Repayment of Unspent CCC and Monetization Funds by Check Form

REPAYMENT OF UNSPENT FUNDS by CHECK

(Section 416(b)/Food for Progress/McGovern-Dole/Local and Regional Procurement)

From (Organization Name):

Point of Contact:

E-mail address:

Date:

In accordance with the above referenced Agreement and Budget, we hereby return a total of $_____________________in unspent funds. $_____________ of this amount is from monetization proceeds (if applicable). Please note that interest on monetization proceeds should be included in this total.

If repaying under the Food for Progress or 416(b) programs, please make the check payable to the Commodity Credit Corporation. If repaying unspent program funds under the McGovern-Dole International Food for Education and Child Nutrition (McGovern-Dole) or the Local and Regional Food Aid Procurement (LRP) programs, please make the check payable to USDA Foreign Agricultural Service.

If returning unspent interest on CCC/FAS funds, a separate check in the amount of $_____________________ shall be made payable to The Department of Health and Human Services (HHS).

Please provide the following information on the check(s):

1. Agreement number:

2. Country:

3. Type of Program: Section 416(b), Food for Progress, McGovern-Dole, or LRP:

To return unspent programs funds for a Section 416(b), Food for Progress, McGovern-Dole, or Local and Regional Procurement agreement, please send a check by courier to:

Director, Food Assistance Division

USDA/Foreign Agricultural Service

STOP 1034

1400 Independence Avenue, S.W., Room 4159-S

Washington, DC 20250

To return unspent interest on CCC/FAS funds, please send checks to:

HHS Program Support Center

P.O. Box 530231

Atlanta, GA 30353-0231