Agency Distribution Report Update

Agency Distribution Report

(Ex: December totals are due by the 5th Day of January)

Report Date*

Year
Month
Day
Report for the month of:*
*(The month you distributed the food, not the month you are turning this report in.)
*(If you need to leave any fields below blank, please put N/A in the box.)
Agency Code*
Full Name of Agency:*
FOR AGENCIES WHO PROVIDE FOOD BOXES
Please tell us the total number of families (households) served by your agency:*
Please tell us the total number of individuals within these households:*
Of the total families served tell us the number of families (households) who received USDA Food:*
From the USDA Household Eligibility Criteria Forms tell us the number of people in these households:*
Of the total families served tell us the total number of families who received GNAP Food:**
From the GNAP Client Intake Forms tell us the total number of people within these households:*
From the GNAP Client Intake Forms tell us the total number of families that are:
*(Total of all three categories must equal number of GNAP Families)
At-Risk Families:*
TANF Clients:*
Transitional Services:*
Describe the needs/circumstances of a family who received GNAP this month:*
FOR AGENCIES WHO PROVIDE ON-SITE FEEDING
Please tell us the total number of individuals who received meals from your agency:*
Please tell us the total number of meals served:*
(Ex: 10 people served x 3 meals x 20 days = 600 meals served for the month)
Please tell us the total number of individuals who received snacks from your agency:*
Please tell us the total number of snacks served:*
(Ex: 10 people served x 3 snacks x 20 days = 600 snacks served for the month)
Please tell us how many total meals were served using USDA Product:*
Please tell us how many total meals were served using GNAP Products:*
Email*
A copy of this report will be sent to this email.
Enter Email Confirm Email

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