Agency Distribution Report Update

Agency Distribution Report

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

Report Date*

YYYY
MM
DD
*(The month you distributed the food, not the month you are turning this report in.)
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:

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