INDIVIDUALS RECEIVING USDA FOODS FOR HOME CONSUMPTION

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FORM APPROVED OMB NO. 0584-0293
Expiration Date:XX/XX/XXXX
U.S. DEPARTMENT OF AGRICULTURE
FOOD AND NUTRITION ADMINISTRATION

INDIVIDUALS RECEIVING USDA
FOODS FOR HOME CONSUMPTION IN
THE EMERGENCY FOOD ASSISTANCE
PROGRAM (TEFAP)

Public reporting burden for this collection of information is estimated to average 2
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
Administration, Office of Research and Analysis (0584-0293), Alexandria, VA 22302.
Do not return the completed form to this address.

1. STATE/TERRITORY:
2. STATE AGENCY NAME:
3. ID NUMBER:
4. TYPE OF SUBMISSION:
A.

INITIAL

B.

REVISION

5. FISCAL YEAR:

QUARTER:

Q1

Q2

Q3

Q4

6. NUMBER OF PARTICIPANTS, 1ST MONTH OF QUARTER:
7. NUMBER OF PARTICIPANTS, 2ND MONTH OF QUARTER:
8. NUMBER OF PARTICIPANTS, 3RD MONTH OF QUARTER:
9. AVERAGE MONTHLY PARTICIPATION FOR QUARTER:
10. REPORT SUBMISSION MAY CONTAIN DUPLICATED DATA:
11. NOTES:

YES

NO

FORM FNA-930 INSTRUCTIONS
PURPOSE: The FNA-930 captures the number of individuals that accessed
USDA Foods for home consumption via The Emergency Food Assistance
Program (TEFAP) each month in each quarter. Per program regulations at 7 CFR
251.10(b)(4), TEFAP State agencies are required to submit this report to USDA’s
Food and Nutrition Administration on a quarterly basis consistent with the
deadlines set in the Food Programs Reporting System (FPRS). The number of
individuals reported per month in this report is considered a proxy for
understanding how many individuals are served by each State agency’s TEFAP
network in a given month. FNA recognizes that data reported in this report by
TEFAP State agencies may contain duplicated data and does not necessarily
represent the number of unique individuals served by each State agency in a
given month.
ITEM:
1. State/Territory – Enter the name of the State or Territory in which the TEFAP
State agency is located.
2. State Agency Name – Enter the name of the TEFAP State agency.
3. ID Number – Enter the 7-digit identification (ID) number
assigned by FNA. This number identifies the State agency and its
TEFAP grant in the FNA automated reporting system.
4. Type of Submission - Indicate type of submission for quarter being reported.
The initial submission of this report should be such by checking (A). Any
subsequent revisions for the report quarter should be indicated by checking (B).
5. Year and Quarter of Submission - Enter the quarter and fiscal year for which
data is reported. Quarter 1 = October – December; Quarter 2 = January – March;
Quarter 3 = April – June; Quarter 4 = July – September.
6. Number of Participants, 1st Month of Quarter - Enter the total number of
persons served by eligible recipient agencies at distribution sites in the
State/Territory in the first month of the quarter. This number should include
individuals served by eligible recipient agencies that have TEFAP agreements
with the State agency in addition to those served by eligible recipient agencies
that have TEFAP agreements with other eligible recipient agencies. FNA
recognizes that this number may contain duplicated data for those individuals
who visited a distribution site more than one time within a month or who visited
multiple distribution sites within the month. State agencies should do their
best to provide unduplicated data whenever available.

1st Month of Quarter
Quarter 1
Quarter 2
Quarter 3
Quarter 4

October
January
April
July

7. Number of Participants, 2nd Month of Quarter – Enter the total number of
persons served by eligible recipient agencies at distribution sites in the
State/Territory in the second month of the quarter. This number should include
individuals served by eligible recipient agencies that have TEFAP agreements
with the State agency in addition to those served by eligible recipient agencies
that have TEFAP agreements with other eligible recipient agencies. FNA
recognizes that this number may contain duplicated data for those individuals
who visited a distribution site more than one time within a month or who visited
multiple distribution sites within the month. State agencies should do their
best to provide unduplicated data whenever available.
2nd Month of Quarter
Quarter 1
Quarter 2
Quarter 3
Quarter 4

November
February
May
August

8. Number of Participants, 3rd Month of Quarter – Enter the total number of
persons served by eligible recipient agencies at distribution sites in the
State/Territory in the third month of the quarter. This number should include
individuals served by eligible recipient agencies that have TEFAP agreements
with the State agency in addition to those served by eligible recipient agencies
that have TEFAP agreements with other eligible recipient agencies. FNA
recognizes that this number may contain duplicated data for those individuals
who visited a distribution site more than one time within a month or who visited
multiple distribution sites within the month. State agencies should do their
best to provide unduplicated data whenever available.
3rd Month of Quarter
Quarter 1
Quarter 2
Quarter 3
Quarter 4

December
March
June
September

FORM FNA-930 INSTRUCTIONS
9. Average Monthly Participation for Quarter – This item does not require State
agency input. Once numbers are input for Items 6-8, FPRS will auto-calculate a
monthly average participation for the quarter.
10. Report May Contain Duplicated Data – Please indicate whether data
reported in items 6-8 may contain duplicated data. Duplicated data means that
the data may only represent the number of unique site visits to a TEFAP

distribution site(s) within a given month and not the number of unique
individuals that visited that distribution site. For example, duplicated data may
report two individuals as visiting a distribution site in a given month, when in
reality, one unique individual visited the distribution site twice in the same
month.
11. Notes – Enter any relevant notes about the data reported.