Form FNS 683 FNS 683 Financial Report

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

WIC FARMERS' MARKET NUTRITION PROGRAM (FMNP)
ANNUAL FINANCIAL REPORT
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
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complete and review the information collection.

PART A - HEADING
1. FEDERAL AGENCY AND ORGANIZATIONAL ELEMENT TO WHICH REPORT
IS SUBMITTED

4. STATE AGENCY NAME AND ADDRESS

2. STATE 7-DIGIT AGENCY CODE

5. BASIS:

3. UNIVERSAL IDENTIFIER NUMBER

6. REPORT YEAR

CASH

FROM

ACCRUAL

TO

PART B - ANALYSIS OF REPORT YEAR PROGRAM ACTIVITY
COST CATEGORY

7.

FORMULA GRANT

8.

BACKSPEND TO PRIOR YEAR

9.

SUBTOTAL (7 PLUS 8)

ADMIN.
(B)

FOOD
(A)

TRANSACTION

TOTAL
(C)

10. GROSS OUTLAYS AND UNLIQUIDATED OBLIGATIONS
FOR REPORT YEAR
11. PROGRAM INCOME
12. NET OUTLAYS AND UNLIQUIDATED OBLIGATIONS
(10 MINUS 11)
13. RECIPIENT'S SHARE OF NET OUTLAYS AND UNLIQUIDATED
OBLIGATIONS
14. FEDERAL PROGRAM OUTLAYS AND UNLIQUIDATED
OBLIGATIONS (12 MINUS 13)
15. BALANCE (9 MINUS 12)
16. BACKSPEND FROM FOLLOWING YEAR
17. RESULTS OF REPORT YEAR PROGRAM OPERATIONS
(13 PLUS 14)

PART C - STATUS OF GRANT AWARD
18. FEDERAL OUTLAYS AGAINST THE FORMULA GRANT:
a. FOR REPORT YEAR OUTLAWS
b. FOR OUTLAYS OF PRIOR YEAR (BACKSPENT)
c. TOTAL FEDERAL OUTLAYS (18a PLUS 18b)
19. FEDERAL UNLIQUIDATED OBLIGATIONS AGAINST THE
FORMULA GRANT
20. FEDERAL OUTLAYS AND UNLIQUIDATED OBLIGATIONS
(18c PLUS 19)
21. FEDERAL FUNDS TO BE RECOVERED (7 MINUS 20)
22. INDIRECT
EXPENSE

a. TYPE OF RATE (Place "X" in appropriate box)
Provisional
Predetermined
b. RATE

Final

c. BASE

d. TOTAL AMOUNT

Fixed
e. FEDERAL SHARE

PART D - OTHER
REMARKS

CERTIFICATION:
I CERTIFY TO THE BEST OF MY KNOWLEDGE AND BELIEF
THAT THIS REPORT IS CORRECT AND THAT ALL OUTLAYS
AND UNLIQUIDATED OBLIGATIONS ARE FOR THE PURPOSES
SET FORTH IN THE AWARD DOCUMENT.
Form FNS-683 (10-03) Previous editions are obsolete
Electronic Form Version Designed in Adobe 7.1 Version

TYPED NAME AND TITLE OF CERTIFYING OFFICIAL

SIGNATURE

TELEPHONE NUMBER

SBU

DATE

PAGE

OF

PAGES

INSTRUCTIONS FOR WIC FARMERS' MARKET NUTRITION (FMNP) PROGRAM
ANNUAL FINANCIAL REPORT

PURPOSE
Each State agency administering the WIC Farmers'
Market Nutrition Program (FMNP) shall use the FMNP
Annual financial Report to: (1) report the composition
and disposition of its authorized FMNP grant for the
Federal fiscal year being closed out (i.e., the "report
year"); (2) declare its intentions to exercise spending
options provided for by 7 CFR 248.14; and (3) report
the final disposition of the formula grant allocated to it
for FMNP costs of the report year. FNS will use this
information to close out the State agency's account for
the report year. Before transmitting the form to the
State agency, FNS shall complete Part A and rows 6
through 8 in Part B. The State agency shall confirm
that these entries agree with its own records and
complete the balance of the form.
Part A - Heading.
1. Federal Agency identifies the Federal agency. It is
self-explanatory.
2. State 7-Digit Code. Enter the seven digit State
agency identification code assigned by FNS.
3. State Agency identifies the State agency. It is selfexplanatory.
4. Basis. Check the block that identifies the reporting
basis (cash or accrual) used to prepare the report.
5. Report Year. Enter the beginning end ending dates
of the report year. This is the 12-month Federal fiscal
year to which the report pertains.
Part B - Analysis of Report Year Program Activity.
This part analyzes the source(s) and applications of
funds available to the State agency for report year
FMNP outlays. column (A) captors this information with
respect to food costs; column (B) captures it for the
outlays of administration; and column (C) captures the
sum of the two components. If a block does not apply,
enter "O." FNS will regard an entry in row 15, as
applicable, as a declaration of the State agency's intent
to exercise the spending option to which the row pertains.
6. Formula Grant. For each column, enter the dollar
amount FNS allocated to the State agency for the report
year.
7. Backspent to Prior Year. Enter the doll amount of funds
originating in the report formula grant but applied to food
and/or Admin outlays of the immediately preceding Federal
fiscal year.
8. Subtotal. Add row 7, as applicable, to row 6.
9. Gross Outlays and Unliquidated Obligations for Report
Year. For each column, enter the sum of the State
agency's outlays and Unliquidated obligations for report
year. Include outlays and Unliquidated obligations funded
from sources other than the Federal FMNP grant.
10. Program Income. Enter the total amount of income
generated by FMNP operations during the report year.
If no program income was realized, enter "O."
11. Net Outlays and Unliquidated Obligations. Selfexplanatory.
12. Recipient's Share of Net Outlays and Unliquidated
Obligations. Self-explanatory.
13. Federal Program Outlays and Unliquidated Obligations.
For each column, subtract row 12 from row 11 to obtain
the portion of the row 11 entry that is supported by the
Federal FMNP grant.

16. Results of Report Year Program Operations. For each
column, add row 15, as applicable, to row 14. If the result
is negative, enclose it in brackets.
Part C - Status of the Report Year Grant Award.
This part captures the status of the formula grant awarded
for the report year.
17. Federal Outlays Against the Formula Grant. This item
captures the State agency's outlays against the report year
formula grant under all spending options for which that
formula grant can be used. Enter "O" in any row that does
not apply.
a. For Report Year Outlays. Enter the amount of
outlays against the formula grant for outlays of the
report year. Do not include outlays supported by
funds identified in rows 7 or 15; such funds are not
part of the report year formula grant.
b. For Prior Year Costs (Backspent). Enter the
portion of row 7 outlayed for costs of the preceding
Federal fiscal year.
c. Total Federal Outlays. For each column, add
together rows 17(a) and 17(b). If the State agency
reports on the accrual basis, the portion of this
entry that consists of accrued expenditures (liabilities)
should be identified in the Remarks section.
18. Federal Unliquidated Obligations Against the Formula
Grant. Enter the amount of cumulative obligations against
the formula grant, for costs of any eligible Federal fiscal year,
that remain Unliquidated on the date of this report. If all such
obligations ha been liquidated, enter "O."
19. Federal Outlays and Unliquidated Obligations Against
the Formula Grant. For each column, add together rows
17(c) and 18.
20. Federal Funds to be Recovered (Restored). For each
column, subtract row 19 from row 6. The result is the
amount FNS will recover in the course of closing out the
State agency's account for the report year.
21. Indirect Expense. This item captures information
pertaining to indirect expense charged to the program.
a. Self-explanatory.
b. Enter the indirect cost rate in effect during the
reporting period.
c. Enter the amount of the base against which the
rate was applied.
d. Enter the total amount of indirect costs charged
during the report period.
e. Enter the Federal share of the total amount.
NOTE: If more than one rate was in effect during the period
shown in item 5, attach a schedule showing the bases
against which the different rates were applied, the respective
rates, the calendar periods they were in defect, amounts of
indirect expense charged to the program, and the Federal
share of indirect expense charged tot he program to date.
Part D - Other.
Remarks.
a. If a spend-forward option was exercised, identify the
option (up to 5 percent) used.
b. Enter any additional information that FNS would need
to interpret the information presented in Parts A through
C.

14. Balance. For each column, subtract row 13 from
row 8. If this results in a negative amount, enclose
it in brackets.

Certification. These entries are self-explanatory.

15. Backspent from Following Year. Enter the dollar
amount originating in the formula grant allocated for
the Federal fiscal year following the report year but
applied to report year food an/or Admin. costs.

The State agency shall submit the FNS-683, FMNP Financial
Report to the applicable FNS regional office by January 31
O. the Federal fiscal year following the report year.

Submission.