Form FNS 683 FNS 683 WIC FARMERS' MARKET NUTRITION PROGRAM (FMNP) ANNUAL FINA

U.S. DEPARTMENT OF AGRICULTURE - Food and Nutrition Service

OMB APPROVED NO. 0584-0447
Expiration Date: XX/XX/XXXX

WIC FARMERS' MARKET NUTRITION PROGRAM (FMNP)
ANNUAL FINANCIAL AND PROGRAM DATA 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 0584-0447. The time required to complete this
information collection is estimated to average 3.5 hours per response, including the time to review instructions, search existing data
resources, gather the data needed, and complete and review the information collection.

PART A - HEADING
1. FEDERAL AGENCY AND ORGANIZATIONAL ELEMENT
TO WHICH REPORT IS SUBMITTED
FOOD AND NUTRITION SERVICE, USDA

2. STATE 7-DIGIT AGENCY CODE

3. UNIVERSAL IDENTIFIER NUMBER

4. STATE AGENCY NAME AND ADDRESS

5. BASIS

6. REPORT YEAR
Revision 0, Closeout Report
From
To

CASH

ACCRUAL

PART B - ANALYSIS OF REPORT YEAR PROGRAM ACTIVITY
COST CATEGORY
TRANSACTION

FOOD
(A)

ADMIN.
(B)

TOTAL
(C)

7. FORMULA GRANT
8. BACKSPEND TO PRIOR YEAR
9. SUBTOTAL (7 PLUS 8)
10. GROSS OUTLAYS AND UNLIQUIDATED OBLIGATIONS FOR
REPORT YEAR
11. PROGRAM INCOME
12. NET OUTLAYS AND UNLIQUIDATED OBLIGATIONS (10 MINUS 11)
13. RECIPIENT'S SHARE OF NET OUTLAYS AND UNLIQUIDATED
OBLIGATIONS
14. FEDERAL PROGRAM OUTLAYS AND UNLIQUIDATED
OBLIGATIONS (12 MINUS 13)
15. BALANCE (9 MINUS 14)
16. BACKSPEND FROM FOLLOWING YEAR
17. RESULTS OF REPORT YEAR PROGRAM OPERATIONS
(15 PLUS 16)

PART C - STATUS OF GRANT AWARD
18. FEDERAL OUTLAYS AGAINST THE FORMULA GRANT:
a. FOR REPORT YEAR OUTLAYS
b. FOR OUTLAYS OF PRIOR YEAR (BACKSPENT)
c. TOTAL FEDERAL OUTLAYS (18a PLUS 18b)
19. FEDERAL UNLIQUIDATED OBLIGATIONS AGAINST THE
FORMULA GRANT
20. FEDERAL OUTLAYS AND UNLIQUIDATED OBLIGATIONS
(18c PLUS 19)
21. FEDERAL FUNDS TO BE RECOVERED (7 MINUS 20)
a. TYPE OF RATE (check appropriate box)
Predetermined
Provisional
22. INDIRECT
EXPENSE
c. BASE
b. RATE

Final

Fixed
d. TOTAL AMOUNT

e. FEDERAL SHARE

PART D - PROGRAM DATA
WIC RECIPIENTS SUPPORTED WITH FEDERAL AND
NON-WIC RECIPIENTS SUPPORTED BY NON-FEDERAL
NON-FEDERAL FUNDS
FUNDS
23. PREGNANT WOMEN
24. BREASTFEEDING WOMEN
25. POSTPARTUM WOMEN
26. INFANTS
27. CHILDREN
28. TOTAL WIC RECIPIENTS (Line 23 THRU Line 27)
29. HOUSEHOLDS
Form FNS-683 (01/14) Previous Editions are Obsolete

30. CHILDREN
31. ELDERLY
32. OTHER
33. TOTAL NON-WIC RECIPIENTS
34. TOTAL OF WIC AND NON-WIC
RECIPIENT (LINE 28 PLUS LINE 33)

SBU

Electronic Form Version Designed in Adobe 10 Version

PROFILE OF VENDORS

FMNP ISSUANCE AND REDEMPTION SUMMARY

35. NUMBER OF AUTHORIZED FARMERS

40. TOTAL VALUE OF COUPONS ISSUED
(FEDERAL + NON-FEDERAL)

36. NUMBER OF AUTHORIZED FARMERS'
MARKETS

41. NUMBER OF COUPONS REDEEMED
(FEDERAL)

37. NUMBER OF AUTHORIZED FARM OR
ROADSIDE STANDS, IF ANY

42. NUMBER OF COUPONS REDEEMED
(NON-FEDERAL)

38. NUMBER OF COUPONS ISSUED
(FEDERAL)

43. TOTAL VALUE OF COUPONS
REDEEMED (FEDERAL + NONFEDERAL)

39. NUMBER OF COUPONS ISSUED
(NON-FEDERAL)

PART E - OTHER
REMARKS

CERTIFICATION:
I CERTIFY TO THE BEST OF MY KNOWLEDGE AND BELIEF THAT
THIS REPORT IS CORRECT AND THAT ALL OUTLAYS AND
UNLIQUIDATED OBLIGATIONS ARE FOR THE PURPOSES SET
FORTH IN THE AWARD DOCUMENT.

TYPED NAME AND TITLE OF CERTIFYING OFFICIAL
SIGNATURE
TELEPHONE NUMBER

DATE

INSTRUCTIONS FOR WIC FARMERS’ MARKET NUTRITION (FMNP) PROGRAM
ANNUAL FINANCIAL AND PROGRAM DATA REPORT
PURPOSE
Each State agency administering the WIC Farmers’
Market Nutrition Program (FMNP) shall use the FMNP
Annual Financial Report to: (1) report the composition and
disposition of its authorized FMNP grant for the Federal
fiscal year closed out (i.e., the “report year”); (2) declare
its intentions to exercise spending options provided by 7
CFR 248.14; and (3) report the FMNP cost of the report
year. FNS will use this information to close out the State
agency’s financial account for the report year.

9. Subtotal. (Row 7 plus row 8).
10. Gross Outlays and Unliquidated Obligations. For
each column, enter the sum of the State agency’s
outlays and unliquidated obligations for report year.
Include outlays and unliquidated obligations funded
from all sources -- Federal FMNP grant, private funds,
local funds, and State funds.

Part A – Heading
1. Federal Agency. Identifies the Federal agency.
Self-explanatory.

11. Program Income. Enter the total amount of any
income generated by FMNP operations during the
report year. If no program income was realized, enter
“0.” See 7 CFR 248.13 for information on program
income.

2. State 7-Digit Code. Enter the seven digit State agency
identification code assigned by FNS.

12. Net Outlays and Unliquidated Obligations. (Row 10
minus row 11).

3. DUNS Universal ID. OMB requires entities applying for
Federal grants to provide government agencies with a
Universal Identifier. The initial and annual FMNP State
Plan submissions are considered to be applications for
a federal grant, and thus State agencies must comply
with this requirement. Currently, the Universal Identifier
system in use is the Data Universal Numbering System
(DUNS).

13. Recipient’s Share of Net Outlays and Unliquidated
Obligations. Self explanatory.

4. State Agency. Identifies the State agency and address.
Self-explanatory.
5. Basis. Check the block that identifies the reporting
basis (cash or accrual) used to prepare the report.
6. Report Year. Enter the beginning and ending dates of
the report year. This is the 12-month Federal fiscal
year to which the report pertains.
Part B – Analysis of Report Year Program Activity.
This part analyzes the source(s) and applications of the
funds available to the State agency for the report year
FMNP outlays. Column (A) captures this information with
respect to food outlays (costs); column (B) captures
administrative outlays (costs); and column (C) captures
the sum of the two components (A&B). FNS will regard an
entry in row 16, as applicable, as a declaration of the
State agency’s intent to exercise the spending option to
which the row pertains.
7. Formula Grant. For each column, enter the total dollar
amount FNS allocated to the State agency for the
report year.
8. Backspend to Prior Year. Enter the dollar amount of
funds originating in the report formula grant as applied
to food and/or admin outlays of the preceding Federal
fiscal year. These amounts are to be reported as a
negative numbers.

14. Federal Program Outlays and Unliquidated
Obligations. (Row 12 minus row 13).
15. Balance. (Row 9 minus row 14).
16. Backspend from Following Year. Enter the dollar
amount originating in the formula grant allocated for
the Federal fiscal year following the report year, but
applied to report year food and/or admin costs.
17. Results of Report Year Program Operations. For each
column, add row 15 plus row 16 (If the result is a
negative, enclose it in parenthesis).
Part C – Status of Grant Award.
18. This item captures the States agency’s outlays against
the report year formula grant under all spending
options for which that formula grant can be used.
Enter “0” in any row that does not apply.
a. For Report Year Outlays. Enter the amount of
outlays against the formula grant for outlays of the
report year. Do not include outlays supported by
funds identified in rows 8 or 16; such funds are not
part of the report year formula grant.
b. For Outlays of Prior Year (Backspend). Enter the
portion of row 8 outlayed costs of the preceding
Federal fiscal year.
c. Total Federal Outlays (18a plus 18b). For each
column, add row 18a and 18b. If the State agency
reports of the accrual basis, the portion of the entry
that consists of accrual expenditures (liabilities)
should be identified in the Remarks section.

INSTRUCTIONS FOR WIC FARMERS’ MARKET NUTRITION (FMNP) PROGRAM
ANNUAL FINANCIAL AND PROGRAM DATA REPORT
19. Federal Unliquidated Obligations Against the Formula
Grant. Enter the amount of cumulative obligations
against the formula grant, for cost of any eligible
Federal fiscal year, that remain unliquidated on the
date of this report. If all such obligations have been
liquidated, enter, “0”.

31. Enter the number of elderly as defined by the State
who received non-Federal benefits.

20. Federal Outlays and Unliquidated Obligations. For
each column add row 18c plus row 19.

33. Enter the sum of Line 30 through Line 32.

21. Federal Funds to be Recovered. For each column
subtract row 20 from row 7. The result is the amount
FNS will recover from the State agency when the
closeout report is submitted for the report year.
22. Indirect Expense. This item captures information
pertaining to indirect expenses charged to the
program.
a. Self-explanatory.
b. Enter the indirect cost rate in effect during the
report period.
c. Enter the amount of the base against which the rate
was applied.
d. Enter the total amount of indirect cost charged during
the report period.
e. Enter the Federal share of the total amount.
Note: If more than one rate was in effect during the
period shown in item 5, attach a schedule showing the
bases against which the different rates were applied, the
respective rates, the calendar periods they were in effect,
amounts of indirect expense charged to the program, and
the Federal share of indirect expenses charged to the
program to date.
Part D – Program Data (Line 23 through Line 27).
The number of WIC and non-WIC recipients who were
issued FMNP coupons supported by Federal and nonFederal funds. If issuance was to households rather than
individuals, enter number of individuals served by
category. If age category is unknown, count as “others”.
The composition of the household must be identified by
category in line 23 through line 27.
28. Enter the sum of WIC recipients served. If a State
agency is serving households, do not include number
in the total.
29. Enter the total number of WIC households served,
otherwise leave blank.
30. Enter the number of any non-WIC children that
received non-Federal FMNP benefits issuance was to
households, the number of families with non-WIC
children.

32. Enter the number of any non-WIC recipients other
than children or elderly who received non-Federal
FMNP benefits.

34. Enter the sum of Line 28 and Line 33.
Profile of Vendors.
35. Enter the number of farmers authorized for
participation in the FMNP.
36. Enter the number of farmers’ markets authorized for
participation in the FMNP.
37. If applicable, enter the number of farm or roadside
stands authorized for participation in the FMNP in
addition to the farmers’ markets reported on Line 36.
FMNP Issuance and Redemption Summary.
38. This line is self-explanatory.
39. This line is self-explanatory.
40. This line is self-explanatory.
41. This line is self-explanatory.
42. This line is self-explanatory.
43. This line is self-explanatory.
Part E – Other.
Remarks. Enter any additional information that FNS
would need to interpret the information presented in Parts
A through D, including any non-Federal funds used to
support FMNP food expenditures.
Certification. These entries are self-explanatory.
Submission. The State agency shall submit the FNS-683,
FMNP Financial and Program Data Report to the
applicable FNS regional office by January 31 of the
Federal fiscal year following the report year.