHOWN

7. SHIP BY (Shipment may be made by rail or truck
unless one of the following is checked)
TRUCK ONLY

RAIL ONLY

8. TITLE AND ADDRESS ONLY OF PERSON TO WHOM THE FORWARDING
NOTICE AND DISTRIBUTION AGENCY CONSIGNEE RECEIPT (Form
MP-209A) SHOULD BE SENT

9. TITLE AND ADDRESS ONLY OF PERSON TO WHOM THE NOTICE OF SHIPMENT
SHOULD BE SENT

10. OUTLET(S) SERVED
NUTRITION PROGRAM FOR
THE ELDERLY (NPE)

CHARITABLE INSTITUTIONS

CHILD AND ADULT
CARE FOOD PROGRAM
(CACFP)

SUMMER CAMPS

COMMODITY SUPPLEMENTAL
FOOD PROGRAM (CSFP)

SUMMER FOOD SERVICE
PROGRAM

FOOD DIST. PRGM ON
INDIAN RESERVATIONS
(FDPIR)

OTHER (Specify)

SCHOOLS

EMERGENCY FOOD
ASSISTANCE PROGRAM (TEFAP)

IF DESTINATION IS A WAREHOUSE, COMPLETE ITEMS 11 THROUGH 14
12. IF COMMERCIAL WAREHOUSE DELIVERY ACCEPTABLE BY

11. TYPE OF WAREHOUSE
STATE OWNED AND OPERATED

COMMERCIAL

13 TYPE(S) OF STORAGE PROVIDED

TRANSFER OF TITLE

LOCAL PICKUP

14. HANDLING OF PERISHABLE FOODS (Check one)
SHIPMENT ALWAYS ENTIRELY UNLOADED AND PLACED IN STORAGE

DRY

REFRIGERATED

FREEZER

PART OF SHIPMENT ALWAYS OR SOMETIMES DISTRIBUTED FROM
CAR OR WAREHOUSE PLATFORM

The above information is true and correct to the best of my knowledge and belief.
15. DATE

16. SIGNATURE OF AGENCY REPRESENTATIVE

DESTINATION
DISTRIBUTING AGENCY - Send a fax/copy to the Food and Nutrition Service Regional Office.
FNS REGIONAL OFFICE - Send a fax/copy to the Kansas City Commodity Office.
FORM FNS-7 (12-98) Previous editions obsolete

Electronic Form Version Designed in JetForm 5.01 Version

INSTRUCTIONS
It is important that a separate form be prepared for each
destination (item 2) when delivery conditions require
changes in elements of information in items 5, 6, 7, 8, or
9.

effect at the point of delivery, the name of the railroad
which serves this location shall be shown. For
example "Blank's Warehouse, ACL," or "Industrial
siding, PPP." Where reciprocal switching is in effect
at the point of delivery, no delivering carrier shall be
specified. If delivery is to be made on a team track,
the name of a specific team track shall not be shown
unless it is essential to program requirements.

In the "Type of Action" entry, check one box only indicating whether the form is to provide data for: (1) a NEW
destination, (2) notification of CHANGE in data for an existing receiving point, or (3) DELETION of a destination receiving point.

Limitations. Show limiting conditions, if any, at the
destination point, e.g., "Cannot handle care over
maximum length of 53 feet."

ITEM
1

Self-explanatory.

2

Name of the city to which shipment is to be made
Show State only if different from item 3.

3

Self-explanatory.

4

Enter the title of the Distributing Agency's
representative who is accountable for distribution
of donated foods. Names are not to be shown
unless essential to the Distributing Agency's
operation. The Entity Number is the code designation assigned by USDA for a destination receiving
point, and will be filled in by the Distribution
Agency each time the form is submitted. (Prior to
submitting the form for establishment of a new
destination receiving point, the Distributing Agency
will contact the FNS Regional Office and obtain an
Entity Number.)

5

6

If delivery at destination is to be accepted by the
Distributing Agency's representative (shown in
item 4), enter "Same as item 4." If delivery at
destination is to be accepted by someone other
than the representative shown in item 4, that
person's title is inserted here. Names are not be
be shown unless essential to the Distributing
Agency's operation.
This item is used jointly with item 7 since the
information to be supplied is dependent upon the
method of shipment indicated in item 7.
A. For Rail Delivery - No entry is to be made unless delivery to a specific location is essential to
program operations, e.g., the receiving warehouse
is located on a rail siding. When an entry is
necessary, the address shown shall include the
specific location at which the car is to be placed for
unloading. When reciprocal switching is not in

B. For Truck Delivery. Show exact street address for
location at which delivery will be accepted. If same as
for "Rail Delivery," enter "Same as for rail delivery."
Limitations. Show limiting conditions, if any, at the
destination point, e.g., "12 1/2-foot clearance."
7

It is desirable that shippers be allowed to make shipment by either rail or truck so that the means of transportation can be selected which will result in least
transportation costs. Distributing agencies may restrict the method of shipment only when necessary to
their program operations. If a specific mode of transportation is shown, an explanation must be made of
the need for the restriction.

8

If this person is the same as the one to whom the
Notice of Shipment is sent, enter "Same as item 9."
Names are not to be shown unless essential to the
Distributing Agency's operations.

9

Self-explanatory. Names are not to be shown unless
essential to the Distributing Agency's operations.

10

Indicate the outlet(s) to which distributions are made
from this destination point.

11

12, 13, and 14 self-explanatory.

15 &
The Distributing Agency's representative (item 4) will
16 complete these entries.


File Typeapplication/pdf
File TitleJetForm:FNS-7.IFD
Authorlhibbitts
File Modified2006-08-10
File Created2006-08-10

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