FNS-710 CN Database Qualification Report

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Overview

Instructions
Product Information
Sheet1

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Sheet 1: Instructions

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 collection 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.

Appendix C – FNS 710 (Excel spreadsheet Version)

OMB APPROVED NO. 0584-0494

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

Expiration Date: xx/xx/20xx

CN Database Qualification Report

Thank you for providing your product information to be included in the Child Nutrition Database!

DO NOT enter any product information on this page. All product information must be entered on "Product Information" sheet.

All nutrient information will be provided for the serving size indicated in column Q.

*Product Name

Status (Discontinued, New)

Brand

UPC

Product Number

*Produced for School Food Service?

*Purchased directly by USDA for distribution through USDA Foods?

*USDA Foods WBSCM Number (if applicable)

*NLEA Adjusted Values

*Form of Product

*Enriched or fortified product?

A numeric value Serving Amount

Ex. cup, ounce, patty, piece, slice Serving Description

*Serving Weight (g)

Based on serving size *Calories

Based on serving size Carbohydrates (g)

Based on serving size Dietary Fiber (g)

Based on serving size Total Sugars (g)

Based on serving size Protein (g)

Based on serving size Vit A (IU)

Based on serving size Vit C (mg)

Vit D (mcg)

Based on serving size Calcium (mg)

Based on serving size Iron (mg)

Potassium (mg)

Based on serving size Moisture (g)

Based on serving size Ash (g)

List of Ingredients

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Sheet 2: Product Information

*MFR Product Name

*Product Name

Status (Discontinued, New)

Brand

UPC

Product Number

*Food Category

*Produced for School Food Service?

*Purchased directly by USDA for distribution through USDA Foods?

*USDA Foods WBSCM Number (if applicable)

*NLEA Adjusted Values

*Form of Product

*Enriched or fortified product?

A numeric value Serving Amount

Ex. cup, ounce, patty, piece, slice Serving Description

*Serving Weight (g)

Based on serving size *Food Energy (kcal)

Based on serving size Total Fat (g)

Based on serving size *Saturated Fat (g)

Based on serving size Trans Fat (g)

Based on serving size Cholesterol (mg)

Based on serving size *Sodium (mg)

Based on serving size Carbohydrate (g)

Based on serving size Total Dietary Fiber (g)

Based on serving size Total Sugars (g)

Based on serving size Protein (g)

Based on serving size Vit A (IU)

Based on serving size Vit C (mg)

Vit D (mcg)

Based on serving size Calcium (mg)

Potassium (mg)

Based on serving size Iron (mg)

Based on serving size Moisture (g)

Based on serving size Ash (g)

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Sheet 3: Sheet1

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 collection 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.