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YOU CAN DOWNLOAD THE ENTIRE PACKET FROM OUR WEBSITE. WE WILL BE UPLOADING IT THE LAST WEEK OF SEPTEMBER.

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MEMORANDUM

DATE: September, 2015 TO: All TEFAP Agencies FROM: Pat Williams

RE: TEFAP packet

TEFAP information for the 4th quarter of 2015, running October through December can be downloaded from our website in its entirety the last week of September. Please make copies of the reporting form to use for each month, and please get your reports in to me by the 15th of each month.

Your Civil Rights poster must be displayed in your pantry. If you do not have one please contact me and I will get one to you. All pantry staff and volunteers need to be aware of Civil Rights requirements and need to have had the Civil Rights Training. You must do this training one (1) time per year.

Be sure to fill out the client form in its entirety once per year. Partial addresses are not acceptable. This is required by NCDA. Clients must sign for their TEFAP box/s each time they pick up. Always ask if anything has changed in their household. Client sheets must be stored at your pantry for a time period of FIVE years per NCDA. Freezer/Refrigerator temperatures must also be recorded daily.

See the last column of the monthly report for reporting TEFAP ending inventory for the month. You need to report this inventory in individual cans/units, not cases. It is important that we know your ending inventory each month to complete our tracking ability.

TEFAP foods are eligible for the “client choice” program. If you chose to use “client choice” in your pantry, please advise the clients that they can choose which of the TEFAP items they would like to receive.

When reporting clients served, please report only those clients who received TEFAP. TEFAP may be distributed to eligible clients as often as is needed but not more than once per week.









NCDA and MANNA recommends that you use up all your last quarter items before ordering from the next quarter. When ordering, please do not order more than you need! The goal is to give out all you have by the end of each quarter. Please follow this guideline.

YOU CAN DOWNLOAD THE ENTIRE PACKET FROM OUR WEBSITE. WE WILL BE UPLOADING IT THE LAST WEEK OF SEPTEMBER. IF YOU WOULD LIKE A PACKET MAILED/EMAILED PLEASE NOTIFY ME BY PHONE OR EMAIL.

Items allocated for this quarter are…… applesauce, green beans, corn flakes, dried cherries, canned chicken, chicken leg qtrs., corn, cranberry sauce, ham, apple juice, grapefruit juice, macaroni, peanut butter, and canned pork.

If you have any questions please contact me at (828) 299-3663 or toll free 1-877-299-3663. My Email is pwilliams@mannafoodbank.org.

Thank you very much.

Pat

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TEFAP – 04a REVISED 9/4/15 MANNA FoodBank TEFAP DISTRIBUTION REPORT

REPORT OF COMMODITIES FOR MONTH OF_____________________, 2015

AGENCY NAME__________________________________________________ AGENCY # ____________ PHONE # _________________ FAX # __________________

ADDRESS __________________________________________________________________________________________________________________________________

NAME AND TITLE OF PERSON COMPLETING THIS FORM _______________________________________________________________________________________

REPORT DUE BY THE 15Th OF THE NEXT MONTH *Reporting period runs from the 1st day of the month to the last day of the month.

*Fill in the invoice number and date in the grid below.

Report the item/amount received in CASES .

Record this amt in units/cans Week 1 Week 2 Week 3 Week 4 Week 5 END OF MONTH-inventory

Invoice # Date

Received

Invoice # Date

Received

Invoice # Date

Received

Invoice # Date Received Invoice # Date Received

PHYSICAL INVENTORY (actual can/bag count) Commodity Amt/Check

() Item Received

Commodity Amt/Check

() Item Received

Commodity Amt/Check

() Item Received

Commodity Amt/Check

() Item Received

Commodity Amt/Check

() Item Received

COMMODITY

ENDING INVENTORY IN IND UNITS/CANS Applesauce

24/#300

Applesauce 24/#300

Applesauce 24/#300

Applesauce 24/#300

Applesauce 24/#300

Applesauce 24/#300 Green Beans

24/#300

Green Beans 24/#300

Green Beans 24/#300

Green Beans 24/#300

Green Beans 24/#300

Green Beans 24/#300 Corn Flakes

12/18 oz

Corn Flakes 12/18 oz

Corn Flakes 12/18 oz

Corn Flakes 12/18 oz

Corn Flakes 12/18 oz

Corn Flakes 12/18 oz Cherries, dried

8/2#

Cherries, dried 8/2#

Cherries, dried 8/2#

Cherries, dried 8/2#

Cherries, dried 8/2#

Cherries, dried 8/2#

Chicken, canned 12/15 oz

Chicken, canned 12/15 oz

Chicken, canned 12/15 oz

Chicken, canned 12/15 oz

Chicken, canned 12/15 oz

Chicken, canned12/15 oz Chicken Leg Qtrs

4/10#

Chicken Leg Qtrs 4/10#

Chicken Leg Qtrs 4/10#

Chicken Leg Qtrs 4/10#

Chicken Leg Qtrs 4/10#

Chicken Leg Qtrs 4/10#

Corn 24/#300

Corn 24/#300

Corn 24/#300

Corn 24/#300

Corn 24/#300

Corn 24/#300 Cranberry Sauce

24/#300

Cranberry Sauce 24/#300

Cranberry Sauce 24/#300

Cranberry Sauce 24/#300

Cranberry Sauce 24/#300

Cranberry Sauce 24/#300 Ham, Frz

12/3#

Ham, Frz 12/3#

Ham, Frz 12/3#

Ham, Frz 12/3#

Ham, Frz 12/3#

Ham, Frz 12/3#

Juice, Apple 8/64 oz

Juice, Apple 8/64 oz

Juice, Apple 8/64 oz

Juice, Apple 8/64 oz

Juice, Apple 8/64 oz

Juice, Apple 8/64 oz Juice, Grapefruit

8/64 oz

Juice, Grapefruit 8/64 oz

Juice, Grapefruit 8/64 oz

Juice, Grapefruit 8/64 oz

Juice, Grapefruit 8/64 oz

Juice,Grapefrt 8/64 oz Macaroni

20/1#

Macaroni 20/1#

Macaroni 20/1#

Macaroni 20/1#

Macaroni 20/1#

Macaroni 20/1#

Peanut Butter 12/18 oz

Peanut Butter 12/18 oz

Peanut Butter 12/18 oz

Peanut Butter 12/18 oz

Peanut Butter 12/18 oz

Peanut Butter 12/18 oz Pork, Canned

24/24 oz

Pork, Canned 24/24 oz

Pork, Canned 24/24 oz

Pork, Canned 24/24 oz

Pork, Canned 24/24 oz

Pork, Canned 24/24 oz

**PLEASE RECORD ACTUAL NUMBER OF INDIVIDUALS SERVED

NUMBER OF HOUSEHOLDS – TOTAL __________ NUMBER OF INDIVIDUALS - TOTAL ________

**PLEASE RETURN THIS FORM TO THE FOOD BANK NO LATER THAN THE 15TH OF THE NEW MONTH. IF YOU HAVE ANY QUESTIONS, PLEASE CALL PAT WILLIAMS AT (828) 299-3663.

**RECORD ENDING MONTHLY INVENTORY IN LAST COLUMN

(3)

MANNA FOODBANK, ASHEVILLE, N.C.

October, November, December, 2015 TEFAP – BALANCED DISTRIBUTION RATES

Case lot distribution to agencies based on columns (4)– (9) below will help assure that families get full variety and amounts based on N.C.D.A. guidelines

.

Agencies should distribute to families the full range of items the agency has in stock in the unit amounts per item listed in column (3). A “balanced box” assures you will run out of all products at the same time.

Keep in mind that TEFAP foods are eligible for the “client choice” program. If you chose to use “client choice” in your pantry, please advise the clients that they can choose which of the TEFAP items they would like to receive.

REVISED 8/31/2015

ITEM PACKAGING

UNITS PER FAMILY SIZE 1-3 / 4+

ITEM

NUMBER OF FAMILIES AGENCY PLANS TO SERVE 24 48 72 96 120 144

(1) (2) (3) (4) (5) (6) (7) (8) (9)

APPLESAUCE 24/#300 CAN 1 / 2 APPLESAUCE 1 2 3 4 5 6

GREEN BEANS 24/#300 CAN 1 / 2 GREEN BEANS 1 2 3 4 5 6

CEREAL, CORN FLAKES

12/18 OZ 1 / 2 CEREAL, CORN FLAKES 2 4 6 8 10 12

CHERRIES, DRIED 8/2# 1 / 2 CHERRIES, DRIED 3 6 9 12 15 18

CHICKEN CAN 12/15 OZ 1 / 2 CHICKEN CAN 2 4 6 8 10 12

CHICKEN LEG QTR 4/10# 1 / 2 CHICKEN LEG QTR, FRZ 6 12 18 24 30 36

CORN 24/#300 CAN 1 / 2 CORN 1 2 3 4 5 6

CRANBERRY SAUCE

24/#300 CAN 1 / 2 CRANBERRY SAUCE 1 2 3 4 5 6

HAM, FRZ 12/3# 1 / 2 HAM, FRZ 2 4 6 8 10 12

JUICE, APPLE 8/64 OZ 1 / 2 JUICE, APPLE 3 6 9 12 15 18

JUICE, GRAPEFRUIT

8/64 OZ 1 / 2 JUICE, GRAPEFRUIT 3 6 9 12 15 18

MACARONI 20/1# PKG 1 / 2 MACARONI 1 2 3 4 6 7

PEANUT BUTTER 12/18 OZ 1 / 2 PEANUT BUTTER 2 4 6 8 10 12

PORK, CAN 24/24 OZ 1 / 2 PORK, CAN 1 2 3 4 5 6

DISTRIBUTE ALL ITEMS FROM LAST QUARTER AT THE RATE OF 1 FOR HOUSEHOLDS OF 1 – 3 AND 2 FOR HOUSEHOLES OF 4 OR MORE OR MAKE ALL BOXES THE SAME (one item per box).

Exception: CRANBERRY JUICE CONCENTRATE IS 2/4.

TO BE ABLE TO ORDER 144 YOU MUST BE THE ONLY TEFAP DISTRIBUTION SITE IN YOUR COUNTY.

***IF YOU WANT TO SERVE MORE CLIENTS YOU CAN PREPARE ALL BOXES USING THE 1-3 FAMILY SIZE REGARDLESS AS TO HOW MANY ARE IN THE FAMILY BUT YOU MUST STAY CONSISTANT WITH THIS DISTRIBUTION RATE

THROUGH-OUT THE QUARTER.

“The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital

status, familial or parental status, sexual orientation, or if all or part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.)

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at

http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov.

Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (in Spanish).

USDA is an equal opportunity provider and employer.”

(4)

In accordance with Federal law and USDA policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age or disability. “To file a complaint of discrimination, write USDA, Director, Office of Adjudication, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call toll free (866) 632-9992 (voice). Individuals who are hearing impaired or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339: or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer.”

TEFAP Eligibility Form October 1, 2015 – September 30, 2016

Name:

Address:

City:

County:

Number of People in Household: Foodstamps

– yes     no    

Effective October 1, 2015 through September 30, 2016

(Household gross income must be at or below for appropriate size household.)

HOUSEHOLD SIZE PER YEAR PER MONTH PER WEEK

1 $23,544 $1,962 $453

2 $31,872 $2,656 $613

3 $40,200 $3,350 $773

4 $48,504 $4,042 $933

5 $56,832 $4,736 $1,093

6 $65,160 $5,430 $1,253

7 $73,464 $6,122 $1,413

8 $81,792 $6,816 $1,573

EACH ADDITIONAL

FAMILY MEMBER $8,328 $694 $160

The above table shows a yearly gross income for each family size. If your household income is at or below the income listed for the number of people in your household, you are eligible to receive food. A household is defined as a group of people who live together and share money and other resources in order to get food. Please look at the income scale above to determine if your household is eligible for TEFAP.

OR

If you currently participate in a Food & Nutrition Services Program (i.e. Food Stamps) you are automatically eligible to receive TEFAP and do not need to look at the income scale.

Note: The above may be read to persons who are unable to read. People who are unable to sign their name may sign by using an X.

Please read the following statement carefully, then sign the form and write in today’s date.

I understand that any misrepresentation of need, sale, or misuse of the foods I have received is prohibited and could result in a fine, imprisonment, or both. (Sec. 211 E, PL 96-494 and Sec. 4C, PL 93-86 as amended.)

The section below is only for homebound individuals

The following persons are authorized to pick up my food (if applicable):

Authorized Representative:

Authorized Representative:

________________________________ ____________

(Client Signature) (Date)

(5)

In accordance with Federal law and USDA policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age or disability. “To file a complaint of discrimination, write USDA, Director, Office of Adjudication, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call toll free (866) 632-9992 (voice). Individuals who are hearing impaired or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339: or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer.”

Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800)877-8339; or (800) 845-6136 (in Spanish)

Date Client Signature

FNS Yearly

Income

Monthly Income

Weekly Income

Agency Representative

Signature Yes No If you do not receive FNS

Benefits (i.e. food stamps), write in your yearly, monthly, or

weekly income.

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FORMA DE ELEGIBILIDAD PARA TEFAP Octubre 2015 – Septiembre 2016

Nombre:

Dirección:

Ciudad:

Condado:

Número de personas en el hogar:

Efectivo desde 1 de Octubre 2015 hasta 30 de Septiembre de 2016

(Los ingresos gruesos tienen que estar en o abajo para el tamaño apropiado del hogar.)

TAMAÑO DE HOGAR POR AÑO POR MES POR SEMANA

1

$23,544 $1,962 $453

2

$31,872 $2,656 $613

3

$40,200 $3,350 $773

4

$48,504 $4,042 $933

5

$56,832 $4,736 $1,093

6

$65,160 $5,430 $1,253

7

$73,464 $6,122 $1,413

8

$81,792 $6,816 $1,573

CADA MIEMBRO ADICIONAL

DE LA FAMILIA

$8,328 $694 $160

La tabla abajo muestra los ingresos gruesos anuales para cada tamaño de familia. Si sus ingresos de hogar están en o debajo los ingresos en la tabla para el número de personas en su hogar, usted es elegible para recibir los alimentos. Un hogar es definido como un grupo de personas que viven juntos y comparten dinero y otros recursos a fin de conseguir el alimento. Por favor mire la escala de ingresos abajo para determinar si su hogar es elegible para TEFAP.

O

Si usted participa en una programa de estampillas de alimentos, usted es automáticamente elegible para recibir TEFAP y no tiene que mirar la escala de ingresos.

Nota: Los siguiente puede ser leído a personas que no saben leer. La gente que es incapaz de firmar su nombre puede firmar usando un X.

Por favor lea la declaración siguiente con cuidado, luego firme la forma y escriba la fecha de hoy.

Entiendo que cualquier falsificación de necesidad, venta, o mal uso de la comida que he recibido es prohibida y podría causar multas, el encarcelamiento, o ambos. (Sec. 211 E, PL 960494 y Sec. 4C, PL 93-86, según enmendado.)

La siguiente sección es sólo para los individuos recluidos Las siguientes personas están autorizadas a recoger a mi comida:

Representante Autorizado:

Representante Autorizado:

Firma de persona recogiendo alimentos: ________________________________ ____________

(Firma de Cliente) (Fecha)

El Departamento de Agricultura de los Estados Unidos (por sus siglas en inglés “USDA”) prohíbe la discriminación contra sus clientes, empleados y solicitantes de empleo por raza, color, origen nacional, edad, discapacidad, sexo, identidad de género, religión, represalias y, según corresponda, convicciones políticas, estado civil, estado familiar o paternal, orientación sexual, o si los ingresos de una persona provienen en su totalidad o en parte de un programa de asistencia pública, o información genética protegida de empleo o de cualquier programa o actividad realizada o financiada por el Departamento. (No todos los criterios prohibidos se aplicarán a todos los programas y/o actividades laborales).

Si desea presentar una queja por discriminación del programa de Derechos Civiles, complete el USDA Program Discrimination Complaint Form (formulario de quejas por discriminación del programa del USDA), que puede encontrar en internet en http://www.ascr.usda.gov/complaint_filing_cust.html, o en cualquier oficina del USDA, o llame al (866) 632-9992 para solicitar el formulario. También puede escribir una carta con toda la información solicitada en el formulario. Envíenos su formulario de queja completo o carta por correo postal a U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, por fax al (202) 690-7442 o por correo electrónico a program.intake@usda.gov.

Las personas sordas, con dificultades auditivas, o con discapacidad del habla pueden contactar al USDA por medio del Federal Relay Service (Servicio federal de transmisión) al (800) 877-8339 o (800) 845-6136 (en español).

El USDA es un proveedor y empleador que ofrece igualdad de oportunidades.

(7)

El programma de estampillas de

Por Ano Por Mes Por Semana Agency Representative

alimentos Signature

Fecha Firma

Si usted no recibe estampillas de comida,

Si No

escribir en tu anual, mensual, semanal o ingresos.

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NORTH CAROLINA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES

FOOD DISTRIBUTION DIVISION PO Box 659

Butner, NC 27509-0659

Loss Report for Month of ________________, 2015

(a) (b) (c) (d)

Product Pack Units Lost Explain in Detail Cause of Loss

______________________ __________________ ___________ ___________________________

______________________ __________________ ___________ ___________________________

______________________ __________________ ___________ ___________________________

______________________ __________________ ___________ ___________________________

______________________ __________________ ___________ ___________________________

______________________ __________________ ___________ ___________________________

______________________ __________________ ___________ ___________________________

______________________ __________________ ___________ ___________________________

______________________ __________________ ___________ ___________________________

______________________ __________________ ___________ ___________________________

______________________ __________________ ___________ ___________________________

______________________ __________________ ___________ ___________________________

______________________ __________________ ___________ ___________________________

______________________ __________________ ___________ ___________________________

(a) Self Explanatory (b) Self Explanatory

(c) List the number of blocks, bags, containers, cans or boxes which have been lost due to damage, pilferage, lack of accountability, etc.

(d) Explain in detail the cause of the loss, such as damage in shipping, hidden damage, loss through lack of accountability, etc.

____________________________________________________________________ ________________________________

(Name of Emergency Feeding Organization) (County)

_____________________________________________________ _________________________________________ ___________________________________

(Signature) (Title) (Date)

(Please attach this form to the TEFAP-4)

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