FNS-292 A Report of Commodity Distribution for Disaster Relief

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U.S. Department of Agriculture - Food and Nutrition Services

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.
1. State

2. Agency

4. Disaster Dates:

3. Agency Code

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

County

Total # Persons

County

Total # Persons

Total # Persons

Total # Persons
6. Type of Feeding:

Congregate

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

7. Type of disaster:
Presidential Declaration:

Yes

Flood

Hurricane

Earthquake

Other (specify)

No

American Red Cross

Tornado

Salvation Army

Other (specify)

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

Total:

Case Weight

Case Value

Total Pounds

#'s:

Total Value

$:

11. Remarks (attach sheet if necessary)

12. Signature

13. Title

14. Date

This report is required by Regulations (7 CFR, Part 250).
The result of the emergency relief operations need to be comprehensive, accurate, and timely.

FORM FNS-292A (04/11) Previous Editions Obsolete

SBU

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