FNS-292 A Report of Commodity Distribution for Disaster Relief

FORM APPROVED OMB NO 0584-0037
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instructions, searching existing data sources, gathering and maintaining the data need, and
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U.S Department of Agriculture - Food and Nutrition Service

Report of Commodity Distribution for
Disaster Relief

Submit completed report to: Regional Administrator, Food and Nutrition Service, USDA, no later than 45 days after completion of emergency relief operations. (Note:
Replacement cannot be authorized until form is reviewed and approved.)
3. Agency Code
1. State
4. Disaster Dates:
2. Agency

5. Total # of persons receiving commodity, by county:
County

County

Total # Persons

County

Total # Persons

Total # Persons

Total # Persons

6. Type of Feeding:

___ Congregate

7. Type of disaster:

___ Household
8. Name of agency(s) issuing commodity to recipients:

Presidential Declaration: ___ Yes ___ No
___ Flood
___ Hurricane ___ Tornado
___ Earthquake ___ Other (specifiy)

___ American Red Cross
___ Other (Specify)

___ Salvation Army

9. Period of Issuance to Disaster Relief Recipients (MM, DD, YYYY):

From:

Through:

10. Commodities Distributed:
Commodity Code & Description

D.O. Number
(Optional)

# of Cases

Case Weight

Total:

Case Value

Total Pounds

#'s:

Total Value

$:

11. Remarks (attach sheet if necessary)

12. Signature

13. Title

14. Date

FORM FNS-292-A (4-08) Previous Editions are Obsolete This report is required by Regulations (7 CFR, Part 250) Electronic Form Version Designed in Adobe 8.1 version
The result of the emergency relief operations need to
be comprehensive, accurate, and timely.

SBU