Form FNS 683 FNS 683 Financial Report

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FORM APPROVED OMB NO. 0584-0447
Expiration Date: XX/XX/XXXX
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
is estimated to average 3 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and
complete and review the information collection.

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

2. STATE 7-DIGIT AGENCY CODE

5. BASIS:

4. STATE AGENCY NAME AND ADDRESS

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 14)
16. BACKSPEND FROM FOLLOWING YEAR
17. RESULTS OF REPORT YEAR PROGRAM OPERATIONS
(15 PLUS 16)

PART C - STATUS OF GRANT AWARD
18. FEDERAL OUTLAYS AGAINST THE FORMULA GRANT:
a. FOR REPORT YEAR OUTLAYS
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 (06-10) Previous Editions are Obsolete
Electronic Form Version Designed in Adobe 8.1 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 closed out (i.e.,
the “report year”); (2) declare its intentions to exercise spending
options provided by 7 CFR 248.14; and (3) report the FMNP cost
of the report year. FNS will use this information to close out the
State agency's financial account for the report year.
Part A - Heading.
1. Federal Agency. Identifies the Federal agency. Selfexplanatory.
2.

State 7-Digit Code. Enter the seven digit State agency
identification code assigned by FNS.

3.

DUNS Universal ID. OMB requires entities applying for
Federal grants to provide government agencies with a
Universal Identifier. The initial and annual FMNP State Plan
submissions are considered to be applications for a federal
grant, and thus State agencies must comply with this
requirement. Currently, the Universal Identifier system in use
is the Data Universal Numbering System (DUNS).

4.

State Agency. Identifies the State agency and address. Selfexplanatory.

5.

Basis. Check the block that identifies the reporting basis
(cash or accrual) used to prepare the report.

6.

Report Year. Enter the beginning and 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 the funds
available to the State agency for the report year FMNP outlays.
Column (A) captures this information with respect to food outlays
(costs); column (B) captures administrative outlays (costs); and
column (C) captures the sum of the two components (A&B). FNS
will regard an entry in row 16, as applicable, as a declaration of the
State agency's intent to exercise the spending option to which the
row pertains.
7.

Formula Grant. For each column, enter the total dollar
amount FNS allocated to the State agency for the report year.

8.

Backspend to Prior Year. Enter the dollar amount of funds
originating in the report formula grant as applied to food and/
or admin outlays of the preceding Federal fiscal year.

9.

Subtotal. (Row 7 plus row 8).

10. Gross Outlays and Unliquidated Obligations. 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 all sources -- Federal
FMNP grant, private funds, local funds, and State funds.
11. Program Income. Enter the total amount of any income
generated by FMNP operations during the report year. If no
program income was realized, enter “0.” See 7 CFR 248.13
for information on program income.
12. Net Outlays and Unliquidated Obligations. ( Row 10 minus
row 11).
13. Recipient's Share of Net Outlays and Unliquidated
Obligations. Self explanatory.
14. Federal Program Outlays and Unliquidated Obligations. (Row
12 minus row 13).
15. Balance. (Row 9 minus row 14).

16. Backspend 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 and/or admin costs.
17. Results of Report Year Program Operations. For each column, add
row 15 plus row 16 (If the result is a negative, enclose it in
parenthesis).
Part C - Status of Grant Award.
18. This item captures the States agency's outlays against the report year
formula grant under all spending options for which that formula grant
can be used. Enter “0” 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 8
or 16; such funds are not part of the report year formula
grant.
b.
For Outlays of Prior Year (Backspend). Enter the portion of
row 8 outlayed costs of the preceding Federal fiscal year.
c.
Total Federal Outlays (18a plus 18b). For each column,
add row 18a and 18b. If the State agency reports of the
accrual basis, the portion of the entry that consists of
accrual expenditures (liabilities) should be identified in the
Remarks section.
19. Federal Unliquidated Obligations Against the Formula Grant. Enter
the amount of cumulative obligations against the formula grant, for
cost of any eligible Federal fiscal year, that remain unliquidated on the
date of this report. If all such obligations have been liquidated, enter,
“0”.
20. Federal Outlays and Unliquidated Obligations. For each column add
row 18c plus row 19.
21. Federal Funds to be Recovered. For each column subtract row 20
from row 7. The result is the amount FNS will recover from the State
agency when the closeout report is submitted for the report year.
22. Indirect Expense. This item captures information pertaining to indirect
expenses charged to the program.
a.
Self-explanatory.
b.
Enter the indirect cost rate in effect during the report period.
c.
Enter the amount of the base against which the rate was
applied.
d.
Enter the total amount of indirect cost 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
effect, amounts of indirect expense charged to the program, and the
Federal share of indirect expenses charged to the program to date.
Part D - Other.
Remarks. Enter any additional information that FNS would need to
interpret the information presented in Parts A through C, including any
non-Federal funds used to support FMNP food expenditures.
Certification. These entries are self-explanatory.
Submission. The State agency shall submit the FNS-683, FMNP Financial
Report to the applicable FNS regional office by January 31 of the Federal
fiscal year following the report year.