Agency Distribution Report

Agency Monthly Distribution Report

Report for the Month of:(Required)

Agency Name:(Required)

Agency Code:(Required)

Please tell us the total number of families (households) served by your agency:(Required)

Please tell us the total number of individuals within these households:(Required)

Of the total families served tell us the number of families (households) who received USDA Food:(Required)

From the USDA Household Eligibility Criteria Forms tell us the number of people in these households:(Required)

Of the total families served tell us the total number of families who received GNAP Food:*(Required)

From the GNAP Client Intake Forms tell us the total number of people within these households:(Required)

*(Total of all three categories must equal number of GNAP Families)

At-Risk Families:(Required)

TANF Clients:(Required)

Describe the needs/circumstances of a family who received GNAP this month:(Required)

Please tell us the total number of individuals who received meals from your agency:(Required)

Please tell us the total number of meals served:(Required)

(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:(Required)

Please tell us the total number of snacks served:(Required)

(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:(Required)

Please tell us how many total meals were served using GNAP Products:(Required)