Worksheet FNS 683 B OMB# 0594

Form FNS-683B Instructions (03-24)

Click this link to open the PDF file containing the FNS-683B (03-24) form and instructions in a new window: FNS-683B.pdf

INSTRUCTIONS FOR WIC FARMERS' MARKET NUTRITION (FMNP) PROGRAM
ANNUAL FINANCIAL AND PROGRAM DATA REPORT

PURPOSE

Each State agency administering the WIC Farmers' Market Nutrition Program (FMNP) shall use the FMNP Annual Financial Report to:(1) report the composition and disposition of its authorized FMNP grant for the Federal fiscal year closed out (i.e., the "report year"); (2) declare its intentions to exercise spending options provided by 7 CFR 248.14; and (3) report the FMNP cost of the report year. FNS will use this information to close out the State agency's financial account for the report year.

 

Part A - Heading

1. Federal Agency identifies the Federal agency. It is self-explanatory.

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

3. DUNS/UEI No. OMB requires entities applying for Federal grants to provide government agencies with a Universal Identifier. The initial and annual FMNP 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 Unique Entity ID assign by SAM.GOV.

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.

 

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 FMNP 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). FNS will regard an entry in row 16, as applicable, as a declaration of the State agency's intent to exercise the spending option to which the row pertains.

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

8. Backspend to Prior Year. Enter the dollar amount of funds originating in the report formula grant as applied to food and/or admin outlays of the preceding Federal fiscal year. These amounts are to be reported as negative numbers.

9. Subtotal. (Row 7 plus row 8).

10. Gross Outlays and Unliquidated Obligations. 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 all sources -- Federal FMNP grant, private funds, local funds, and State funds.

11. Program Income. Enter the total amount of any income generated by FMNP operations during the report year. If no program income was realized, enter “0.” See 7 CFR 248.13 for information on program income.

12. Net Outlays and Unliquidated Obligations. (Row 10 minus row 11).

13. Recipient's Share of Net Outlays and Unliquidated Obligations. Self-explanatory.

14. Federal Program Outlays and Unliquidated Obligations. (Row 12 minus row 13).

15. Admin to Food Conversions. Enter the amount of admin funds converted to food funds.

16. Balance. (Row 9 minus row 14 plus 15).

17. Backspend from Following Year. Enter the dollar amount originating in the formula grant allocated for the Federal fiscal year following the report year but applied to report year food and/or admin costs.

18. Results of Report Year Program Operations. For each column, add row 16 plus row 17 (If the result is a negative, enclose it in parenthesis).

 

Part C - Status of Grant Award.

19. This item captures the States agency's outlays against the report year formula grant under all spending options for which that formula grant can be used. Enter “0” in any row that does not apply.

a. For Report Year Outlays. Enter the dollar value of outlays against the formula grant for outlays of the report year. Do not include outlays supported by funds identified in rows 8 or 17; such funds are not part of the report year formula grant.

b. For Outlays of Prior Year (Backspend). Enter the portion of row 8 outlayed costs of the preceding Federal fiscal year.

c. Total Federal Outlays (19a plus 19b). For each column, add row 19a and 19b. If the State agency reports of the accrual basis, the portion of the entry that consists of accrual expenditures (liabilities) should be identified in the Remarks section.

20. Federal Unliquidated Obligations Against the Formula Grant. Enter the amount of cumulative obligations against the formula grant, for cost of any eligible Federal fiscal year, that remain unliquidated on the date of this report. If all such obligations have been liquidated, enter, “0”.

21. Federal Outlays and Unliquidated Obligations. For each column add row 19c plus row 20.

22. Federal Funds to be Recovered. For each column subtract row 21 from row 7. The result is the amount FNS will recover from the State agency when the closeout report is submitted for the report year.

23. Indirect Expense. This item captures information pertaining to indirect expense charged to the program.

a. Self-explanatory.

b. Enter the indirect cost rate in effect during the report period.

c. Enter the amount of the base against which the rate was applied.

d. Enter the total amount of indirect cost charged during the report period.

e. Enter the Federal share of the total amount.

Note: If more than one rate was in effect during the period shown in item 5, attach a schedule showing the bases against which the different rates were applied, the respective rates, the calendar periods they were in effect, amounts of indirect expense charged to the program, and the Federal share of indirect expenses charged to the program to date.

Part D - Program Data (Line 24 through Line 43).

WIC Recipients Supported with Federal and Non-Federal Funds

The number of WIC and non-WIC recipients who were issued FMNP Food Benefits supported by Federal and non-Federal funds. If issuance was to households rather than individuals, enter number of individuals served by category. The composition of the household must be identified by category in line 24 through line 28.

29. Enter the sum of WIC recipients served. If a State agency is serving households, do not include number in the total.

30. Enter the total number of WIC households served, otherwise leave blank.

Non-WIC Recipients Supported by Non-Federal Funds

31. Enter the number of any non-WIC children that received non-Federal FMNP benefits issuance. If issuance was to households, enter the number of families with non-WIC children.

 

32. Enter the number of elderly as defined by the State who received non-Federal benefits.

 

33. Enter the number of any non-WIC recipients other than children or elderly who received non-Federal FMNP benefits.

 

34. Enter the sum of Line 31 through Line 33.

 

35. Enter the sum of Line 29 and Line 34.

 

Profile of Vendors

36. Enter the number of farmers authorized for participation in the FMNP.

 

37. Enter the number of farmers' markets authorized for participation in the FMNP.

 

38. If applicable, enter the number of farm or roadside stands authorized for participation in the FMNP in addition to the farmers' markets reported on Line 37.

39. Enter the sum of Line 36 through line 38

 

FMNP Issuance and Redemption Summary

40. Enter the dollar value of Federal Food Benefits issued.

 

41. Enter the dollar value of Federal Food Benefits redeemed.

 

42. Enter the dollar value of Non-Federal Food Benefits issued.

43. Enter the dollar value of Non-Federal Food Benefits redeemed.

 

Part E - Other.

Remarks. Enter any additional information that FNS would need to interpret the information presented in Parts A through D, including any non-Federal funds used to support FMNP food expenditures.

Certification. These entries are self-explanatory.

Submission. The State agency shall submit the FNS-683B, FMNP Financial Report and Program Data to the applicable FNS regional office by January 31 of the Federal fiscal year following the report year.