Form FNS 203 FNS 203 WIC Farmers' Market Nutrition Program Report

Print
OMB APPROVED NO. 0584-0447
U.S. DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION SERVICE

FISCAL YEAR

STATE AGENCY

WIC FARMERS' MARKET NUTRITION
PROGRAM REPORT

7-DIGIT CODE

8. UNIVERSAL IDENTIFIER NUMBER

PROFILE OF RECIPIENTS

Total number of WIC recipients who received FMNP coupons (funded by either Federal or non-Federal funds) during
the year: (See instructions on reverse.)
1) Pregnant Women
2) Breastfeeding Women
3) Postpartum Women
4) Infants
5) Children
6) Total WIC Recipients
7) Households

Total number of Non-WIC recipients who received FMNP coupons supported by non-Federal funds, if any:
(See instructions on reverse.)
8) Children
9) Elderly
10) Other
11) Total non-WIC recipients of non-Federal benefits

12) Total number of recipients
(WIC and non-WIC) =

PROFILE OF VENDORS
13) Number of authorized farmers
14) Number of authorized farmers' markets
15) Number of authorized farm or roadside stands, if any

FMNP ISSUANCE AND REDEMPTION SUMMARY
16) Total value of coupons issued (Federal + non-Federal)
17) Total value of coupons redeemed (Federal + non-Federal)

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL

FORM FNS - 203 (10/03)

NAME OF AUTHORIZED CERTIFYING OFFICIAL
(Please print or type)

SBU

DATE

Electronic Form Version Designed in Adobe 7.1 Version

INSTRUCTIONS
PROFILE OF RECIPIENTS
WIC recipients - The number of WIC recipients to whom coupons were issued. This number includes those served
with either Federal or non-Federal funds or both. Provide the numbers for each category served under this heading.
Line 6 Total WIC Recipients - Enter the sum of lines 1 through 5. If the State agency is serving households, do not
include the household number in the total.
Line 7

Households - If issuance was to households rather than to individuals, enter the total number of WIC
households served, otherwise, leave line 7 blank. The composition of the household must be
identified by category in lines 1 - 5.

Non-WIC Recipients of Non-Federal FMNP Benefits - The number of non-WIC recipients who were issued FMNP
coupons supported by non-Federal funds. If issuance was to households rather than individuals, enter number of
individuals served by category. If age category is unknown, count as "other".
Line 8 Children - Enter the number of any non-WIC children that received non-Federal FMNP benefits, or if
issuance was to households, the number of families with non-WIC children.
Line 10 "Other" - Enter the number of any non-WIC recipients other than children or elderly who received nonFederal FMNP benefits.
Line 11 Total Non-WIC FMNP Recipients - Enter the sum of lines 8 through 10.
Line 12 Total Number of Recipients - Enter the sum of lines 6 and 11.
PROFILE OF VENDORS
Line 13 Number of authorized farmers - Enter the number of farmers authorized for participation in the FMNP.
Line 14 Number of authorized farmers' markets - Enter the number of farmers' markets authorized for participation in
the FMNP.
Line 15 Number of Authorized Farm or Roadside Stands - If applicable, enter the number of farm or roadside stands
authorized for participation in the FMNP in addition to the farmers' markets reported on line 14.
FMNP ISSUANCE AND REDEMPTION SUMMARY
These items are self-explanatory.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless
it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0447. The time
required to complete this information collection is estimated to average 1.0 hours per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the information collection.