Appendix I - Annual Financial and Program Data Report

Appendix I
Annual Financial and Program
Data Report

U.S. DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION SERVICE

SENIOR FARMERS' MARKET NUTRITION PROGRAM (SFMNP)
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 0584-0541. The time required to complete this information collection is
estimated to average 2 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

2. STATE 7-DIGIT AGENCY CODE 3. DUNS UNIVERSAL ID NUMBER

FOOD AND NUTRITION SERVICE, USDA
4. STATE AGENCY NAME AND ADDRESS

5. BASIS
CASH

6. REPORT YEAR
From
To

ACCRUAL

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

(A)
FOOD

(B)
ADMIN.

(C)
TOTAL

7.
8.
9.
10.
11.
12.
13.

FEDERAL GRANT
GROSS OUTLAYS AND UNLIQUIDATED OBLIGATIONS
PROGRAM INCOME
NET OUTLAYS AND UNLIQUIDATED OBLIGATIONS (8 MINUS 9)
FEDERAL PROGRAM OUTLAYS
FEDERAL UNLIQUIDATED OBLIGATIONS
FEDERAL PROGRAM OUTLAYS AND UNLIQUIDATED OBLIGATIONS
(11 PLUS 12)
14. FEDERAL FUNDS TO BE RECOVERED (7 MINUS 13)

PART C - PROGRAM DATA
Profile of Participants
15.
16.
17.
18.

Profile of Farmers/Authorized Outlets

60 or Older
Less than 60
Non-Federal
Total Participants

19.
20.
21.
22.
23.

Number of authorized farmers
Number of authorized/participating farmers' markets
Number of authorized roadside stands
Number of authorized CSAs
Total number of markets, roadside stands, CSAs (20+21+22)

Bulk Purchases
24. Food funds used for bulk purchases during Fiscal Year's months of operation

COUPON ISSUANCE AND REDEMPTION SUMMARY
Federal

Non-Federal

Total

25. Total value of coupons issued
26. Total value of coupons redeemed

PART D - OTHER
REMARKS

TYPED NAME AND TITLE OF CERTIFYING OFFICIAL

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.
STAMP/CERTIFY DATE
FORM FNS-683a (08-07) Previous Editions Obsolete

SIGNATURE
TELEPHONE NUMBER

DATE

LAST UPDATED BY

LAST UPDATED ON

Electronic Form Version Designed in Adobe 10.0 Version
Page 1 of 1

INSTRUCTIONS FOR SENIOR FARMERS' MARKET NUTRITION PROGRAM (SFMNP)
ANNUAL FINANCIAL AND PROGRAM DATA REPORT

PURPOSE

11.

Federal Program Outlays. Self-explanatory.

Each State agency administering the Senior Farmers’ Market
Nutrition (SFMNP) Program must use the SFMNP Annual
Financial and Program Data Report to report: (1) the
composition and disposition of its authorized SFMNP Grant for
the Federal fiscal year closed out (i.e., the “report year”); and
(2) the program data for the number of participants served,
authorized farmers and outlets.

12.

Federal Unliquidated Obligations. Self-explanatory.

13.

Federal Program Outlays and Unliquidated Obligations.
(For each column add row 11 plus row 12).

14.

Federal Funds to be Recovered. (Row 7 minus row 14)

Part C – Program Data.
Part A – Heading.
1.

Federal Agency. Identifies the Federal agency. Selfexplanatory.

2.

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

3.

DUNS Universal ID. OMB requires entities applying for
Federal grants to provide government agencies with a
Universal Identifier. The initial and annual SFMNP 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).

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.

15.

60 or Older. Enter the number of persons or households
that meet the eligibility requirements and to whom coupon
or equivalent benefits have been issued.

16.

Less than 60. Enter the number of persons or households
that meet the eligibility requirements and to whom coupon
or equivalent benefits have been issued. This may include
participants from Indian Tribal Organizations (ITOs), and
participants that are disabled.

17.

Non-Federal. Enter the number of persons or households
that meet the eligibility requirements and to whom coupon
or equivalent benefits have been issued.

18.

Total Participants. Self-explanatory.

19.

Number of Authorized Farmers. Self-explanatory.

20.

Number of Authorized Farmers’ Markets. Self-explanatory.

21.

Number of Authorized Roadside Stands. Self-explanatory.

22.

Number of Authorized CSAs. Self-explanatory.

23.

Total Number of Authorized Outlets. Markets, roadside
stands, and CSAs, but does not include the number of
authorized farmers.

24.

Bulk Purchases. Enter the amount of food funds used
during the report year for bulk purchases. The amount of
funds used for bulk purchases is a subset of (11A).

25.

Total Value of Coupons Issued. Self-explanatory.

26.

Total Value of Coupons Redeemed. Self-explanatory.

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 SFMNP 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).
7.

Federal Grant. For each column, enter the total dollar
amount FNS allocated to the State agency for the report
year.

Part D – Other.
8.

Gross Outlays and Unliquidated Obligations for Report
year. 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 sources other than the Federal SFMNP grants, e.g.
private funds, local funds, State funds.

9.

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

10.

Net Outlays and Unliquidated Obligations. (Row 8 minus
row 9).

Remarks. Enter any additional information that FNS would need
to interpret the information presented in Parts A through C.
Certification. These entries are self-explanatory.
Submissions. The State agency shall submit the FNS-683a,
SFMNP Financial Report, to the applicable FNS regional office
by January 31 of the Federal fiscal year following the report year.