FNS-153 Monthly CSFP Report and Quarterly Administrative

Appendix O- FNS-153 Monthly CSFP Report and Quarterly Administrative Financial Status
FORM APPROVED OMB NO.
0584-0594 Expiration Date: XX/XXXXX
UNITED STATES DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION SERVICE

MONTHLY REPORT OF THE COMMODITY SUPPLEMENTAL FOOD PROGRAM AND QUARTERLY ADMINISTRATIVE FINANCIAL
STATUS REPORT
SEE INSTRUCTIONS ON REVERSE
1. REPORTING MONTH
AND YEAR

3. TYPE OF SUBMISSION

4. NUMBER OF PARTICIPANTS

5. REPORTING MEASUREMENTS

(A) - INITIAL
INFANTS
(0-3) MONTHS
(A)

(B) - LATEST REV.

2A. ST AGENCY NAME

(C) - CLOSEOUT
INVENTORY

INFANTS
(4-12) MONTHS
(B)

CHILDREN
(1-6) YEARS
(C)

2B. DA CODE

COMMODITY
NAME

POST-PARTUM
WOMEN
(E)

TOTAL NO. PART.
(4A + B + C + D + E = 4F)
(F)

TOTAL NO. OF
ELDERLY PART.
(G)

(A) CASES

(B) UNITS

STATE AND LOCAL DATA
6A.

6.

PREGNANT/BREAST
FEEDING WOMEN
(D)

6B.

CODE

7.

8.

PACK

STATE AND

SIZE

LOCAL

9.

RECEIPTS

10.

REDONATIONS
IN

BEGINNING
INVENTORY

11.
COMMODITY ISSUANCE
TOTAL

A059

24/300 can

GREEN BEANS 303

A060

24/303 can

BEANS VEG 300

A090

24/300 can

CARROTS

A095

24/303 can

CARROTS 300

A098

24/300 can

CORN KERNEL 300

A119

24/300 can

CORN CREAM

A120

24/303 can

CORN KERNEL

A121

24/303 can

CORN CREAM 300

A122

24/300 can

LENTILS

A135

12/2 lb.

PEAS 300

A144

24/300 can

PEAS 303

A145

24/303 can

PUMPKIN

A163

24/300 can

SPINACH

A166

24/303 can

SPINACH 300

A167

24/300 can

POTATOES 303

A169

24/303 can

POTATOES SLC 300

A170

24/300 can

POTATOES DEHY 12

A196

12/1 lb.

FORM FNS - 153 (07/08) Previous editions obsolete

TOTAL NUMBER
ISSUED TO:

AVAILABLE

14.

W-I-C

ELDERLY

15.
ADJUSTMENTS
STATE AND

TOTAL
ACTIVITY

(7 + 8 + 9 = 10)

SBU

13.
COMMODITY ACTIVITY

INVENTORY

(A)
GREEN BEANS 300

12.

TOTAL
NUMBER
ISSUED
(11A + B = 12)

REDONATIONS

(A)

(B)

(B)

Electronic Form Version Designed in Adobe 8.1 Version

FOOD
LOSS

AMT USED
FOR
NUT ED

POSITIVE

NEGATIVE

LOCAL
ENDING

(12A + B + C
+D = 13)

INVENTORY

OUT

((10 - 13) +/14A & B = 15)
(C)

(D)

(A)

(B)

PAGE 1 OF 8

REPORTING MONTH AND YEAR:

STATE AGENCY NAME:

REPORTING MEASUREMENT:

MONTHLY REPORT OF THE COMMODITY SUPPLEMENTAL
FOOD PROGRAM STATE AND LOCAL INVENTORY

CASES (

)

OR UNITS (

)

STATE AND LOCAL DATA
6.

6A.
COMMODITY
NAME

6B.

CODE

7.

8.

PACK

STATE AND

SIZE

LOCAL
BEGINNING
INVENTORY

9.

RECEIPTS

10.

REDONATIONS
IN

11.
COMMODITY ISSUANCE
TOTAL

A221

SWT POTATOES 300

A223

24/300 can

TOMATOES 300

A240

24/300 can

TOMATO SAUCE 300

A244

24/300 can

TOMATOES 303

A248

24/303 can

GRAPEFRUIT J

A280

12/46 oz.

APPLE J

A282

12/46 oz.

GRAPE J

A285

12/46 oz.

PINEAPPLE J

A286

12/46 oz.

TOMATO J

A290

12/46 oz.

ORANGE J

A300

12/46 oz.

APPLESAUCE 303

A145

24/303 can

F COCKTAIL 303

A163

24/303 can

F COCKTAIL 300

A166

24/300 can

PEACHES CLING 300

A167

24/300 can

PEACHES CLING 303

A169

24/303 can

PEARS 300

A170

24/300 can

PEARS 303

A196

24/303 can

PINEAPPLE 2

A169

24/2 can

PLUMS 303

A170

24/303 can

PRUNES 24

A196

24/1 lb.

13.

AVAILABLE

14.

TOTAL NUMBER
ISSUED TO:
ELDERLY

(7 + 8 + 9 = 10)

STATE AND

TOTAL
ACTIVITY

W-I-C

15.
ADJUSTMENTS

COMMODITY ACTIVITY

INVENTORY

(A)

SWT POTATOES 303

12.

TOTAL
NUMBER
ISSUED
(11A + B = 12)

REDONATIONS

(A)

(B)

(B)

FOOD
LOSS

AMT USED
FOR
NUT ED

POSITIVE

NEGATIVE

LOCAL
ENDING

(12A + B + C
+D = 13)

INVENTORY

OUT

((10 - 13) +/14A & B = 15)
(C)

(D)

(A)

(B)

24/303 can

FORM FNS - 153 (07/08) Previous editions obsolete

Electronic Form Version Designed in Adobe 8.1 Version

PAGE 2 OF 8

REPORTING MONTH AND YEAR:

REPORTING MEASUREMENT:

STATE AGENCY NAME:

MONTHLY REPORT OF THE COMMODITY SUPPLEMENTAL
FOOD PROGRAM STATE AND LOCAL INVENTORY

CASES (

)

OR UNITS (

)

STATE AND LOCAL DATA
6.

6A.
COMMODITY
NAME

6B.

CODE

7.

8.

PACK

STATE AND

SIZE

LOCAL
BEGINNING
INVENTORY

9.

RECEIPTS

10.

REDONATIONS
IN

11.
COMMODITY ISSUANCE
TOTAL

A562

EGG MIX 6

A570

48/6 oz.

STEW CND

A587

24/24 oz.

STEW 24/15

A589

24/15 oz.

BEEF NJ

A610

24/29 oz.

PORK NJ

A630

24/29 oz.

TUNA 12.25

A740

24/12.5 oz.

SALMON 24

A803

24/14.7 oz.

BEANS DK R KIDNEY

A906

12/2 lb.

BEENS BLKEYE 2

A910

12/2 lb.

BEANS B LIMA 2

A912

12/2 lb.

BEANS PINTO 2

A914

12/2 lb.

BEANS R KIDNEY 2

A915

12/2 lb.

BEANS GRT NORTH 2

A917

12/2 lb.

BEANS NAVY PEA 2

A918

12/2 lb.

BEANS LT KIDNEY 2

A920

12/2 lb.

PEAS SPLIT 2

A922

12/2 lb.

13.

AVAILABLE

14.

TOTAL NUMBER
ISSUED TO:
ELDERLY

(7 + 8 + 9 = 10)

STATE AND

TOTAL
ACTIVITY

W-I-C

15.
ADJUSTMENTS

COMMODITY ACTIVITY

INVENTORY

(A)

CHICKEN CND

12.

TOTAL
NUMBER
ISSUED
(11A + B = 12)

REDONATIONS

(A)

(B)

(B)

FOOD
LOSS

AMT USED
FOR
NUT ED

POSITIVE

NEGATIVE

LOCAL
ENDING

(12A + B + C
+D = 13)

INVENTORY

OUT

((10 - 13) +/14A & B = 15)
(C)

(D)

(A)

(B)

24/29 oz.

FORM FNS - 153 (07/08) Previous editions obsolete

Electronic Form Version Designed in Adobe 8.1 Version

PAGE 3 OF 8

REPORTING MONTH AND YEAR:

REPORTING MEASUREMENT:

STATE AGENCY NAME:

MONTHLY REPORT OF THE COMMODITY SUPPLEMENTAL
FOOD PROGRAM STATE AND LOCAL INVENTORY

CASES (

)

OR UNITS (

)

STATE AND LOCAL DATA
6.

6A.
COMMODITY
NAME

6B.

CODE

7.

8.

PACK

STATE AND

SIZE

LOCAL
BEGINNING
INVENTORY

9.

RECEIPTS

10.

REDONATIONS
IN

11.
COMMODITY ISSUANCE
TOTAL

B081

48/12 Fl oz.

INSTANT 24

B090

6/4 lb.

EVAP 24

B117

24/12 Fl oz.

CORNMEAL 5 DEG

B137

10/5 lb.

CORNMEAL 8/5 DEG

B138

8/5 lb.

CORNMEAL 10 DEG

B141

5/10 lb.

CORNMEAL 40 DEG

B142

5/10 lb.

FORMULA POWDER 14.1

B158

24/14 oz.

FARINA

B160

24/14 oz.

CEREAL INFANT R8

B161

12/8 oz.

FORMULA SOY DRY 6/14

B162

6/14 oz.

FORMULA SOY 12

B163

12/13 Fl oz.

FORMULA 12

B164

12/13 Fl oz.

FORMULA

B165

24/13 Fl oz.

FORMULA SOY

B166

24/13 Fl oz.

FORMULA POWDER

B167

12/1 lb.

FORMULA POWDER 6

B168

6/1 lb.

FORMULA SOY PWDR 6

B169

6/1 lb.

FORM FNS - 153 (07/08) Previous editions obsolete

13.

AVAILABLE

14.

TOTAL NUMBER
ISSUED TO:
ELDERLY

(7 + 8 + 9 = 10)

STATE AND

TOTAL
ACTIVITY

W-I-C

15.
ADJUSTMENTS

COMMODITY ACTIVITY

INVENTORY

(A)
EVAP 12

12.

TOTAL
NUMBER
ISSUED
(11A + B = 12)

REDONATIONS

(A)

(B)

(B)

Electronic Form Version Designed in Adobe 8.1 Version

FOOD
LOSS

AMT USED
FOR
NUT ED

POSITIVE

NEGATIVE

LOCAL
ENDING

(12A + B + C
+D = 13)

INVENTORY

OUT

((10 - 13) +/14A & B = 15)
(C)

(D)

(A)

(B)

PAGE 4 OF 8

REPORTING MONTH AND YEAR:

REPORTING MEASUREMENT:

STATE AGENCY NAME:

MONTHLY REPORT OF THE COMMODITY SUPPLEMENTAL
FOOD PROGRAM STATE AND LOCAL INVENTORY

CASES (

)

OR UNITS (

)

STATE AND LOCAL DATA
6.

6A.
COMMODITY
NAME

6B.

CODE

7.

8.

PACK

STATE AND

SIZE

LOCAL
BEGINNING
INVENTORY

9.

RECEIPTS

10.

REDONATIONS
IN

11.
COMMODITY ISSUANCE
TOTAL

B381

10/5 lb.

GRITS CW 40

B382

8/5 lb.

HONEY 24

B403

24/24 oz.

MACARONI 1

B425

24/1 lb.

OATS 3

B445

12/3 lb.

PB 2

B470

24/2 lb.

PB RDU-FAT 2

B471

24/2 lb.

CHUNKY RDU-FAT 2

B488

24/2 lb.

RICE 2

B510

24/2 lb.

CEREAL CORN RTE 17.5

B847

14/17.5 oz.

CEREAL RICE 15

B848

12/15 oz.

CEREAL CORN 18

B849

12/18 oz.

CEREAL CORN 16

B851

12/16 oz.

CEREAL CORN 17.5

B852

12/17.5 oz.

CEREAL OATS 15.5

B854

12/15.5 oz.

FORM FNS - 153 (07/08) Previous editions obsolete

13.

AVAILABLE

14.

TOTAL NUMBER
ISSUED TO:
ELDERLY

(7 + 8 + 9 = 10)

STATE AND

TOTAL
ACTIVITY

W-I-C

15.
ADJUSTMENTS

COMMODITY ACTIVITY

INVENTORY

(A)
GRITS CW 5

12.

TOTAL
NUMBER
ISSUED
(11A + B = 12)

REDONATIONS

(A)

(B)

(B)

Electronic Form Version Designed in Adobe 8.1 Version

FOOD
LOSS

AMT USED
FOR
NUT ED

POSITIVE

NEGATIVE

LOCAL
ENDING

(12A + B + C
+D = 13)

INVENTORY

OUT

((10 - 13) +/14A & B = 15)
(C)

(D)

(A)

(B)

PAGE 5 OF 8

REPORTING MONTH AND YEAR:

REPORTING MEASUREMENT:

STATE AGENCY NAME:

MONTHLY REPORT OF THE COMMODITY SUPPLEMENTAL
FOOD PROGRAM STATE AND LOCAL INVENTORY

CASES (

)

OR UNITS (

)

STATE AND LOCAL DATA
6.

6A.
COMMODITY
NAME

6B.

CODE

7.

8.

PACK

STATE AND

SIZE

LOCAL
BEGINNING
INVENTORY

9.

RECEIPTS

10.

REDONATIONS
IN

11.
COMMODITY ISSUANCE
TOTAL

B860

24/15 oz.

CEREAL OATS 16

B861

12/16 oz.

CEREAL RICE 12

B866

12/13 oz.

CEREAL RICE 17.5

B867

12/17 oz.

CEREAL RICE RTE 17.5

B868

14/17.5 oz.

CEREAL WHEAT 16

B871

12/16 oz.

CEREAL WHEAT RTE 16

B872

14/16 oz.

13.

AVAILABLE

14.

TOTAL NUMBER
ISSUED TO:
ELDERLY

(7 + 8 + 9 = 10)

STATE AND

TOTAL
ACTIVITY

W-I-C

15.
ADJUSTMENTS

COMMODITY ACTIVITY

INVENTORY

(A)
CEREAL OATS

12.

TOTAL
NUMBER
ISSUED
(11A + B = 12)

REDONATIONS

(A)

(B)

(B)

FOOD
LOSS

AMT USED
FOR
NUT ED

POSITIVE

NEGATIVE

LOCAL
ENDING

(12A + B + C
+D = 13)

INVENTORY

OUT

((10 - 13) +/14A & B = 15)
(C)

(D)

(A)

(B)

16. REMARKS (Provide Explanation as Requested by Instructions.) (Attach Additional Sheets as Deemed Necessary.)

17. SIGNATURE

18. TITLE

19. DATE

20.
CSFP

OUTLAYS
(A)

UNLIQ. OBLIGATION
(B)

TOTAL
(C)

UNLIQ. BAL. OF
ADVANCES
(D)

ADMINISTRATION
FORM FNS - 153 (07/08) Previous editions obsolete

Electronic Form Version Designed in Adobe 8.1 Version

PAGE 6 OF 8

FNS-153 REPORTING INSTRUCTIONS
Reporting Measurements - Data reported on ths FNS-153 form can be shown in either "case/remaining" or
"units." Reporting data in "cases/remaining units" for some columns and just "units"for other columns or
vice versa is prohibited on the same form. Prior FNS approval is required for a State agency to switch one
reporting measurement to another. The choice of the measurement "cases/remaining units" or "units" is left
to the discretion of the reporting State agency. Rounding the count is unacceptable.
"Cases" means the container size in which the commodity is shipped. For example, the pack size for
egg mix is 48/6 oz. foils. If reporting "cases/remaining units," 48 cases and 3 units would be shown on
the FNS-153 as "48/3." Any number appearing to the left of the slash will represent the number of cases.
In contrast, any number to the right of the slash will represent the actual number of units. When a number
appears with no slash, FNS will automatically assume it is whole cases when 5A is checked.
"Unit" means individual cans, boxes, packages, etc., not cases. For example, 1 case of egg mix
would be reported as "48," and 5A would be checked.
Submission - The CSFP State agency shall collect the necessary data for this report from the local
certification, State and local warehouse sites within its jurisdiction and combine the data so that only one
FNS-153 report would be submitted by the CSFP State agency to the appropriate FNS regional office no
later than 30 days after the end of the month being reported for. Financial status data (item 20) shall be
completed quarterly and submitted on the FNS-153 for December, March, June, and September. A final
closeout SF-269 for CSFP must be submitted to FNS within 90 days after the end of the fiscal year.
1. Reporting Month and year - Enter month and year for which data is reported.
2A &2B. State Agency name & DA Code - Self-explanatory.
3. Type of Invent/Part Submission - Indicate type of submission for month being reported. The initial
submission of this report should be such by checking (A). Any subsequent revisions for the report month
should be indicated by checking 3(b). The submission of the annual physical inventory which is due for the
report month of September should be indicated by checking 3(c). If the September report is submitted with
3(c) checked, FNS will automatically consider it the final report for September.
4. Number of Participants - (A through E) Enter the toal number of participants by category, to whom
commodities were actually issued.
4(F). Self-explanatory.
4(G). Enter the total number of elderly participants to whom commodities were actually issued.
5. (A and B) - Reporting Measurement - (see above explanation) Check appropriate clock 5A or 5B.
6. (A and B) - Commodity name, code and shipping pack size - Where the code and name of a
commodity is not preprinted on this form, enter that information on the next available blank line.
7. State and Local Beginning Inventory - Enter the number appearing in item 15 in the previous
month's report. (This number must reflect all foods physically located at State and local storage and
distribtion site(s).

during the reported month. (This column should not reflect commodity movement between State and local
agencies.)
9. Redonations In - Enter the total number of redonated commodities received by the State from
another State agency or another USDA program from the CSFP. Specify in the remarks section the name of
the State and program those commodities were redonated from and their commodity code.
10. Total Inventory Available - Enter the total number of commodities available for issuance for the
CSFP. (The sum of items 7, 8, and 9 should equal item 10.)
11. CSFP Issuance - Enter the total number of commodities actually issued to and accepted by
participants during the reporting month as specified below. This figure should exclude those commodities not
accepted by the participant at the time of food pick-up. If a participant has refused a commodity at pick-up
it should not be considered issued.
(A) Reflect the total number of commodities that were actually issued and accepted by Women,
Infants and Children (W-I-C).
(B) Reflect the total number of commodities actually issued and accepted by elderly during the
reporting month.
12. Commodity Activity.
12A. Total number issued - Self-explanatory (11A + 11B = 12A).
12B. Redonations Out - Enter the total number of commodities shipped by the reporting State to
another State agency or to another USDA food program. Specify in the remarks section the name of the
State and program those commodities were redonated to and their commodity code.
12C. Food Loss - Enter the number of commodities that are actual food losses. These would
include foods that: (1) after consignee receipt were found to have concealed damaged; (2) were damaged in
the warehouse or during transit from the State warehouse to the local sites; (3) were found to be out-ofcondition or unfit for human consumption; or (4) were known to have been stolen or lost due to fraud, misuse
or embezzlement. (The reasons for food loss must be detailed in the REMARKS section. Attach additional
pages if necessary.)
12D. Food Used for Nutrition Education - Enter the number of commodities used for CSFP nutrition
education purposes.
13. Total Activity - Self-explanatory (sum 12A thru 12D = 13).
14. Inventory Adjustments - Enter the actual number of commodities adjusted. A partial list of
such adjustments are provided below as examples. (Note: the reasons for adjustments must be detailed in
"Remarks," item 16). This column should not reflect the movement of commodities between the State and
its local agencies.

8. Receipts - Enter the total number of commodities actually accepted in good condition from USDA
PAGE 7 OF 8

REPORTING INSTRUCTIONS - CONTINUED
(a) A "Positive" Commodity adjustments could be the result of a bookkeeping error or previous
inaccurate inventory count. Any commodity still in good condition which was returned to a distribution
site by a participant should be reflected as a positive adjustment.
(b) A "Negative" Commodity adjustment could be caused by a bookkeeping discrepancy.
15. State and Local Ending Inventory - Enter the combined total number of CSFP commodities in
inventory at the end of the reporting month at all State and local storage and distribution sites (10-13) plus
or minus 14A and 14B = 15.
16. Remarks - Self-explanatory.
17. Signature - Self-explanatory.
18. Title - Self-explanatory.
19. Date - Self-explanatory.
20. Complete item number 20 for CSFP as follows.
(a) Outlays - Show the administrative outlays for State and local agencies, administrative outlays are
the cumulative year-to-date payments, or invoices certified by the program for payment, for administrative
costs incurred through the quarter being reported for. (Do not report advances as outlays.)

(b) Unliquidated Obligations - Show the unliquidated obligations for the State and local
agencies. Unliquidated administrative obligations are the cumulative year-to-date dollars which the
State agency expects to pay out for administrative cost incurred through the quarter being reported
for but not yet paid or certified for payment. (Only obligations to be paid with Federal funds should
be shown.)
(c) Total - Show the sums of (A) and (B).
(d) Unliquidated Balances of Advances - where applicable show the unliquidated balance of
advances as of the end of the report quarter. This should be calculated as follows:
(1) Determine the total amount of payments provided to local agencies and contract agents
for administration year-to-date.
(2) Determine the total amount of outlays made by local agencies and contract agents for
administration for the year-to-date.
(3) Subtract (2) from (1) and record the result as the unliquidated balances of advances.
Advances for Administration are actual payments made by the State agency to a local agency or
contract agent which are not administrative costs already paid or fees for goods/services already
provided.

Public reporting burden for this collection of information is estimated to average 6.3 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Research and Analysis (0584-0594, Alexandria, VA 22302. Do not return the completed form to this address.

PAGE 8 OF 8