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pdfFORM APPROVED OMB NO. 0584-0293
Expiration Date: XX/XX/XXXX
UNITED STATES DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION SERVICE
MONTHLY REPORT OF THE COMMODITY SUPPLEMENTAL FOOD PROGRAM AND QUARTERLY ADMINISTRATIVE FINANCIAL
STATUS REPORT
SEE INSTRUCTIONS ON REVERSE
1. REPORTING MONTH
AND YEAR
3. TYPE OF SUBMISSION
4. NUMBER OF PARTICIPANTS
(A) - INITIAL
INFANTS
(0-3) MONTHS
(A)
(B) - LATEST REV.
2A. ST AGENCY NAME
(C) - CLOSEOUT
INVENTORY
INFANTS
(4-12) MONTHS
(B)
CHILDREN
(1-6) YEARS
(C)
2B. DA CODE
COMMODITY
NAME
PREGNANT/BREAST
FEEDING WOMEN
(D)
POST-PARTUM
WOMEN
(E)
TOTAL NO. PART.
(4A + B + C + D + E = 4F)
(F)
TOTAL NO. OF
ELDERLY PART.
(G)
(A) CASES
(B) UNITS
STATE AND LOCAL DATA
6A.
6.
5. REPORTING MEASUREMENTS
6B.
CODE
7.
PACK
SIZE
8.
STATE AND
LOCAL
9.
RECEIPTS
10.
REDONATIONS
IN
BEGINNING
INVENTORY
11.
COMMODITY ISSUANCE
TOTAL
INVENTORY
AVAILABLE
A059
24/300 can
GREEN BEANS 303
A060
24/303 can
BEANS VEG 300
A090
24/300 can
CARROTS
A095
24/303 can
CARROTS 300
A098
24/300 can
CORN KERNEL 300
A119
24/300 can
CORN CREAM
A120
24/303 can
CORN KERNEL
A121
24/303 can
CORN CREAM 300
A122
24/300 can
LENTILS
A135
12/2 lb.
PEAS 300
A144
24/300 can
PEAS 303
A145
24/303 can
PUMPKIN
A163
24/300 can
SPINACH
A166
24/303 can
SPINACH 300
A167
24/300 can
POTATOES 303
A169
24/303 can
POTATOES SLC 300
A170
24/300 can
POTATOES DEHY 12
A196
12/1 lb.
FORM FNS - 153 (07/08) Previous editions obsolete
W-I-C
ELDERLY
(7 + 8 + 9 = 10)
SBU
13.
14.
REDONATIONS
(A)
(B)
(B)
Electronic Form Version Designed in Adobe 8.1 Version
OUT
FOOD
LOSS
STATE AND
TOTAL
ACTIVITY
TOTAL
NUMBER
ISSUED
(11A + B = 12)
15.
ADJUSTMENTS
COMMODITY ACTIVITY
TOTAL NUMBER
ISSUED TO:
(A)
GREEN BEANS 300
12.
AMT USED
FOR
NUT ED
POSITIVE
NEGATIVE
LOCAL
ENDING
(12A + B + C
+D = 13)
INVENTORY
((10 - 13) +/14A & B = 15)
(C)
(D)
(A)
(B)
PAGE 1 OF 8
REPORTING MONTH AND YEAR:
MONTHLY REPORT OF THE COMMODITY SUPPLEMENTAL
STATE AGENCY NAME:
REPORTING MEASUREMENT:
FOOD PROGRAM STATE AND LOCAL INVENTORY
CASES (
)
OR UNITS (
)
STATE AND LOCAL DATA
6.
6A.
COMMODITY
NAME
6B.
CODE
7.
PACK
SIZE
8.
STATE AND
LOCAL
BEGINNING
INVENTORY
9.
RECEIPTS
10.
REDONATIONS
IN
11.
COMMODITY ISSUANCE
TOTAL
INVENTORY
AVAILABLE
A221
24/303 can
SWT POTATOES 300
A223
24/300 can
TOMATOES 300
A240
24/300 can
TOMATO SAUCE 300
A244
24/300 can
TOMATOES 303
A248
24/303 can
GRAPEFRUIT J
A280
12/46 oz.
APPLE J
A282
12/46 oz.
GRAPE J
A285
12/46 oz.
PINEAPPLE J
A286
12/46 oz.
TOMATO J
A290
12/46 oz.
ORANGE J
A300
12/46 oz.
APPLESAUCE 303
A145
24/303 can
F COCKTAIL 303
A163
24/303 can
F COCKTAIL 300
A166
24/300 can
PEACHES CLING 300
A167
24/300 can
PEACHES CLING 303
A169
24/303 can
PEARS 300
A170
24/300 can
PEARS 303
A196
24/303 can
PINEAPPLE 2
A169
24/2 can
PLUMS 303
A170
24/303 can
PRUNES 24
A196
24/1 lb.
FORM FNS - 153 (07/08) Previous editions obsolete
13.
W-I-C
ELDERLY
(7 + 8 + 9 = 10)
14.
REDONATIONS
(A)
(B)
(B)
Electronic Form Version Designed in Adobe 8.1 Version
OUT
FOOD
LOSS
STATE AND
TOTAL
ACTIVITY
TOTAL
NUMBER
ISSUED
(11A + B = 12)
15.
ADJUSTMENTS
COMMODITY ACTIVITY
TOTAL NUMBER
ISSUED TO:
(A)
SWT POTATOES 303
12.
AMT USED
FOR
NUT ED
POSITIVE
NEGATIVE
LOCAL
ENDING
(12A + B + C
+D = 13)
INVENTORY
((10 - 13) +/14A & B = 15)
(C)
(D)
(A)
(B)
PAGE 2 OF 8
REPORTING MONTH AND YEAR:
MONTHLY REPORT OF THE COMMODITY SUPPLEMENTAL
REPORTING MEASUREMENT:
STATE AGENCY NAME:
FOOD PROGRAM STATE AND LOCAL INVENTORY
CASES (
)
OR UNITS (
)
STATE AND LOCAL DATA
6.
6A.
COMMODITY
NAME
6B.
CODE
7.
PACK
SIZE
8.
STATE AND
LOCAL
BEGINNING
INVENTORY
9.
RECEIPTS
10.
REDONATIONS
IN
11.
COMMODITY ISSUANCE
TOTAL
INVENTORY
AVAILABLE
A562
24/29 oz.
EGG MIX 6
A570
48/6 oz.
STEW CND
A587
24/24 oz.
STEW 24/15
A589
24/15 oz.
BEEF NJ
A610
24/29 oz.
PORK NJ
A630
24/29 oz.
TUNA 12.25
A740
24/12.5 oz.
SALMON 24
A803
24/14.7 oz.
BEANS DK R KIDNEY
A906
12/2 lb.
BEENS BLKEYE 2
A910
12/2 lb.
BEANS B LIMA 2
A912
12/2 lb.
BEANS PINTO 2
A914
12/2 lb.
BEANS R KIDNEY 2
A915
12/2 lb.
BEANS GRT NORTH 2
A917
12/2 lb.
BEANS NAVY PEA 2
A918
12/2 lb.
BEANS LT KIDNEY 2
A920
12/2 lb.
PEAS SPLIT 2
A922
12/2 lb.
FORM FNS - 153 (07/08) Previous editions obsolete
13.
W-I-C
ELDERLY
(7 + 8 + 9 = 10)
14.
REDONATIONS
(A)
(B)
(B)
Electronic Form Version Designed in Adobe 8.1 Version
OUT
FOOD
LOSS
STATE AND
TOTAL
ACTIVITY
TOTAL
NUMBER
ISSUED
(11A + B = 12)
15.
ADJUSTMENTS
COMMODITY ACTIVITY
TOTAL NUMBER
ISSUED TO:
(A)
CHICKEN CND
12.
AMT USED
FOR
NUT ED
POSITIVE
NEGATIVE
LOCAL
ENDING
(12A + B + C
+D = 13)
INVENTORY
((10 - 13) +/14A & B = 15)
(C)
(D)
(A)
(B)
PAGE 3 OF 8
REPORTING MONTH AND YEAR:
MONTHLY REPORT OF THE COMMODITY SUPPLEMENTAL
REPORTING MEASUREMENT:
STATE AGENCY NAME:
FOOD PROGRAM STATE AND LOCAL INVENTORY
CASES (
)
OR UNITS (
)
STATE AND LOCAL DATA
6.
6A.
COMMODITY
NAME
6B.
CODE
7.
PACK
SIZE
8.
STATE AND
LOCAL
BEGINNING
INVENTORY
9.
RECEIPTS
10.
REDONATIONS
IN
11.
COMMODITY ISSUANCE
TOTAL
INVENTORY
AVAILABLE
B081
48/12 Fl oz.
INSTANT 24
B090
6/4 lb.
EVAP 24
B117
24/12 Fl oz.
CORNMEAL 5 DEG
B137
10/5 lb.
CORNMEAL 8/5 DEG
B138
8/5 lb.
CORNMEAL 10 DEG
B141
5/10 lb.
CORNMEAL 40 DEG
B142
5/10 lb.
FORMULA POWDER 14.1
B158
24/14 oz.
FARINA
B160
24/14 oz.
CEREAL INFANT R8
B161
12/8 oz.
FORMULA SOY DRY 6/14
B162
6/14 oz.
FORMULA SOY 12
B163
12/13 Fl oz.
FORMULA 12
B164
12/13 Fl oz.
FORMULA
B165
24/13 Fl oz.
FORMULA SOY
B166
24/13 Fl oz.
FORMULA POWDER
B167
12/1 lb.
FORMULA POWDER 6
B168
6/1 lb.
FORMULA SOY PWDR 6
B169
6/1 lb.
FORM FNS - 153 (07/08) Previous editions obsolete
13.
W-I-C
ELDERLY
(7 + 8 + 9 = 10)
14.
REDONATIONS
(A)
(B)
(B)
Electronic Form Version Designed in Adobe 8.1 Version
OUT
FOOD
LOSS
STATE AND
TOTAL
ACTIVITY
TOTAL
NUMBER
ISSUED
(11A + B = 12)
15.
ADJUSTMENTS
COMMODITY ACTIVITY
TOTAL NUMBER
ISSUED TO:
(A)
EVAP 12
12.
AMT USED
FOR
NUT ED
POSITIVE
NEGATIVE
LOCAL
ENDING
(12A + B + C
+D = 13)
INVENTORY
((10 - 13) +/14A & B = 15)
(C)
(D)
(A)
(B)
PAGE 4 OF 8
REPORTING MONTH AND YEAR:
MONTHLY REPORT OF THE COMMODITY SUPPLEMENTAL
REPORTING MEASUREMENT:
STATE AGENCY NAME:
FOOD PROGRAM STATE AND LOCAL INVENTORY
CASES (
)
OR UNITS (
)
STATE AND LOCAL DATA
6.
6A.
COMMODITY
NAME
6B.
CODE
7.
PACK
SIZE
8.
STATE AND
LOCAL
BEGINNING
INVENTORY
9.
RECEIPTS
10.
REDONATIONS
IN
11.
COMMODITY ISSUANCE
TOTAL
INVENTORY
AVAILABLE
B381
10/5 lb.
GRITS CW 40
B382
8/5 lb.
HONEY 24
B403
24/24 oz.
MACARONI 1
B425
24/1 lb.
OATS 3
B445
12/3 lb.
PB 2
B470
24/2 lb.
PB RDU-FAT 2
B471
24/2 lb.
CHUNKY RDU-FAT 2
B488
24/2 lb.
RICE 2
B510
24/2 lb.
CEREAL CORN RTE 17.5
B847
14/17.5 oz.
CEREAL RICE 15
B848
12/15 oz.
CEREAL CORN 18
B849
12/18 oz.
CEREAL CORN 16
B851
12/16 oz.
CEREAL CORN 17.5
B852
12/17.5 oz.
CEREAL OATS 15.5
B854
12/15.5 oz.
FORM FNS - 153 (07/08) Previous editions obsolete
13.
W-I-C
ELDERLY
(7 + 8 + 9 = 10)
14.
REDONATIONS
(A)
(B)
(B)
Electronic Form Version Designed in Adobe 8.1 Version
OUT
FOOD
LOSS
STATE AND
TOTAL
ACTIVITY
TOTAL
NUMBER
ISSUED
(11A + B = 12)
15.
ADJUSTMENTS
COMMODITY ACTIVITY
TOTAL NUMBER
ISSUED TO:
(A)
GRITS CW 5
12.
AMT USED
FOR
NUT ED
POSITIVE
NEGATIVE
LOCAL
ENDING
(12A + B + C
+D = 13)
INVENTORY
((10 - 13) +/14A & B = 15)
(C)
(D)
(A)
(B)
PAGE 5 OF 8
REPORTING MONTH AND YEAR:
MONTHLY REPORT OF THE COMMODITY SUPPLEMENTAL
REPORTING MEASUREMENT:
STATE AGENCY NAME:
FOOD PROGRAM STATE AND LOCAL INVENTORY
CASES (
)
OR UNITS (
)
STATE AND LOCAL DATA
6.
6A.
COMMODITY
NAME
6B.
CODE
7.
PACK
8.
STATE AND
SIZE
LOCAL
BEGINNING
INVENTORY
9.
RECEIPTS
10.
REDONATIONS
IN
11.
COMMODITY ISSUANCE
TOTAL
INVENTORY
AVAILABLE
B860
24/15 oz.
CEREAL OATS 16
B861
12/16 oz.
CEREAL RICE 12
B866
12/13 oz.
CEREAL RICE 17.5
B867
12/17 oz.
CEREAL RICE RTE 17.5
B868
14/17.5 oz.
CEREAL WHEAT 16
B871
12/16 oz.
CEREAL WHEAT RTE 16
B872
14/16 oz.
13.
W-I-C
ELDERLY
(7 + 8 + 9 = 10)
14.
REDONATIONS
(A)
(B)
(B)
OUT
FOOD
LOSS
STATE AND
TOTAL
ACTIVITY
TOTAL
NUMBER
ISSUED
(11A + B = 12)
15.
ADJUSTMENTS
COMMODITY ACTIVITY
TOTAL NUMBER
ISSUED TO:
(A)
CEREAL OATS
12.
AMT USED
FOR
NUT ED
POSITIVE
NEGATIVE
LOCAL
ENDING
(12A + B + C
+D = 13)
INVENTORY
((10 - 13) +/14A & B = 15)
(C)
(D)
(A)
(B)
16. REMARKS (Provide Explanation as Requested by Instructions.) (Attach Additional Sheets as Deemed Necessary.)
17. SIGNATURE
18. TITLE
19. DATE
20.
CSFP
OUTLAYS
(A)
UNLIQ. OBLIGATION
(B)
TOTAL
(C)
UNLIQ. BAL. OF
ADVANCES
(D)
ADMINISTRATION
FORM FNS - 153 (07/08) Previous editions obsolete
Electronic Form Version Designed in Adobe 8.1 Version
PAGE 6 OF 8
FNS-153 REPORTING INSTRUCTIONS
Reporting Measurements - Data reported on ths FNS-153 form can be shown in either "case/remaining" or
"units." Reporting data in "cases/remaining units" for some columns and just "units"for other columns or
vice versa is prohibited on the same form. Prior FNS approval is required for a State agency to switch one
reporting measurement to another. The choice of the measurement "cases/remaining units" or "units" is left
to the discretion of the reporting State agency. Rounding the count is unacceptable.
"Cases" means the container size in which the commodity is shipped. For example, the pack size for
egg mix is 48/6 oz. foils. If reporting "cases/remaining units," 48 cases and 3 units would be shown on
the FNS-153 as "48/3." Any number appearing to the left of the slash will represent the number of cases.
In contrast, any number to the right of the slash will represent the actual number of units. When a number
appears with no slash, FNS will automatically assume it is whole cases when 5A is checked.
"Unit" means individual cans, boxes, packages, etc., not cases. For example, 1 case of egg mix
would be reported as "48," and 5A would be checked.
Submission - The CSFP State agency shall collect the necessary data for this report from the local
certification, State and local warehouse sites within its jurisdiction and combine the data so that only one
FNS-153 report would be submitted by the CSFP State agency to the appropriate FNS regional office no
later than 30 days after the end of the month being reported for. Financial status data (item 20) shall be
completed quarterly and submitted on the FNS-153 for December, March, June, and September. A final
closeout SF-269 for CSFP must be submitted to FNS within 90 days after the end of the fiscal year.
1. Reporting Month and year - Enter month and year for which data is reported.
2A &2B. State Agency name & DA Code - Self-explanatory.
3. Type of Invent/Part Submission - Indicate type of submission for month being reported. The initial
submission of this report should be such by checking (A). Any subsequent revisions for the report month
should be indicated by checking 3(b). The submission of the annual physical inventory which is due for the
report month of September should be indicated by checking 3(c). If the September report is submitted with
3(c) checked, FNS will automatically consider it the final report for September.
4. Number of Participants - (A through E) Enter the toal number of participants by category, to whom
commodities were actually issued.
4(F). Self-explanatory.
4(G). Enter the total number of elderly participants to whom commodities were actually issued.
5. (A and B) - Reporting Measurement - (see above explanation) Check appropriate clock 5A or 5B.
6. (A and B) - Commodity name, code and shipping pack size - Where the code and name of a
commodity is not preprinted on this form, enter that information on the next available blank line.
7. State and Local Beginning Inventory - Enter the number appearing in item 15 in the previous
month's report. (This number must reflect all foods physically located at State and local storage and
distribtion site(s).
during the reported month. (This column should not reflect commodity movement between State and local
agencies.)
9. Redonations In - Enter the total number of redonated commodities received by the State from
another State agency or another USDA program from the CSFP. Specify in the remarks section the name of
the State and program those commodities were redonated from and their commodity code.
10. Total Inventory Available - Enter the total number of commodities available for issuance for the
CSFP. (The sum of items 7, 8, and 9 should equal item 10.)
11. CSFP Issuance - Enter the total number of commodities actually issued to and accepted by
participants during the reporting month as specified below. This figure should exclude those commodities not
accepted by the participant at the time of food pick-up. If a participant has refused a commodity at pick-up
it should not be considered issued.
(A) Reflect the total number of commodities that were actually issued and accepted by Women,
Infants and Children (W-I-C).
(B) Reflect the total number of commodities actually issued and accepted by elderly during the
reporting month.
12. Commodity Activity.
12A. Total number issued - Self-explanatory (11A + 11B = 12A).
12B. Redonations Out - Enter the total number of commodities shipped by the reporting State to
another State agency or to another USDA food program. Specify in the remarks section the name of the
State and program those commodities were redonated to and their commodity code.
12C. Food Loss - Enter the number of commodities that are actual food losses. These would
include foods that: (1) after consignee receipt were found to have concealed damaged; (2) were damaged in
the warehouse or during transit from the State warehouse to the local sites; (3) were found to be out-ofcondition or unfit for human consumption; or (4) were known to have been stolen or lost due to fraud, misuse
or embezzlement. (The reasons for food loss must be detailed in the REMARKS section. Attach additional
pages if necessary.)
12D. Food Used for Nutrition Education - Enter the number of commodities used for CSFP nutrition
education purposes.
13. Total Activity - Self-explanatory (sum 12A thru 12D = 13).
14. Inventory Adjustments - Enter the actual number of commodities adjusted. A partial list of
such adjustments are provided below as examples. (Note: the reasons for adjustments must be detailed in
"Remarks," item 16). This column should not reflect the movement of commodities between the State and
its local agencies.
8. Receipts - Enter the total number of commodities actually accepted in good condition from USDA
PAGE 7 OF 8
REPORTING INSTRUCTIONS - CONTINUED
(a) A "Positive" Commodity adjustments could be the result of a bookkeeping error or previous
inaccurate inventory count. Any commodity still in good condition which was returned to a distribution
site by a participant should be reflected as a positive adjustment.
(b) A "Negative" Commodity adjustment could be caused by a bookkeeping discrepancy.
15. State and Local Ending Inventory - Enter the combined total number of CSFP commodities in
inventory at the end of the reporting month at all State and local storage and distribution sites (10-13) plus
or minus 14A and 14B = 15.
16. Remarks - Self-explanatory.
(b) Unliquidated Obligations - Show the unliquidated obligations for the State and local
agencies. Unliquidated administrative obligations are the cumulative year-to-date dollars which the
State agency expects to pay out for administrative cost incurred through the quarter being reported
for but not yet paid or certified for payment. (Only obligations to be paid with Federal funds should
be shown.)
(c) Total - Show the sums of (A) and (B).
(d) Unliquidated Balances of Advances - where applicable show the unliquidated balance of
advances as of the end of the report quarter. This should be calculated as follows:
17. Signature - Self-explanatory.
(1) Determine the total amount of payments provided to local agencies and contract agents
for administration year-to-date.
18. Title - Self-explanatory.
(2) Determine the total amount of outlays made by local agencies and contract agents for
administration for the year-to-date.
19. Date - Self-explanatory.
20. Complete item number 20 for CSFP as follows.
(a) Outlays - Show the administrative outlays for State and local agencies, administrative outlays are
the cumulative year-to-date payments, or invoices certified by the program for payment, for administrative
costs incurred through the quarter being reported for. (Do not report advances as outlays.)
(3) Subtract (2) from (1) and record the result as the unliquidated balances of advances.
Advances for Administration are actual payments made by the State agency to a local agency or
contract agent which are not administrative costs already paid or fees for goods/services already
provided.
Public reporting burden for this collection of information is estimated to average 6.3 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Research and Analysis (0584-0293), Alexandria, VA 22302. Do not return the completed form to this address.
PAGE 8 OF 8
File Type | application/pdf |
File Modified | 2009-10-29 |
File Created | 2007-06-25 |