Form FNS-710 CN Database Qualification Report

OMB APPROVED NO. 0584-0494
Expiration Date: xx/xx/xxxx

Appendix A – FNS 710 (Paper)
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, Continued:

Manufacturer Information:

Company Website:
Company Phone: (xxx) yyy-zzzz:
Company Fax: (xxx) yyy-zzzz:
Contact Name:
Contact Phone:
Contact Email:
MFR Product Name: (Max 255 characters-example: Pizza, pepperoni topping, regular crust, frozen, cooked)

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

Product Name Shortened:(Max 60 charactersexample: Pepperoni Pizza)

Brand: (Max 40 characters)

Unit UPC: (12 numbers)

Product Number/Code:

-

-

-

Food Category Code: (from table under CN Qualification Product Is Produced For Child Nutrition Programs?
Report Field Explanation on
NO
page 3)
YES

Product is purchased directly by USDA for
distribution to schools through USDA Foods?
NLEA Adjusted Values:

YES

YES

NO

If Yes, Material Code:

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

A

U

C

P
YES

NO

Notes:

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FORM FNS-710 (03-14) Previous Editions Obsolete

SBU

Electronic Form Version Designed in Adobe 10.0 Version

Product Number/Code (from page 1):

Household Serving Amount: (a numeric value)

Household Serving Measure Description:

Household Serving Size In Grams:
g

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

Nutrient Serving Size (Gram Weight of Product Upon Which The Following Nutrients Are Based):

g

Food Energy:

kcal

*Vitamin A:

IU or

% DV

*Total Fat:

g

*Total Sugars:

Saturated Fat:

g

*Vitamin C:

*Trans Fat:

g

*Vitamin D:

*Cholesterol:

mg

*Iron:

Sodium:

mg

*Calcium:

*Carbohydrate:

g

*Potassium

*Total Dietary Fiber:

g

*Water (Moisture):

g

*Protein:

g

*Ash:

g

g

____ mg or ______% DV
% DV

mcg
mcg

mg or

% DV

____ mg or ______% DV
% DV

mg

* It is optional to list values for these nutrients

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CN Qualification Report Field Explanation
Enter the Date Submitted and Manufacturer Contact 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 be a clear and concise shortened version of the full MFR product name,
not an abbreviation of each word in the MFR product name. The Brand for the product should be listed
separately from the MFR 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. Enter the Product Number/Code. If you do not use a separate
product number or code, the Product Number/Code should be your product's 5 digit UPC# (The portion after
the second dash).

E n t e r t h e n u m b e r o f t h e Food Category Code from the following list of categories:
1
2
3
4
5
6
7
8
9

Dairy and Egg Products
Spices and Herbs
Baby Foods
Fats and Oils
Poultry Products
Soups, Sauces, and Gravies
Sausages and Luncheon Meats
Breakfast Cereals
Fruits and Fruit Juices

10. Pork Products
11. Vegetable and Vegetable Products
12. Nut and Seed Products
13. Beef Products
14. Beverages
15. Finfish and Shellfish Products
16. Legums and Legume Products
17. Lamb, Veal, and Game Products
18. Baked Products

19. Sweets
20. Cerreal Grains and Pasta
21. Fast Foods
22. Meals, Entrees, and Side Dishes
25. Snacks
35. American Indian/Alaska Native Foods
36. Restaurant Foods

Indicate whether the Product is purchased directly by USDA for distribution to schools through USDA Foods.
If the answer is "yes", enter the Material Code (WBSCM number). Indicate if the nutritional information is based on the
Nutrition Labeling and Education Act (NLEA) Adjusted Values (Nutrition Facts data).
Select your Value Type Code for the nutrient data you are reporting from the following list: 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 or Fortified. There is a space for Notes, if needed.
Repeat the Product Number/Code from page one.
th

The typical serving size, such as “1/2 cup”, “2 tablespoons”, “1 slice (1/8 pizza)”, “1 banana”, is defined by the
Household Serving Amount and Measure Description and so forth. The Household Serving Amount is a numeric
value used to describe the amount, s u c h a s “ 1 / 2 ” f r o m “ 1 / 2 c u p ” o r ” 2 ” f r o m “ 2 t a b l e s p o o n s ” .
The Household Serving Measure Description is the unit of measure, such as “”cup” from “1/2 cup” or “banana”
from “1 banana”. Try to avoid using a weight measure, such as ounces or grams, if a volume or “each-type”
measure is available for the serving size. The intent is to help the user determine the nutrients of typical servings
and allow for conversions to volume measures, if a volume measure is provided.
The Household Serving Size is the gram weight for the Household Serving Amount and Household Serving
Measure Description (combined to make the serving size), such as 125 grams for the ½ cup Household Serving
Measure (“1/2”) and Measure Description (“cup”).
The Nutrient Serving Size may be the same as the Household Serving Size. If the Household Serving Size
is the same as the Nutrient Serving Size, be sure to enter exactly the same gram weight for each, so there are
no errors introduced due to rounding the data when making conversions.
Provide the nutrient values in the appropriate units designated in the nutrient list. Calories, saturated fat,
and sodium are required nutrients. The product will not be included in the CN Database unless the
required nutrients are included Nutrients listed with an asterisk are optional, but we encourage you to
submit all that are available.
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