FNS 710 CN Database Qualification Report

OMB APPROVED NO. 0584-0494
Expiration Date: XX/XX/XXXX

U.S. Department of Agriculture • Food and Nutrition Service

CN Database Qualification Report
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a Collection of Information unless it displays a valid
OMB control number. The valid OMB control number for this information collection is 0584-0494. The time required to complete this information
is estimated to average 120 minutes per response, including the time to review instructions, search existing data resources, gather the data
needed, and complete and review the information collection.

Date Submitted:

(MM/DD/YYYY)

Manufacturer Information:

Manufacturer Information Continued:

Company Name:
Street1:
Street2:
City, State:
Zip Code:

Company Website:
Company Phone: (xxx) yyy-zzzz:
Company Fax: (xxx) yyy-zzzz:
General Email:

MFR Product Name:

(Max 255 characters-example: Pizza, pepperoni topping, regular crust, frozen, cooked)

Product Name Shortened:(Max 60 characters-example:

Brand:

Unit UPC:

Product Number/Code:

pepperoni pizza)

(12 numbers)

(Max 40 characters)

__ - __ __ __ __ __ - __ __ __ __ __ - __
Food Category Code: (from table on field explanation page 3)

Product Is Produced For School Food Service?

Product Is Produced With USDA Commodity Food?
NLEA Adjusted Values:

YES

YES

NO

YES

NO

NO

Value Type Code: Analytical Data (A), USDA Data (U), Calculated Data (C)
As Served (S) or As Purchased (P):
Is This An Enriched Or Fortified Product?

S

P
YES

A

U

C

NO

Notes:

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FNS-710 (05-11) Previous Editions Obsolete

SBU

Electronic Form Version Designed in Adobe 9.1 Version

Product Number/Code (from page one):

Household Serving Amount: (a numeric value)

Household Serving Measure Description:

Household Serving Size In Grams or Ounce:
g or
oz

(Example: Cup, Ounce, Patty, Piece, Slice)

Nutrient Serving Size (Total Gram Weight Of Product Upon Which The Following Nutrients Are Based):
(Ounce To Gram Conversion Factor: Ounce X 28.35g/oz = Grams)

IU or

g

Total Calories:

Kcal (Calories)

Vitamin A:

% DV

Total Fat:

g

*Vitamin A:

Saturated Fat:

g

Vitamin C:

mg or

% DV

*Trans Fat:

g

Iron:

mg or

% DV

Cholesterol:

mg

Calcium:

mg or

% DV

Sodium:

mg

*Water (Moisture):

g

Total Carbohydrate:

g

*Ash:

g

Total Dietary Fiber:

g

Protein:

g

RAE

* It Is Optional To List Values For These Nutrients

LIST OF INGREDIENTS:

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CN Qualification Report Field Explanation
Enter the Date Submitted, and Manufacturer Information. The MFR Product Name should follow the naming
convention used in the USDA's National Nutrient Database for Standard Reference ({HYPERLINK "http://www.
nal.usda.gov/fnic/foodcomp/search/"}). The Product Name Shortened should not be an abbreviation of each
word in the full product name but rather should be a clear and concise shortened version of the full product
name. The Brand for the product should be listed separately from the full or shortened product name. The Unit
UPC is the 12 digit Universal Product Code and is important for correctly matching the information to the product.
Example: 0 - 12345 - 12345 - 0. The Product Number/Code should be your product's 5 digit UPC# (The
portion after the second dash) if you do not use a separate product number or code. The Food Category Code
comes from a USDA Table. Please select from the following list of 2-digit categories.
Food Category Codes
01
02
03
04

Dairy: butter, cheese, eggs, milk, yogurt
Spice: seasonings, flavorings, leavening agents
Baby food
Fats & Oils: margarine, shortening, mayonnaise, salad
dressings
05 Poultry Products
06 Soups, Sauces and Gravies
07 Luncheon meat & sausage
08 Breakfast Cereals
09 Fruits and fruit juices
10 Pork Products
11 Vegetables: includes beans & legumes
12 Nuts and seeds
13 Beef
14 Beverages
15 Fish

16
17
18
19
20
21
22
25
29

Condiments: catsup, mustard, relish
Lamb, veal and game products
Baked goods: bread, cakes, cookies, crackers, pies, rolls
Sweets
Grains
Fast Foods
Meals, Entrees, and Sidedishes
Snacks
Miscellaneous

30 - 39 Reserved for USDA Recipes
43
44
45

Purchased mixed dishes: lunch entries
Purchased mixed dishes: breakfast entrees
Meat substitute/Vegetable proteins

Indicate whether the product is or is not intended for School Food Service and whether it is or is not produced
with USDA Commodity Food. Indicate whether the nutritional information is based on the Nutrition Labeling
and Education Act (NLEA) Adjusted Values (Nutrition Facts data).
Select your Value Type Code from the following list based on the nutrient data you are reporting: A= Analytical
-laboratory data; U = USDA - from a USDA database; C = Calculated - from nutrition facts panel or from
individual ingredients.
Indicate whether the nutritional information provided is on an As Served or As Purchased basis and whether
or not the product is Enriched/Fortified. There is a space for Notes if needed.
Repeat the Product Number/Code from page one so that page two can be matched up if necessary. The
Household Serving Amount is a numeric value used to describe the amount of a specific Household Serving
Measure Description. The two combined make up the Household Serving Size. The Household Serving
Measure Description should be chosen from the following list of abbreviations:
CM
CUP
FT
GAL
GM
IN
KG
LB
LT
M

Centimeter
Cup (volume; sometimes fluid; 1 cup = 8 fluid ounces)
Feet (dimension)
Gallon (volume; sometimes fluid)
Gram (weight)
Inch (dimension; 12 inch = 1 foot
Kilogram (weight; 1 kg = 1000 grams)
Pound (weight)
Liter (volume; usually fluid)
Meter (dimension)

MG
ML
OZ
FL OZ
PACKAGE
PIECE
PT
QT
TBSP
TSP

Milligram (1000th of gram)
Milliliter (volume; usually fluid)
Ounce (weight; 16 ounces = 1 pound)
Fluid Ounce (volume; 8 fluid ounces = 1 cup)
Package/Box/Case/Bag
Piece/Portion/Unit/Item/Serving
Pint (volume; sometimes fluid)
Quart (volume; sometimes fluid; 4 quarts = 1 gallon)
Tablespoon (volume; 16 tablespoons = 1 cup)
Teaspoon (volume; 3 teaspoon = 1 tablespoon)

The Nutrient Serving Size in grams may be equivalent to the Household Serving Size or the net weight on a
single serve package if you are reporting Nutrition Facts (NLEA) data. For example, if the Nutrient Serving
Size is based on one 57 gram single serve package, then the Household Serving Amount plus the
Household Serving Measure Description (=Household Serving Size) would be 2.0 OZ for a non-liquid
product. 57 grams divided by 28.35 grams per ounce equals the Household Serving Size of 2.0 ounces.
Provide the nutrient values in the appropriate units designated in the nutrient list. Nutrients listed with an
asterisk are Optional; Lastly, provide a List of Ingredients found in the product by order of predominance.
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