Appendix F - FY 24 Consolidated State Plan Guidance - Complete

Appendix F
FY 2024 Consolidated State Plan Guidance
WIC FMNP & SFMNP

OMB Control Number 0584-0447, Expiration 08/31/2024
OMB Control Number 0584-0541, Expiration 1/31/2026

Senior Farmers’ Market Nutrition Program
and
WIC Farmers’ Market Nutrition Program
Fiscal Year (FY) 2024
Complete State Plan Information for
(State agency name)
The Food and Nutrition Service (FNS) is collecting this information in order to provide fresh, nutritious, unprepared, locally grown fruits and
vegetables through farmers’ markets and roadside stands to WIC participants and low-income seniors, and to expand awareness and use of, and
sales at, farmers’ markets and roadside stands through the WIC Farmers’ Market Nutrition Program (FMNP) and Senior Farmers’ Market Nutrition
Program (SFMNP). This is a mandatory collection and FNS will use the information to ensure the efficient management of the FMNP and
SFMNP. The collection does not request personally identifiable information under the Privacy Act of 1974. Responses will be kept private to the
extent provided by law and FNS regulations. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers
for this information collection are 0584-0447 and 0584-0541. The time required to complete this information collection is estimated to average 40
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. 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 Service, Office of Policy
Support, 1320 Braddock Place, 5th Floor, Alexandria, VA 22314. ATTN: PRA (0584-0447/0584-0541). Do not return the completed form to this
address.

1

Senior Farmers’ Market Nutrition Program (SFMNP) and
WIC Farmers’ Market Nutrition Program (FMNP)
Fiscal Year (FY) 2024 Consolidated State Plan Guidance
Table of Contents
I. Goals ............................................................................................................................................. 3
II. General Administration ............................................................................................................... 4
III. Funding ..................................................................................................................................... 10
IV. Certification.............................................................................................................................. 25
V. Food Instrument, Farmers’ Market, Roadside Stand, Bulk Purchase, and CSA Program
Management ................................................................................................................................... 35
VI. Management Evaluations and Reviews ................................................................................... 44
VII. Nutrition Education Requirements ......................................................................................... 46
VIII. Miscellaneous Requirements ................................................................................................. 49
Appendices ..................................................................................................................................... 53

2

SENIOR FARMERS' MARKET NUTRITION PROGRAM
WIC FARMERS' MARKET NUTRITION PROGRAM
Consolidated State Plan of Operations
Fiscal Year 2024
Please clearly identify any attachments/addenda according to the lettering/numbering
system described in the “Appendices” section of this document.
State Agency:
I. Goals
A. Describe the State agency's plans to achieve each of the purposes of the SFMNP (§ 249.1)
and the FMNP (§ 248.1), as follows:
SFMNP:
1. To provide resources in the form of fresh, nutritious, unprepared, locally grown fruits,
vegetables, honey and herbs from farmers’ markets, roadside stands, and CSA
programs to low-income seniors;

2. To increase the domestic consumption of agricultural commodities by expanding or
aiding in the expansion of domestic farmers' markets, roadside stands, and CSA
programs; and

3. To develop or aid in the development of new and additional farmers' markets,
roadside stands, and CSA programs.

FMNP:
1. To provide resources in the form of fresh, nutritious, unprepared foods (fruits,
vegetables, and herbs) from farmers’ markets to women, infants, and children who are
nutritionally at risk and who are participating in the WIC Program or are on the waiting
list for the WIC Program; and

2. To expand the awareness, use of, and sales at farmers’ markets.

3

B. Describe how the State agency plans to target the programs to areas with high
concentrations of eligible persons with the greatest access to farmers’ markets. Be sure to
include any special features, such as the use of volunteers and community resources or
specialized management information systems, which the State agency plans to implement
to enhance operation and administration of the SFMNP (§ 249.4(a)(9)(i)) and the FMNP (§
248.4(a)(9)(i)).

C. For a State agency submitting an initial application for funding (i.e., a State agency that did
not operate the SFMNP or the FMNP in FY 2023), please summarize any prior experience
with similar farmers’ market projects or programs. The summary should describe:
1. The number and category (seniors, women, infants, children) of participants served;
2. The scope of the program (e.g., limited to a city, county, or was it a State agency-wide

program?); and
3. The source(s) of funding for the program.

Please include any data that was collected concerning the benefits or impact of the
program(s).

II. General Administration
(Please note: SFMNP State agencies that received an American Rescue Plan Act (ARPA)
grant should not include ARPA-funded participation or benefit amounts in this section. This
section should reflect program operations with regular FY 2023 and FY 2024 funds.
Reporting requirements for ARPA grants are specified in the grants’ terms and conditions.)
A. This section of the Consolidated State Plan Guidance is to report on general operations.
1. Number of participants in FY 2023 (if applicable):
SFMNP:
FMNP:
2. Estimated number of participants in FY 2024:
SFMNP:
FMNP:
3. Proposed months of Program operation (i.e., months of benefit usage by participants
(No later than 11/30)):
SFMNP:
through
FMNP:
through
4. Proposed months of food instruments issuance (No later than 9/30):

SFMNP:
FMNP:

through
through

4

5. Proposed months of benefit redemption (submission for payment) by farmers, markets

roadside stands, and/or CSAs:
SFMNP:
through
FMNP:
through

6. (SFMNP only) Proposed months of bulk purchase:

through

7. Is the State agency aware of any SFMNP or FMNP authorized outlets also authorized to

accept WIC Cash Value Vouchers/Benefits (CVVs/CVBs)?
Yes

No

8. Are any markets currently/planning to offer incentives (for example, Double Bucks)?

Yes

No

If yes, for which programs?

WIC

SNAP

FMNP

SFMNP

Other:

a. How much is the incentive?
b. How does the market determine who receives the incentive?
c. How is the incentive funded?
9. Do any farmers allow participants to order eligible foods by phone or online for pick-up

and payment at the market?
Yes

No

If yes, please list the farmers or markets or provide a map detailing which offer online
ordering and cite appendix reference.

10. Briefly describe the coupon/food instrument system used (e.g., paper coupons, e-solution,

other):

If applicable, please reference and attach the appendix/amendment for the State agency’s
e-solution as required under Appendix B of the WIC FMNP and SFMNP FY 2022
Guidance Package | Food and Nutrition Service (usda.gov).

B. Staffing
1. List all SFMNP/FMNP staff positions below, including both full and part-time positions.
Attach job descriptions for each position. An organizational chart identifying levels of

5

responsibility can be provided with this list. § 249.4(a)(4) of the federal SFMNP
regulations and § 248.4(a)(3) of the federal FMNP regulations require a detailed budget in
the State Plan, including a description of the federal and non-federal funds that will be
used to operate the program. Although use of non-federal funds is not required under the
SFMNP, describing the use of any such funds is helpful for the State agency and FNS to
understand the administrative capabilities of the State agency; the use of non-federal funds
will not result in the reduction of the federal grant.
Paid through Federal SFMNP Administrative funds
Percentage of Funds
Allocated to:
Position

Full Time

Part Time

Paid through Non-Federal SFMNP funds/sources (specify source)
Percentage of Funds
Allocated to:
Position

Full Time

Part Time

6

Paid through Federal FMNP Administrative funds
Percentage of Funds
Allocated to:
Position

Full Time

Part Time

Paid through State agency FMNP funds/sources (specify source)
Percentage of Funds
Allocated to:
Position

Full Time

Part Time

Paid through other funding source(s) (specify source and program)
Percentage of Funds
Allocated to:
Position

Full Time

Part Time

7

C. Will any other State or local government agency(ies), non-profit or for-profit organizations, or
the Cooperative Extension Service provide services for the State agency under the FMNP
and/or SFMNP?
Yes

No

If yes, list the State or local government agency(ies) and/or other organizations, and
include which program they will provide services for.

Include a copy of the signed agreement(s) between the State agency and other
agencies and/or the non-profit or for-profit organizations delineating the services to
be performed. (§ 248.4(a)(1) & (§ 249.4(a)(1)).
D. Indicate in the space provided the State agency that will be responsible for performing (or
overseeing the local agency or other entity/organization that will perform) each function listed
below (e.g., State Department of Agriculture, State Department of Health, State Agency on
Aging, etc.):
Lead State agency
Certify participants for the SFMNP
Collect racial/ethnic participation information for the SFMNP
Certify WIC recipients for the FMNP
Authorize and train local agencies/clinics
Issue food instruments to participants
Issue food instruments to local agencies/clinics
Negotiate contracts with CSA/bulk purchase farmers (SFMNP only)
Provide nutrition education to program participants
Reconcile food instruments
Conduct reviews of local agencies/clinics
Authorize farmers/farmers' markets/roadside stands/CSA programs
Train farmers/farmers’ markets/roadside stands/CSA programs

8

Monitor farmers/farmers' markets/roadside stands/bulk purchase/CSA programs
Manage WIC Cash Value Vouchers/Benefits (CVVs/CVBs) issued to FMNP
participants
If the State agency and the partnering State agency(ies) are different, include as an
attachment a copy of each signed agreement between the agencies, clearly stating the
functions to be performed as indicated above. The written agreement(s) should delineate
the responsibilities of and specific work activities to be performed by each agency, and
should identify the responsible designated representative of each agency. Please list
attachment.
E. Indicate how Program benefits will be issued to participants (allocated either by individuals or
by household):
SFMNP:
FMNP:

Individuals
Individuals

Households
Households

F. Indicate the total federal food instrument amount for each participant for each Program:
SFMNP: $

FMNP: $

(§ 249.8(b) of the federal SFMNP regulations states that the federal SFMNP benefit level
received by each participant, whether a household or individual, may not be less than $20
per year or more than $50 per year, except for certain State agencies that were legacied
into the SFMNP using a different benefit level.
Similarly, § 248.8(b) of the federal FMNP regulations states that the value of the federal
FMNP benefit received by each recipient, or by each family within a household in those
State agencies which elect to issue benefits on a household basis under § 248.6(c), may
not be less than $10 per year or more than $30 per year).
G. If applicable, indicate the total federal SFMNP benefit amount allotted to each participant for
use at a CSA Program if this benefit amount is different than for use at farmers’ markets or
roadside stands: $
(§ 249.8(b) of the federal SFMNP regulations states that such
SFMNP participants may receive a higher benefit level than non-CSA participants, but it may
not be more than $50 per year, except under certain conditions).
H. If applicable, indicate the total federal SFMNP benefit amount for each participant for use in a
bulk purchase program (if this benefit amount is different than for use at farmers’ markets or
roadside stands): $

9

III. Funding
A. Describe in detail the State agency's financial management system that will provide for
accurate, current, and complete disclosure of the financial status of the SFMNP/FMNP. At a
minimum, include the following elements:
1. Procedures to ensure prompt and accurate payment of allowable and allocable costs, and
to ensure that costs claimed are in accordance with 2 CFR 225 (the cost principles and
standard provisions of 2 CFR part 200, subpart E, USDA implementing regulations 2 CFR
parts 400 and 415) and FNS guidelines and instructions (see § 249.11(d) of SFMNP
regulations on allowable and allocable costs and § 248.12 of FMNP regulations and
FMNP Policy Memorandum 2002-1);
2. Procedures for obligating funds, including disbursing funds from the Letter of Credit;
3. Description(s) of how farmers are paid;
4. Claims procedures for overpayments to farmers, farmers' markets, roadside stands, bulk
purchases, CSAs, and participants; and
5. Description of the time-reporting system used to distribute employee salaries and related
costs, and procedures and forms for conducting time studies.

B. Describe the funding source(s) and amounts the State agency intends to use to meet the
minimum 30 percent State agency match requirement for the FMNP, which will be $
for your State agency in FY 2024, based on the Federal Funds Request and the State agency
Matching Funds Estimation Worksheet on pages 21-22, per § 248.14(a)(i)(ii).
(Please note that the 30 percent minimum match requirement only applies to the total
FMNP administrative cost, although the State agency may meet this match requirement
with State agency funds provided for food in addition to administrative costs.)
Type
State agency and local funds

Source

$

Private funds

$

In-kind contributions

$

Similar programs

$

Program income

$

Amount

Total: $

10

State agency and local funds: If available, please attach documentation, such as a copy
of appropriation legislation, budget page containing this line item, etc.
Private funds: Please describe in detail or attach documentation of all cash donations or
letters of commitment from organizations/individuals planning to make such donations.

In-kind contributions: If any portion of the State agency’s minimum 30 percent
matching requirement will be met through in-kind contributions, please describe the inkind contribution and its monetary value, and include any supporting documentation.

Similar programs: Include the title of the program, the source of funding, and a brief
description of how the program operates. Federal funds provided for SFMNP or any
other FNS program cannot be used as a match source.

Program income: Describe type(s) and amount(s). (More specific information can be
found in WIC Policy Memorandum #2005-3, Price Adjustments, Collections, Fines, and
Program Income)

C. Is the State agency seeking approval to use up to 2 percent of its total FMNP funds for market
development or technical assistance to farmers’ markets in FY 2024?
Yes

No

NOTE: These funds are only available to develop or assist farmers’ markets in socially or
economically disadvantaged areas or remote rural areas, where individuals eligible for
participation in the FMNP have limited access to locally grown fruits and vegetables (§
248.14(h)).
If yes, describe in detail the justification for the market development and/or technical
assistance funds, including documentation to support the qualifications of the area to
be targeted and specific plans to achieve the stated goals.
D. Describe in detail the State agency's record keeping systems for the SFMNP (§ 249.23) and
the FMNP (§ 248.23), addressing at a minimum the following areas:
1. Financial operations
2. Food instrument issuance and redemption
3. CSA/bulk purchase contracts and payments (SFMNP only)

11

4. SFMNP/FMNP participation reporting
5. Tracking staff time and other administrative expenses to ensure that federal
SFMNP/FMNP funds are only used for costs which are allowable and allocable for the
SFMNP/FMNP.

NOTE: A description of the State agency's financial management system is required
earlier in Section III(A). If some of the same information has already been provided
under that section, it is not necessary to duplicate that information. It may either be
provided here or cross-referenced to the relevant section.
If forms have been developed to facilitate any of these functions, an example of each
form, along with a brief explanation should be attached to this document.
E. FMNP Federal Funds Allocation Process and the State agency Match
As required under § 248.14(a)(i), there is a matching requirement of administrative funds
equal to or not less than 30 percent. Detailed below are the FMNP Federal Funds Allocation
Process and how the State agency match is calculated.
1. Total Federal funds requested (prior year’s total Federal grant) x 17% (or 19%, if
requesting a maximum of 2% for market development or technical assistance) = Federal
administrative funds.
2. Federal administrative funds ÷ 70% = Estimated total administrative cost.
3. Estimated total administrative cost x 30% = State agency match amount.
(A State agency may provide more in State agency funds to administer the Program than is
required. However, the FNS allocation is based on the minimum amount that a State
agency must match, not the total amount of funds/resources a State agency provides.)
4. Total Federal funds requested (prior year’s total Federal grant) + State agency match
amount = Estimated total Program cost.
F. Federal Funds Request and Budget Worksheets
§ 249.4(a)(4) of the Federal SFMNP regulations and § 248.4(a)(4) of the Federal FMNP
regulations require that the State Plan include a detailed budget, including a description of the
Federal and non-Federal funds that will be used to operate each program, and assurance that
no more than 50 percent of the Federal SFMNP Food grant will be used for CSA programs,
except as stipulated at 7 CFR 249.10(a)(5). The types of worksheets used to calculate your
federal funds are described below.

12

SFMNP FY 2024 Budget Summary:
If using the excel worksheet provided to assist with calculations, please attach a copy of the
worksheet to this section or cite appendix reference.
(Please note: State agencies that received an American Rescue Plan Act (ARPA) grant should not
include those funds or related ARPA-funded operations in their FY 2024 Budget Summary. These
worksheets should reflect program operations with regular FY 2023 and FY 2024 funds and with
FY 2024 expansion funds, should they become available. Reporting requirements for ARPA
grants are specified in the grants’ terms and conditions.)
I. FY 2024 SFMNP ESTIMATED FEDERAL BUDGET SUMMARY
This worksheet summarizes the Federal food and administrative funds. All State agencies must
complete this worksheet.
II. FY 2024 SFMNP ADMINISTRATIVE BUDGET ESTIMATE
This worksheet summarizes administrative activities and related funding. All State agencies
must complete this worksheet.
III. FY 2024 ESTIMATED SFMNP FEDERAL CASELOAD CALCULATION
This worksheet summarizes participant caseload in relation to funding. All State agencies must
complete this worksheet.
IV. FY 2024 ESTIMATED SFMNP NON-FEDERAL BUDGET SOURCE OF NON-FEDERAL
FUNDS
This worksheet summarizes non-federal funding used to support the SFMNP. All State agencies
must complete this worksheet.

13

State Agency:

Universal Identifier

WORKSHEET I. FY 2024 SFMNP PROPOSED FEDERAL BUDGET SUMMARY
Note: State agencies that received an American Rescue Plan Act (ARPA) grant should not
include ARPA funds in these calculations. Reporting requirements for ARPA grants are
specified in the grants’ terms and conditions.
1. Total Federal Funds Requested
(Prior Year's Total Federal Grant or Less):

$

2. Plus: Expansion Funds Requested (if any):
(Include expansion funds in calculation of
requested funds)

$

3. Total Federal Funds requested (line 1 + line 2)

$

4. Less: Federal Administrative Funds at 10% of
Total:

$

5. Federal Foods Funds (minimum 90% of total):

$

14

WORKSHEET II. FY 2024 SFMNP ADMINISTRATIVE BUDGET ESTIMATE
Note: State agencies that received an American Rescue Plan Act (ARPA) grant should not include
ARPA funds in these calculations. Reporting requirements for ARPA grants are specified in the
grants’ terms and conditions.

Certification
$

Food
Instrument
Management
$

%

Market
Management
$

%

Nutrition
Education
$

%

Financial
Management
$

%

Total @
10%
$

%

100%

Certification: Eligibility determinations and outreach services.
Food Instrument Management: Pricing and reconciling/issuing food instruments to recipients, and
instructing recipients on the purpose of the program and their proper use.
Market Management: Authorizing, training, technical assistance, marketing, and monitoring of
farmers/ farmers’ markets/roadside stands.
Nutrition Education: Instructing recipients on the nutritional benefits of fresh, nutritious,
unprepared foods such as fruits and vegetables.
Financial Management: Preparing financial and recipient reports, issuing payments to
farmers/farmers’ markets and costs associated with SFMNP audits.

15

WORKSHEET III. FY 2024 ESTIMATED SFMNP FEDERAL CASELOAD
CALCULATION
Note: State agencies that received an American Rescue Plan Act (ARPA) grant should not
include ARPA funds in these calculations. Reporting requirements for ARPA grants are
specified in the grants’ terms and conditions.
This worksheet determines the number of participants that can be supported with the Federal
funds requested. To ensure that no more than 50 percent of the SFMNP grant has been used for
CSA programs; line 4 must not exceed one half of line 3 on this page. If benefits are not used for
CSA programs, then only the first three steps below apply. Line 9, the Grand Total, includes
non-CSA program caseload and CSA/bulk purchase program caseloads. Line 10 provides the
percentage of the SFMNP food funds grant used only for CSA programs.
State Agency:
1. Federal food funds for food instruments (non-CSA/Bulk purchase)

$

2. Proposed non-CSA food instrument benefit level
(Minimum $20, Maximum $50) (Except for a current State agency that has
legacied in a lower benefit level)

$

3. Total projected food instrument Federal caseload (Total Federal food funds for
food instrument option divided by food instrument benefit level [Line 1 divided
by Line 2]):
4. Available food funds remaining for participants using CSA and/or bulk
purchase programs (total Federal food funds minus federal food funds for food
instrument option (Worksheet I #5 minus Worksheet III #1)
a. CSA
b. Bulk Purchase
5. Proposed total CSA benefit level (May be the same
as for non-CSA participants, or higher, but must be a minimum $20, maximum
$50, and must be the same for all CSA participants, except per § 249.8(b)).

$
$
$

6. Total projected CSA Federal caseload:
(#4a divided by #5)
7. Total projected bulk purchase benefit level

$

8. Total projected bulk purchase caseload: (#4b divided by #7)
9. Grand Total Projected Federal Caseload
Please fill out only one option (continued on next page).
16

(Line 3) = Food instrument only
(Line 3 + Line 6) = Food instrument and CSA
option
(Line 3 + Line 8) = Food instrument and bulk
purchase option
(Line 6) = CSA only
(Line 8) = Bulk purchase only
(Line 3 + Line 6 + Line 8) = All Options

OR
OR
OR
OR
OR

10. Line 4a Worksheet III divided by Line 5 Worksheet I (Federal food funds for
CSA divided by total Federal food funds), multiplied by 100 (this total may not be
more than 50%).

%

WORKSHEET IV. FY 2024 ESTIMATED SFMNP NON-FEDERAL BUDGET SOURCE
OF NON-FEDERAL FUNDS
Please list the source and amount of non-Federal funds, if any, which the State agency plans to
use for the SFMNP. § 249.4(a)(4) of the Federal SFMNP regulations requires a detailed budget
in the State Plan, including a description of the Federal and non-Federal funds that will be used
to operate the Program. This information supports whether the State agency will have sufficient
resources to meet caseload and/or administrative goals beyond those supported by Federal
funds.
Type
State agency and Local Funds
Private Funds
Other
Total

Source

Amount
$
$
$
$

Purpose

17

FMNP FY 2024 Budget Summary:
If using the excel worksheet provided to assist with calculations, please attach a copy of the
worksheet to this section or cite appendix reference.
(Please note: State agencies that received an American Rescue Plan Act (ARPA) grant to
modernize benefit delivery should not include those funds in their FY 2024 Budget Summary.
These worksheets should reflect program operations with regular FY 2023 and FY 2024 funds
and with FY 2024 expansion funds, should they become available. Reporting requirements for
ARPA grants are specified in the grants’ terms and conditions.)
I. FY 2024 FMNP ESTIMATED FEDERAL BUDGET SUMMARY
This worksheet summarizes the Federal food and administrative funds. All State agencies must
complete this worksheet.
II. ADMINISTRATIVE BUDGET ESTIMATE
This worksheet summarizes administrative activities and related funding. All State agencies
must complete this worksheet.
III. FEDERAL FUNDS REQUEST AND STATE AGENCY MATCHING FUNDS
ESTIMATION
This worksheet estimates either the amount of Federal funds based on the State agency match
amount available, or the State agency match amount and total program funds based on the amount
of Federal food funds requested. All State agencies must complete either Part A or Part B of
this worksheet as applicable.
IV. FEDERAL FOOD FUNDS REQUEST BASED ON A UNIFORM BENEFIT LEVEL
This worksheet estimates the number of recipients that can be supported with the Federal funds
requested, when each category of recipient (i.e., women, infants, and children) will receive the
same benefit level. All State agencies must complete either this worksheet or worksheet V,
below.
V. FEDERAL FOOD FUNDS REQUEST BASED ON VARYING BENEFIT LEVELS
This worksheet estimates the number of recipients that can be supported with the Federal funds
requested, when one or more of the recipient categories (women, infants and children) will
receive a benefit level different from the other categories. All State agencies must complete
either this worksheet or worksheet IV, above.

18

State Agency:

Universal Identifier

WORKSHEET I. FY 2024 FMNP ESTIMATED FEDERAL BUDGET SUMMARY
Note: State agencies that received an American Rescue Plan Act (ARPA) grant should not include
ARPA funds in these calculations. Reporting requirements for ARPA grants are specified in the
grants’ terms and conditions.
1. Total Federal funds requested
(Prior Year's Total Federal Grant or Less):

$

$

2. Plus: Expansion funds requested (if any):
(Include expansion funds in calculation of requested funds)

$

$

3. Less: Federal administrative funds at 17% of total:

$

4. Less: Market development/technical assistance funds:
(up to 2% of total)
5. Federal foods funds:
a. 83% (total without market development funds request):

$

$

OR
b. 81% (total with market development funds request):

$

19

WORKSHEET II. FY 2024 FMNP ADMINISTRATIVE BUDGET ESTIMATE

Note: State agencies that received an American Rescue Plan Act (ARPA) grant should not include
ARPA funds in these calculations. Reporting requirements for ARPA grants are specified in the
grants’ terms and conditions.
Use Table B if requesting use of 2% market development funds.
Table A.
Food Instrument
Management

$

Market
Management

$
%

Table B.
Food Instrument
Management

$

$
%

Market
Management

$
%

Nutrition
Education

Total @ 17%

$
%

Nutrition
Education

$
%

Financial
Management

$
%

Financial
Management

100%

Total @ 19%

$
%

$
%

100%

Food Instrument Management: Pricing and reconciling/issuing food instruments to recipients, and
instructing recipients on the purpose of the program and their proper use.
Market Management: Authorizing, training, technical assistance, marketing, and monitoring of
farmers/ farmers’ markets/roadside stands.
Nutrition Education: Instructing recipients on the nutritional benefits of fresh, nutritious,
unprepared foods such as fruits and vegetables.
Financial Management: Preparing financial and recipient reports, issuing payments to
farmers/farmers’ markets and costs associated with FMNP audits.

20

WORKSHEET III. FY 2024 FMNP FEDERAL FUNDS REQUEST AND STATE AGENCY
MATCHING FUNDS ESTIMATION
Note: State agencies that received an American Rescue Plan Act (ARPA) grant should not include ARPA
funds in these calculations. Reporting requirements for ARPA grants are specified in the grants’ terms
and conditions.
Part A of this worksheet should be completed by a State agency that knows exactly the amount of State
agency funds available to meet the matching requirement, and wants to estimate the level of Federal
funds the State agency matching funds can support.
Part B of this worksheet should be completed by a State agency that wishes to estimate its match amount
and total program funds based on the amount of Federal food funds requested.
For State agencies requesting the extra 2 percent administrative rate for market development or technical
assistance to promote such development in disadvantaged areas or remote rural areas, use the calculations
based on 19 percent to determine your (A) estimated total federal funds or (B) estimated total program
funds.
A. To estimate the federal administrative funds based on the matching amount:
17% rate:
1. Matching Funds:
$
/ .30 =
Total Administrative Funds
2. Total Administrative Funds:

=

-

Matching Funds
Federal Administrative Funds

/ .17 =

3. Federal Administrative Funds:

$

Total
Federal
Funds

A. To estimate the federal administrative funds based on the matching amount:
19% rate:
1. Matching Funds:

$

2. Total Administrative Funds:

=

3. Federal Administrative Funds:

/ .30 =

Total Administrative Funds

-

Matching Funds
Federal Administrative Funds

/ .19 =

$

Total
Federal
Funds

21

B. To estimate the matching and administrative amounts based on the federal food funds requested:
17% rate:
1. Prior Year's
Food Grant:

$

Total Federal Funds Requested,
Food and Administrative

/.83 =

x.17 =

Federal
Administrative
Funds

3. Federal Administrative Funds:

/.70 =

Estimated Total
Administrative
Funds, Federal and
State

4. Estimated Total Administrative
Funds:

-

2. Total Federal Funds Requested:

=

Federal Administrative Funds:
State Agency's Match for New Fiscal Year.

+

5. State agency Matching Funds:

Total Federal Funds

=

$

Estimated Total Program Funds
B. To estimate the matching and administrative amounts based on the federal food funds requested:
19% rate:
1. Prior Year's
Food Grant:

$

Total Federal Funds Requested,
Food and Administrative

/.81 =

x.19 =

Federal
Administrative
Funds

3. Federal Administrative Funds:

/.70 =

Estimated Total
Administrative
Funds, Federal and
State

4. Estimated Total Administrative
Funds:

-

2. Total Federal Funds Requested:

=

Federal Administrative Funds:

State Agency's Match for New Fiscal Year.

5. State agency Matching Funds:
$
Estimated Total Program Funds

+

=

Total Federal Funds

22

WORKSHEET IV. FY 2024 FMNP FEDERAL FOOD FUND REQUEST BASED ON A
UNIFORM BENEFIT LEVEL
Note: State agencies that received an American Rescue Plan Act (ARPA) grant should not
include ARPA funds in these calculations. Reporting requirements for ARPA grants are
specified in the grants’ terms and conditions.
This worksheet estimates the number of recipients that can be supported with the Federal funds
requested, when each category of recipient (i.e., women, infants, and children) will receive the
same benefit level:
1. Total Federal Funds Requested (Prior Year's Total Federal Grant or Less):
2. Percent of Total Federal Funds
Available for Food:
3. Available Food Funds:

x .83
$
Divided by

4. Proposed Federal Food Benefit Level
Minimum $10; Maximum $30

$

$

or

x. 81
$
Divided by
$

5. Total Projected Federal
Caseload:

23

WORKSHEET V. FY 2024 FMNP FEDERAL FOOD FUNDS REQUEST BASED ON
VARYING BENEFIT LEVELS
Note: State agencies that received an American Rescue Plan Act (ARPA) grant should not
include ARPA funds in these calculations. Reporting requirements for ARPA grants are
specified in the grants’ terms and conditions.
This worksheet estimates the number of recipients that can be supported with the Federal funds
requested, when one or more of the recipient categories (woman, infants and children receives a
benefit level different from the other categories:
1. Total Federal funds requested (prior year's total Federal grant or less):
2. Percent of total Federal funds
available for food:

x .83

3. Available food funds:

$

or

$

x. 81
$

CATEGORY I
(specify)

CATEGORY II
(specify)

CATEGORY III
(specify)

4. Number of proposed program
recipients by category
X
5. Proposed food benefit level:

X

$

$

X
$

6. Total per category =
7. Add together the total of Lines 6, which must be equal to or be less than the total available
Federal food funds in line 3:
Grand
CATEGORY I
CATEGORY II
CATEGORY III
Total
$

+

$

+

$

=

$

24

IV. Certification
A. Targeting Benefits
SFMNP:
1. As required under § 249.4(a)(9), describe the State agency's plans to target areas with a
high concentration of eligible persons and access to farmers' markets, roadside stands
and/or CSA programs within the broadest possible geographic area. For example, will the
State agency concentrate on serving only a few areas where there are large numbers of
potential participants who have access to farmers' markets, roadside stands and/or CSA
programs, or will it provide State agency-wide coverage?

a. Provide a detailed description of the service area(s), including the number (and
location, if available) of participating markets/roadside stands/CSA/bulk purchase
programs and local agencies (such as Area Agencies on Aging, Senior Centers or
CSFP distribution sites).

b. Estimated number of SFMNP participants per local agency:
Local Agency:

# of Participants:

2. As required under § 249.6(g)(2), when all available program benefits have been allocated
to eligible participants, are local agencies required to maintain a waiting list of new
applicants likely to be served?
Yes

No

If yes, will which of the following be included on the waiting list?

25

Name of the applicant
Date placed on waiting list
Address
Participant telephone number
Participant mobile telephone number
Other telephone number
Other:
3. In State agencies where the FMNP also operates, are the SFMNP service areas the same as
the FMNP service areas, or closely overlapping, so that the same farmers’ markets and
roadside stands may serve both SFMNP and FMNP participants?
Yes

No

If no, please explain.
FMNP:
1. As required under § 248.4(a)(9), describe the State agency’s plans to target areas with a
high concentration of eligible persons and access to farmers’ markets within the broadest
possible geographic area. For example, will the State agency concentrate on serving only a
few areas where there are large numbers of WIC recipients who have access to farmers’
markets, or will it provide State agency-wide coverage?
a. Provide a detailed description of the service area(s), including the number and
addresses of participating markets, roadside stands, and WIC clinics.

b. Attach a map outlining the service area(s) and proximity of markets and roadside
stands to clinics.
c. Estimated number of WIC recipients per local agency/clinic:
Clinic

# of Recipients

26

2. Intended FMNP recipients:
(Excluding Expansion)

(Including Expansion)

WIC recipients only
WIC applicants on
waiting lists only
Both
3. Will all WIC recipients in an FMNP service delivery area be issued FMNP food
instruments, checks, or e-solution benefits? Or only certain categories/groups?
All eligible recipients
Specific categories/groups (check all that apply):
(Excluding Expansion)

(Including Expansion)
Pregnant women
Breastfeeding women
Postpartum women
Infants (over 4 months)
Children
(If sub-categories of children,
e.g., ages 1-2 years old and
3-4 years old, are defined
by the State agency, please
indicate accordingly.)
Other designation
(e.g., only Priority I
pregnant or breastfeeding
women)

B. Application Process (SFMNP Only) (§ 249.6)
1. Does the State agency require all local agencies to use a standardized application process
for all persons applying for the SFMNP?
Yes

No

27

2. The State agency shares
State agency-wide or
at local agency option (check one), a
common application or certification form with (check all that apply):
No other benefit programs
Commodity Supplemental Food Program (CSFP)
Food Distribution Program on Indian Reservations (FDPIR)
Supplemental Nutrition Assistance Program (SNAP)
Aging Services
Supplemental Security Income (SSI)
Reduced price health care program(s)
Other (specify)
3. As required by § 249.6(g), does the State agency have processing standards in place to
notify SFMNP applicants of eligibility, ineligibility, or placement on a waiting list within
15 days from the date of application?
Yes

No

(Attach the State agency’s standardized format for this notification, if applicable.)
4. Applicants for the SFMNP must be notified of their eligibility or ineligibility for benefits,
or of their placement on a waiting list, within 15 days from the date of application. The
15-day period begins when the applicant (check all that apply):
Telephones the local agency to request benefits
Visits the local agency in person
Makes a written request for benefits
Makes an appointment
5. How does the State agency define “reasonable expectations that additional funds may
become available” in order to determine whether to maintain a waiting list?

6. Is each participant or authorized representative informed on how to use farmers’ market
food instruments or their CSA SFMNP benefits, and on the availability of other services,
as set forth in § 249.6(d)(3) of the Federal SFMNP regulations?
Yes

No

7. Does the State agency have procedures to ensure that participants are certified only for the
current fiscal year’s period of SFMNP operation?
Yes

No

If yes, please provide a brief description:

28

8. May a participant designate another person as an authorized representative/proxy to do the
following if the participant is unable to (check all that apply):
Apply for certification?
Shop at farmers’ markets and/or roadside stands?
Pick up eligible foods from CSA program or bulk purchase distribution sites?
9. a. Does the State agency limit the number of proxies that one individual can have (e.g.,
one participant may designate three different proxies)?
Yes

No

If yes, how many?
b. Does the State agency limit how many participants may use the same proxy (e.g., one
person is the proxy for 5 participants)?
Yes

No

If yes, how many?
10. If the State agency permits authorized representatives/proxies, are signed statements from
the participant required for this purpose per § 249.6(f) of the federal SFMNP regulations?
Yes

No

11. Attach a copy of the State agency’s written procedures regarding the designation of
authorized representatives/proxies for the SFMNP, if available. Include details on the
process of when and how these signatures are obtained, including the format of the
signature (e.g. written, text, email, other electronic format, etc.).

12. Is certification for SFMNP performed at no cost to the applicant or authorized
representative?
Yes

No

13. Attach a copy of the FY 2024 Certification or Application form that will be used for the
SFMNP (Appendix V).

29

C. Categorical and Residency Eligibility (SFMNP only)
1. Will only individuals who meet the basic regulatory definition of “senior” (i.e., 60 or
older) in an SFMNP service delivery area be provided SFMNP benefits, or will the State
agency (per § 249.6(a)(1)) also serve special categories of participants?
(Excluding Expansion)

(Including Expansion)

Seniors > 60 years of age
Special categories/groups: (check all that apply):
Higher minimum age
(e.g., 62, 65 – specify in
space provided)
Native Americans
(> 55 years of age)
Disabled*
(*residing in predominantly-elderly housing where congregate nutrition services are
provided)
Lower income level
(Specify in space provided)
Other (specify)
2. For the residency requirement, the State agency uses:
State agency jurisdiction residency
Local agency service area residency
D. Income Eligibility (SFMNP only) (§ 249.6(a)(3))
1. For income eligibility, the State agency uses (check all that apply):
Maximum gross household income of 185% of annual poverty income guidelines
Maximum gross household income of
income guidelines

% (less than 185%) of annual poverty

Participation in Commodity Supplemental Food Program (CSFP)
Participation in Supplemental Nutrition Assistance Program (SNAP) *

30

(* as long as SNAP income eligibility does not exceed 185% of poverty)
Participation in Food Distribution Programs on Indian Reservations (FDPIR)*
(* as long as FDPIR income eligibility does not exceed 185% of poverty)
Participation in Supplemental Security Income (SSI)
Member of a family/economic unit participating in the Special Supplemental Nutrition
Program for Women, Infants and Children (WIC), or on a waiting list for WIC
Member of a family/economic unit participating in FMNP
Participation in another means-tested program for which income eligibility is set at or
below 185% of the poverty income guidelines
2. For the normal income eligibility screening process and determination of household size,
is the household defined by the State agency as a group of related or nonrelated
individuals who are living together as one economic unit?
Yes

No

3. a. For documentation of income eligibility per § 249.6(b), the State agency accepts (check
all that apply):
Signed statement of applicant (if so, attach copy in Appendix V)
Notice of eligibility or its equivalent for participation in or certification for other
programs
Pay stub or other statement of earnings
W-2, tax return, or other tax forms
Other:
(Please describe)
b. If the State agency accepts a signed statement of applicant, provide a detailed
explanation or attach the State agency’s policy explaining when the participant signature
is obtained (e.g. at time of application, at another time during the season) and which
signature formats are acceptable (e.g. written, text, email, other electronic format, etc.).

4. The State agency requires
State agency-wide, or
the verification of applicant income information.

at local agency option (check one),

No
Yes (check all sources required, as appropriate):
Employer
Public assistance offices

31

State employment offices (wage match, unemployment)
Social Security Administration
School districts/offices
Collateral contacts
Other (specify):
E. Participant Rights and Responsibilities (SFMNP only)
1. If found ineligible, are applicants for SFMNP notified in writing of the reason(s) for
ineligibility and the right to a fair hearing, as required per § 249.6(d)(4)?
Yes

No (Attach the standardized format for this in Appendix T)

2. Is each participant or authorized representative informed during the certification process
of their rights and responsibilities as set forth in § 249.6(d)(1),(2) of the federal SFMNP
regulations?
Yes

No

3. Is this information provided in a language other than English where a significant number
or proportion of the eligible population needs this information in a language other than
English?
Yes

No

If yes, list other languages this information is provided in:

F. Participant and Applicant Confidentiality
1. Does the State agency share information obtained from applicants for and/or participants
in SFMNP/FMNP with any other programs, agencies, law enforcement officials, or any
other organizations or persons?
Yes

No

If yes, explain below and attach documentation such as information-sharing agreements,
statements of policies and procedures, legal citations, etc.

2. Per § 249.24 of the federal SFMNP regulations and § 248.24 of the federal FMNP
regulations, the State agency restricts the use or disclosure of information obtained from
applicants/participants to:

32

a. Persons directly connected with the administration or enforcement of SFMNP/FMNP,
including investigation and prosecution of SFMNP/FMNP violations by any public
authority;
Yes

No

b. Representatives of public organizations under written agreements for
eligibility/outreach purposes regarding other programs, without third party access or
disclosure;
Yes

No

c. The Comptroller General of the United States, General Accounting Office (GAO).
Yes

No

3. Does the State agency permit an applicant and/or participant access to the information that
the applicant and/or participant provided to the program?
Yes

No

4. Does the State agency permit an FMNP applicant or participant to sign a release or similar
document allowing the information provided by the applicant and/or participant to be
shared with other organizations or persons?
Yes

No

5. Does the State agency prohibit local agencies from requiring the applicant or participant to
sign a written consent or release form or similar document to share confidential
information with another entity or organization during the SFMNP eligibility
determination process, e.g., by completing and separating the certification screening
process from the request for a release to be signed?
Yes

No (if signing a release is a condition of eligibility, please explain)

G. Dual Participation
1. Does the State agency have policies and procedures in place to prevent and detect dual
participation (participation of program recipients in more than one service delivery area at
the same time) in SFMNP?
Yes (please describe)
No (if no, please explain why not)

33

2. Does the State agency have policies and procedures in place to prevent and detect dual
participation (participation of program recipients in more than one service delivery area at
the same time) in FMNP?
Yes (please describe)
No (if no, please explain why not)
H. Nondiscrimination
1. State agencies are required to comply with all applicable and pertinent laws and
regulations regarding the assurance of nondiscrimination on the basis of race, color,
national origin, age, sex, or disability (§ 249.7, § 248.7). Describe the State agencies
system or procedures for:
a. Public notification of the nondiscrimination policy:

;

b. Annual reviews of local agencies/clinics to assure nondiscrimination against any of the
protected classes:
.
2. Per § 249.7 and § 248.7, the State agency ensures that no person will be denied benefits,
or otherwise discriminated against on the grounds of race, color, national origin, age, sex,
or disability.
Yes

No

3. Per § 249.7 and § 248.7, how does the State agency:
a. Notify the public, participants, and potential participants of the nondiscrimination
policy?
b. Notify participants and potential participants of complaint procedures regarding
alleged unlawful discrimination? (See Section VIII below regarding the complaint
process).
c. Review and monitor program activities to ensure compliance with nondiscrimination
policies and procedures?

34

V. Food Instrument, Farmers’ Market, Roadside Stand, Bulk Purchase, and CSA Program
Management
A. Issuing benefits to participants: § 248.4(a)(10),(11) and § 249.4(a)(11),(14).
1. Describe the State agency’s procedures for ensuring the secure transportation and storage
of food instruments. Include the method used to transport food instruments from the
contractor who produces them to the State agency, and from the State agency to the local
agencies. Include a description of how unissued SFMNP/FMNP food instruments are
stored, or how secure handling of food instrument stock and electronic food instrument
numbers is ensured, at the State agency, local agency, and/or local issuing sites. Also
include any type of reporting form used to gather data.

2. Describe the food instrument issuance system for participants. Include any reporting forms
used to gather data. This description should include automated as well as manual
processes used for issuance of food instruments to SFMNP/FMNP participants.

3. If the State agency intends to use a bulk purchase option in the SFMNP, describe (1) how
the State agency will identify the farmers from whom the eligible fruits and vegetables
will be purchased, (2) the entity/ies (if different from the State agency) that will negotiate
and contract for the purchase of the produce, (3) how the State agency will ensure that the
value of the food provided to each participant falls within the regulatory minimum and
maximum levels, (4) how the State agency will ensure that all SFMNP participants receive
an amount of food that offers an equitable benefit, and distribute the fruits and vegetables
to program participants.

4. For CSA programs, describe the system for ensuring that each SFMNP shareholder
receives an equitable amount of eligible foods at each delivery, and that the total value of
the eligible foods provided under the SFMNP falls within the minimum and maximum
Federal SFMNP benefit levels. Also, describe the system to ensure receipt by eligible
participants of eligible foods provided through the CSA program. Such a system should
include a written receipt or distribution log, with the participant’s signature (or that of the
eligible participant’s proxy, if proxies are allowed) and the date of each distribution
(please attach a copy of this receipt form or log).

5. Describe the State agency’s system for instructing participants on the proper use of FMNP
food instruments. If this function is performed by the local agency on behalf of the State
agency, indicate who issues the food instruments; what materials are provided during
issuance; and who explains the use of the food instruments and redemption procedures to
35

the participant. Please include materials provided to recipients instructing them on how to
use FMNP food instruments and any list of authorized farmers' markets provided to
recipients.

6. Describe the State agency’s system for instructing participants on the proper use of
SFMNP food instruments. If this function is performed by the local agency on behalf of
the SFMNP State agency, indicate who issues the food instruments; what materials are
provided during issuance; and who explains the use of the cards and redemption
procedures to the participant. For bulk purchase/CSA programs, describe how participants
will be instructed on the procedures for delivery and distribution of eligible foods through
the bulk purchase/CSA programs to the participants.

7. Describe the State agency’s coupon replacement policy or include the statement that
FMNP/SFMNP coupons will not be replaced.

8. Attach a copy of the log or other form used to record food instrument issuance to valid
certified participants (Appendix I).
B. Authorization of farmers and/or farmers’ markets, roadside stands, and CSA programs.
The State agency is responsible for the fiscal management of and accountability for,
SFMNP/FMNP-related activities for farmers and/or farmers’ markets, roadside stands, and (in
the SFMNP) bulk purchase and CSA programs. Each State agency may decide whether to
authorize farmers individually, farmers’ markets, or both farmers and farmers’ markets, as
well as roadside stands and CSA programs. Only farmers and/or farmers’ markets and
roadside stands authorized by the State agency may redeem SFMNP (§ 249.10)/FMNP (§
248.10) food instruments; only CSA programs authorized by the SFMNP State agency may
distribute eligible food to participants.
1. Describe the State agency’s general authorization procedures for farmers and/or farmers’
markets, roadside stands, bulk purchase and CSA programs.

2. List or attach the criteria used to authorize farmers’ markets (Appendix L). Examples of
authorization criteria include: 1) permanent market location; 2) sufficient number of
growers who participate in the market; 3) a wide selection of products; 4) authorized to
redeem SFMNP/FMNP food instruments; 5) community support from non-SFMNP or
FMNP sales; 6) produce offered for sale is locally grown; or 7) accessibility to senior
service areas or WIC local agencies/clinics.

36

3. List or attach the criteria used to authorize farmers (Appendix M). Examples of
authorization criteria include: 1) grows a minimum percentage of the produce to be sold
(please specify); 2) owns land within the State agency jurisdiction where produce is
grown; 3) certified by the State Agriculture Department, ITO, Cooperative Extension
Agent or by a Farmers’ Market Association within the State agency jurisdiction; 4)
authorized to redeem SFMNP/FMNP food instruments; 5) offers locally-grown produce;
or 6) accessible to senior service areas or WIC local agencies/clinics.

4. List or attach the criteria used to authorize roadside stands (Appendix N).

5. (SFMNP only) List or attach the criteria used to authorize CSA programs (Appendix X).

6. (SFMNP only) List or attach the criteria used to select farmers for bulk purchase programs
(Appendix O).

7. FNS defines “eligible foods” to mean fresh, nutritious, unprepared, locally grown fruits,
vegetables and herbs. Does the State agency use a different of more restrictive definition
for “eligible foods”?
Yes

No

Include a list of the fruits, vegetables, and/or fresh herbs that may be purchased using
SFMNP (§ 249.2)/FMNP (§ 248.2) benefits in Appendix G.
(NOTE: Honey is also an eligible food under the SFMNP, at the State agency’s
discretion. FMNP eligible foods do not include honey.)
Eligible foods may not be processed or prepared beyond their natural state except for
usual harvesting and cleaning processes. Maple syrup, cider, nuts, seeds, dried plums
(prunes), dried chilies or tomatoes, eggs, meat, cheese and seafood are examples of
ineligible foods for purposes of both the SFMNP and the FMNP. State agencies may also
describe eligible foods as “all fruits, vegetables, honey (SFMNP only) and herbs locally
grown except…”:
.
8. Per SFMNP (§ 249.2)/FMNP (§ 248.2), FNS defines “locally grown” to mean produce
grown within State agency borders or areas in neighboring States/ITOs adjacent to its

37

borders. How does the State agency define "locally grown produce" in order to designate
eligible foods?
Within the State agency borders only
Within the State agency borders and adjacent counties (e.g., one county into the next
State)
Within the county lines
Other (please specify)
9. To what extent does the State agency permit or prohibit the participation of individuals
who are selling produce grown by someone else, in addition to their own produce?
Individuals who exclusively sell produce grown by someone else, such as wholesale
distributors, cannot be authorized to participate in the SFMNP (§ 249.10(a)(2)), or the
FMNP (§ 248.10(a)(2)).

10. Describe how the State agency will ensure that there is no conflict of interest between the
State or local agency and any participating farmer, farmers’ market, roadside stand, or
CSA program (§ 249.10(a)(10), § 248.10(a)(7)).

11. Indicate the number of farmers’ markets, farmers, and/or roadside stands, and/or CSA
programs that are expected to be authorized in FY 2024:
Farmers’ markets
Farmers
Roadside stands
Bulk purchase programs
CSA programs
12. Does the State agency require that the Market Manager be bonded?
Yes

No

C. Farmers and/or Farmers’ Market and/or Roadside Stand Agreements and/or CSA/Bulk
Purchase Agreements
NOTE: Some State agencies administer the SFMNP/FMNP by executing agreements
with farmers’ market associations that are responsible for managing farmers’ markets.
In such instances, the provisions and requirements outlined in this section related to
farmers’ markets must also be applied to such State agency/farmers’ market association
agreements.
Each State agency shall enter into a written agreement with all participating farmers and/ or
farmers’ markets, roadside stands and/or CSA/bulk purchase programs including sanctions for
38

non-compliance with SFMNP requirements. Include the SFMNP/FMNP State agencyFarmers/Farmers’ Market/Roadside Stand/CSA/Bulk Purchase Agreements in
Appendix P.
This agreement as described in § 249.10 for SFMNP and in § 248.10 for FMNP must contain
at a minimum the following specifications.
1. The farmer and/or farmers’ market and roadside stand shall (§ 249.10(b)(1)(i-xii) (§
248.10(b)(1)(i-xii)):
i.
ii.
iii.
iv.
v.

vi.
vii.
viii.
ix.
x.
xi.
xii.

Provide such information as the State agency shall require for its periodic reports
to FNS;
Assure that SFMNP/FMNP food instruments are redeemed only for eligible foods;
Provide eligible foods at the current price or less than the current price charged to
other customers;
Accept SFMNP/FMNP food instruments within the dates of their validity and
submit food instruments for payment within the allowable time period established
by the State agency;
In accordance with a procedure established by the State agency, mark each
transacted food instrument with a farmer identifier. In those cases where the
agreement is between the State agency and the farmer or roadside stand, each
transacted SFMNP/FMNP food instrument shall contain a farmer identifier and
shall be batched for reimbursement under that identifier. In those cases where the
agreement is between the State agency and the farmers' markets, each transacted
SFMNP/FMNP food instrument shall contain a farmer identifier and be batched
for reimbursement under a farmers' market identifier;
Accept training on SFMNP/FMNP procedures and provide training to farmers and
any employees with SFMNP/FMNP responsibilities on such procedures;
Agree to be monitored for compliance with SFMNP/FMNP requirements –
including both overt and covert monitoring;
Be accountable for actions of farmers or employees in the provision of foods and
related activities;
Pay the State agency for any food instruments transacted in violation of this
agreement;
Offer SFMNP/FMNP recipients the same courtesies as other market customers;
Comply with the nondiscrimination provisions of USDA regulations; and
Notify the State agency if any farmer or farmers’ market, roadside stand or CSA
ceases operation prior to the end of the authorization period. Provide the State
agency with a regularly updated list of all farmers at the authorized market who
accept SFMNP/FMNP food instruments in exchange for their produce, and their
effective dates of participation.

2. The farmer and/or farmer’s market and roadside stand shall not (§ 249.10(b)(2)(i-iii), §
248.10(b)(2)(i-iii)):
i.

Collect sales tax on SFMNP/FMNP food instrument purchases;

39

ii.
iii.

Seek restitution from SFMNP/FMNP recipients for food instruments not paid by
the State agency: and
Issue cash change or credit (including rain checks) in exchange for purchases that
are in an amount less than the value of the SFMNP/FMNP food instrument(s).

3. Neither the State agency nor the farmer and/or farmers’ market, roadside stand or CSA has
an obligation to renew the agreement. The State agency or the farmer and/or farmers’
market or roadside stand may terminate the agreement for cause after providing advance
written notification. The period of time within which such advance notification must be
provided is to be stipulated by the State agency as part of the standard agreement.
4. The State agency may deny payment to the farmer and/or farmers’ market or roadside
stand for improperly redeemed SFMNP/FMNP food instruments or may establish a claim
for payments already made on improperly redeemed food instruments. The State agency
may disqualify a market and/or a farmer or roadside stand for program abuse.
Note: Under § 249.16(a)(1)(iii),(b) and § 248.16(c)(1), the State agency shall provide
a hearing procedure whereby parties adversely affected by certain actions of the State
agency may appeal those actions. The State agency shall at a minimum provide the
affected party with a “Written notification of the adverse action, the cause(s) for the
action, including the effective date of the action including the State agency’s
determination of whether the action shall be postponed under paragraph (c) of this
section if it is appealed, and the opportunity for a hearing. Such notification shall be
provided within a reasonable timeframe established by the State agency and in
advance of the effective date of the action.”
5. The State agency may disqualify a farmer and/or farmers’ market, roadside stand or CSA
for SFMNP/FMNP abuse.
6. A farmer and/or farmers’ market or roadside stand that commits fraud or engages in other
illegal activity is liable to prosecution under applicable Federal, State agency or local
laws.
7. A farmer and/or a farmer's market, roadside stand or CSA may appeal an action of the
State agency denying its application to participate, imposing a sanction, or disqualifying it
from participating in the SFMNP/FMNP. If a State agency has agreements with farmers'
markets, then a farmer shall appeal such actions to the farmers' market. Expiration of a
contract or agreement shall not be subject to appeal through the SFMNP/FMNP State
agency.
8. Agreements may not exceed 3 years. The farmers and/or farmers' market and/or roadside
stand and/or CSA program agreements are valid for
years.
9. Describe other partnerships/arrangements that may have been negotiated by the
SFMNP/FMNP State agency, such as with Cooperative Extension Service programs, or a
State Agriculture Department, State Department of Aging, or ITO to authorize

40

farmers/farmers markets/roadside stands/CSA programs and attach agreement in
Appendix D.

D. Annual training for farmers, farmers’ market managers and/or farmers who operate a roadside
stand or CSA program.
State agencies shall conduct annual training for farmers, farmers' market managers,
and/or farmers who operate a CSA program in the SFMNP/FMNP. The State agency
must also conduct a one-time, face-to-face training for all farmers and farmers' market
managers who have never previously participated in the FMNP (§ 248.10(d)) and a onetime, interactive training for all farmers and farmers' market managers who have never
previously participated in the SFMNP (§ 249.10(d)). Face-to-face training refers to an
interactive format that includes opportunity for questions and answers, which may include
interactive remote video conferencing as well as actual face-to-face training sessions.
After a farmer/farmers' market manager's first year of SFMNP/FMNP operation, State
agencies have discretion in determining the method used for annual training purposes. At a
minimum, annual training shall include instruction emphasizing:
•
•
•
•
•
•

Eligible food choices;
Proper SFMNP/FMNP food instrument redemption procedures, including deadlines
for submission of food instruments for payment, and/or receipt of payment for CSA
programs’ distribution of eligible foods;
Equitable treatment of SFMNP/FMNP participants, including the availability of
eligible foods to SFMNP/FMNP participants that are of the same quality and cost as
those sold to other customers;
Civil rights compliance and guidelines;
Guidelines for storing SFMNP/FMNP food instruments safely; and
Guidelines for cancelling SFMNP/FMNP food instruments, such as punching holes or
rubber-stamping.

1. Describe the procedures the State agency has in place for the face-to-face training required
for all farmers and farmers’ market managers who have never previously participated in
the FMNP. This description should also include the subsequent training methods made
available to authorized farmers and farmers’ market managers after the first year’s face-to
face training.

E. Food Instrument Accountability
The food instrument reconciliation process as contained in § 249.10(h) and in § 248.10(h) is
intended to assure accountability by enabling the State agency to reconstruct the "life history"
of each food instrument, from the time it is issued through redemption. While State agencies

41

are not required to extract and show, for each coupon, the participant and the farmer/market
associated with the coupon and record the link (e.g., in the form of a spreadsheet or other
document), State agencies must have the ability to trace redeemed coupons to a valid recipient
and authorized farmer/market.
The State agency is responsible for reconciling validly redeemed food instruments, as well as
lost, stolen, voided, expired, or SFMNP/FMNP food instruments that do not match issuance
records. The process for reconciling lost and/or stolen food instruments must ensure that
farmers accepting such instruments in good faith, and through approved procedures, are not
unfairly penalized.
1. Describe the State agency's system for identifying and reconciling SFMNP/FMNP food
instruments that were redeemed, voided, expired, or reported lost or stolen. Validly
redeemed SFMNP/FMNP food instruments are those that are issued to a valid
SFMNP/FMNP participant and redeemed by an authorized farmer, farmers’ market, or
roadside stand within valid dates. They must, at a minimum:
•
•
•
•

Have a valid participant identifier from the signature on the issuance log,
Have a unique and sequential serial number;
Be transacted within valid dates; and
Be redeemed by an authorized farmers' market, an authorized farmer operating
under the auspices of the authorized market, or operating a roadside stand.

a. Describe the State agency’s system for ensuring that food instruments are redeemed
only by authorized farmers (including those operating roadside stands), and farmers’
markets for eligible foods.

b. Describe the State agency's system for identifying and disallowing food instruments
that are redeemed or submitted for payment outside valid dates or by unauthorized
farmers or farmers' markets.

2. Food Instrument Timeframes
•
•
•
•

Issuance to participants
(no later than September 30)
Redemption by participants:
(no later than November 30)
Submission for payment by farmers/farmers' markets:
Payment by the State agency:

All of the functions described above must be completed within a timeframe that allows the
State agency to reconcile food instruments, liquidate obligations, and submit its financial
42

and program data reports (i.e., the FNS-683A for SFMNP & FNS-683B for FMNP) to
FNS through FPRS no later than January 30 of each year.
Provide a copy of the SFMNP/FMNP food instrument in Appendix J.

43

VI. Management Evaluations and Reviews
Indicate in the chart below the total number of local agencies serving SFMNP/FMNP
recipients, the number of each type of farmers' markets, farmers, roadside stands, and/or CSAs
authorized for this year, and the number of reviews of each type in the chart below.
A. The State agency must ensure that authorized farmers/farmers' markets/roadside stands (onsite)/CSAs are reviewed. A minimum of 10 percent or at least one of each type of authorized
outlet (farmer, farmers’ market, roadside stand, CSA) (whichever is greater) must be
monitored each year. For example, if there are five authorized farmers’ markets in a
participating State agency and 40 authorized farmers, the State agency must review a
minimum of one farmers’ market and four farmers. These four farmers may or may not be
participating within the one farmers’ market being monitored.
New Fiscal Year:
Total # of Local Agencies Participating
# of local agencies to be reviewed
(This is the # of local agencies not
the # of participating clinics, unless
designated as local agencies.)
Total # of Farmers Markets Authorized
# to be reviewed (min 10%)
Total # of Farmers authorized
# to be reviewed (min 10%)
Total # of Roadside stands authorized
# to be reviewed (min 10%)
Total # of CSAs
# to be reviewed (min 10%)

FMNP

SFMNP

Previous Fiscal Year:
Total # of Local Agencies Participating
# of local agencies reviewed
(This is the # of local agencies not
the # of participating clinics, unless
designated as local agencies.)
Total # of Farmers Markets Authorized
# of markets reviewed
Total # of Farmers authorized
# of farmers reviewed
Total # of Roadside stands authorized
# of Roadside stands reviewed
Total # of CSAs
# of CSAs reviewed

FMNP

SFMNP

44

B. Describe the State agency’s criteria for defining a high-risk farmer. Such criteria must include
at a minimum:
1. Proportionately high volume of food instruments redeemed within a farmers’ market and
within a State agency;
2. Participant complaints;
3. New farmers, farmers’ markets, and CSA programs in their first year of operation; and
4. In the case of CSA programs, a history of or ongoing inability to provide the full SFMNP
benefit to each shareholder as contracted.

C. Describe the State agency’s policies and procedures for determining the type and level of
sanctions to be applied against farmers, farmers’ markets, roadside stands, and CSA programs
that violate Federal and/or State agency SFMNP/FMNP requirements based upon the severity
and nature of the SFMNP/FMNP violations.

D. Describe the State agency’s plans for reviewing SFMNP (§ 249.17(c)(1)(ii)) and FMNP
(§248.17(c)(1)(ii)) practices at local agencies in FY 2024. All local agencies must be reviewed
at least once every two years by State agency staff. Attach a copy of the State agency’s review
instrument that will be used to review FMNP and SFMNP local agencies (Appendix U).

E. Attach a copy of the State agency’s review instrument that will be used to review farmers,
farmers’ markets, roadside stands, and CSAs (Appendix R).
F. Attach a list of all reviews and findings of farmers, markets, roadside stands and CSA
programs from the previous year.

45

VII. Nutrition Education Requirements
A. List or attach the locations or settings where nutrition education for SFMNP/FMNP is
provided (e.g., local agencies, farmers’ markets, community centers, facilities for the aging,
schools, etc.). If nutrition education is provided remotely (e.g., mailed materials, online),
please write N/A.

1. Does the State agency coordinate with other agencies around issues related to nutrition
education and promotion?
No
Yes (If yes, check the applicable partnerships below):
Supplemental Nutrition Assistance Program (SNAP)
Team Nutrition
Area Agencies on Aging
Commodity Supplemental Food Program (CSFP)
Children and Adult Care Food Program (CACFP)
Temporary Assistance for Needy Families Program (TANF)
Food Distribution Program on Indian Reservations (FDPIR)
Other FNS programs (specify):
Expanded Food and Nutrition Education Program (EFNEP) and/or
Cooperative
Extension Service
Other USDA programs (Agricultural Marketing Service (AMS), Farm Service
Agency (FSA), etc.)
Other government programs (e.g., 5 A Day, Head Start, etc.)
Non-profit organizations (specify):
For-profit organizations (specify):
Industry (specify):
Professional organizations (specify):
Educational Institutions (specify):
Religious Institutions (specify):
Other (specify):
2. Describe how nutrition education for SFMNP/FMNP is coordinated with other nutrition
education programs or services, such as WIC, SNAP, Extension Service, 5 A Day, or State
agency initiatives.

46

3. Describe the nutrition education materials developed by the State agency and how they are
used. In addition, describe any new materials the State agency plans to develop.

4. Does the State agency plan to develop new participant educational materials containing
the current Dietary Guidelines for Americans?
Yes

No

If yes, please describe the elements below.
Type of material

Target audience

Project completion date

5. If the State agency intends to collect survey information to assess the effects of the

Program on farmers’ markets and the change in consumption of fresh fruits and vegetables
by SFMNP/FMNP participants, attach copies of survey forms.

B. Describe in detail the State agency’s plans to provide nutrition education to SFMNP (§ 249.9)
and FMNP (§ 248.9) participants and the manner in which it is provided (e.g., in person,
mailed materials, online). If the administering State agency for the SFMNP/FMNP has
entered into an agreement with another agency to provide nutrition education, attach a copy of
that other agency’s nutrition education plans for SFMNP/FMNP participants (Appendix 5).

Guidelines:
1. Responsibility
It is not mandatory that the SFMNP/FMNP State agency retain sole responsibility for
providing nutrition education to Program recipients. Nor is it intended that the
SFMNP/FMNP State agency duplicate the nutrition education that may be currently
provided by the other agencies. The SFMNP/FMNP nutrition education requirement may
be fulfilled directly by the farmer’s markets or another branch of the State Department of
Agriculture or ITO, or under agreement with the local WIC agency, area colleges and
universities, the Expanded Food and Nutrition Education Program (EFNEP), the
Cooperative Extension Service, and/or any number of other entities having the capability
to address the particular nutritional benefits of fruits and vegetables that can be obtained at
farmers’ markets. Any costs associated with the provision of nutrition education by an
entity other than the administering agency of the SFMNP/FMNP are allowable
administrative expenses under SFMNP/FMNP funding. This aspect of the program
responds directly to the Congressional intent in establishing the SFMNP/FMNP as a way
to increase recipients’ awareness and use of farmers’ markets.
47

2. Encourage Partnerships
FNS believes that the effectiveness of nutrition education can be greatly enhanced through
collaboration with others interested in promoting health and nutrition in low-income
populations. Therefore, FNS strongly encourages collaboration and coordination of efforts
with State agency-wide public and private partners to enhance both the outreach and
efficacy of the nutrition education efforts. FNS encourages such collaboration to facilitate
development of long-term, coordinated nutrition education plans and sustainable
infrastructures, foster an integrated approach to nutrition education across programs in the
State agency, capitalize on promotional opportunities, coordinate and pool resources for
material development, duplication, and dissemination, and ensure development of sciencebased messages that are consistent with the U.S. Dietary Guidelines for Americans, My
Plate, and other Federal guidance.
3. Promote the Dietary Guidelines
To create a base of messages that may be reinforced across FNS programs, FNS
encourages State agencies to incorporate the messages contained in the latest edition of the
U.S. Dietary Guidelines for Americans into their nutrition education plans. It is expected
that nutrition education messages will logically be tailored to address the most urgent
nutrition education needs of constituents. However, as opportunities arise, FNS strongly
encourages State agencies to convey at a minimum four key messages through WIC and
other FNS programs so that program recipients have repeated exposure to these messages.
The messages, all designed to promote food and physical activity choices for a healthy
lifestyle, are as follows:
Balancing Calories
• Enjoy your food, but eat less.
• Avoid oversized portions.
Foods to Increase
• Make half your plate fruits and vegetables.
• Make at least half your grains whole grains.
• Switch to fat-free or low-fat (1%) milk.
Foods to Reduce
• Compare sodium in foods like soup, bread, and frozen meals ― and choose the
foods with lower numbers.
• Drink water instead of sugary drinks.
Increase physical activity and reduce time spent in sedentary behaviors
These messages - derived from the Dietary Guidelines - are being consistently and
prominently promoted in all of the FNS programs to advance an integrated, behaviorbased, comprehensive nutrition education approach across FNS programs. Using these
four core messages, nutrition education program administrators across the many FNS
programs can collaborate and work jointly around these common themes for their nutrition
education interventions, for example to pool resources to develop materials jointly,
conduct social marketing campaigns, and reinforce educational messages.

48

VIII. Miscellaneous Requirements
A. Civil Rights
Executive Order (EO) 13988, “Preventing and Combating Discrimination on the Basis of
Gender Identity or Sexual Orientation.” was issued to all Federal Agencies. The EO set out
policies that all persons are entitled to dignity, respect, and equal treatment under the law, no
matter their gender identity or sexual orientation. The EO does not usurp section 17 of 42
U.S.C, as amended or applicable regulations. However, where appropriate, State agencies may
update their policies and procedures to align with the contents of the EO.
1. Describe per SFMNP (§ 249.7(b)/FMNP (§ 248.7(b)) the State agency’s procedures for
handling complaints of discrimination on the basis of race, color, national origin, age, sex
or disability, including timeframes for submitting such complaints and for investigating
them and responding to plaintiffs. The State agency’s procedures for handling complaints
of discrimination in the SFMNP/FMNP should be consistent with established and
approved procedures for handling such complaints related to other assistance programs
administered by the State agency. For example, if CSFP-related allegations of
discrimination are to be forwarded to FNS Headquarters for investigation and resolution,
then SFMNP/FMNP complaints should be handled in the same way. It is not necessary for
the State agency to develop separate, duplicative procedures for the SFMNP/FMNP if
such procedures already exist in a related Program administered by the State agency.

2. Does the State agency use the current non-discrimination statement below on all SFMNP
and FMNP brochures and publications, excluding materials that provide only nutrition
education information without mentioning the SFMNP/FMNP, and such items as caps,
buttons, magnets, and pens, when the size or configuration make it impractical?
In accordance with federal civil rights law and U.S. Department of Agriculture
(USDA) civil rights regulations and policies, this institution is prohibited from
discriminating on the basis of race, color, national origin, sex (including gender
identity and sexual orientation), disability, age, or reprisal or retaliation for prior
civil rights activity.
Program information may be made available in languages other than English.
Persons with disabilities who require alternative means of communication to obtain
program information (e.g., Braille, large print, audiotape, American Sign Language),
should contact the responsible state or local agency that administers the program or
USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA
through the Federal Relay Service at (800) 877-8339.
To file a program discrimination complaint, a Complainant should complete a Form
AD-3027, USDA Program Discrimination Complaint Form which can be obtained
online at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-

49

Complaint-Form-0508-0002-508-11-28-17Fax2Mail.pdf, from any USDA office, by
calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must
contain the complainant’s name, address, telephone number, and a written
description of the alleged discriminatory action in sufficient detail to inform the
Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged
civil rights violation. The completed AD-3027 form or letter must be submitted to
USDA by:
1. mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
2. fax:
(833) 256-1665 or (202) 690-7442; or
3. email:
program.intake@usda.gov
This institution is an equal opportunity provider.
FMNP (§ 248.7(a)(1))

Yes

No

SFMNP (§ 249.7(a)(1))

Yes

No

3. If the size of the material is too small to include the full statement, does the State agency
include the following statement(s) in print in the same size as the text?
“This institution is an equal opportunity provider.”
FMNP (§ 248.7(a)(1))

Yes

No

SFMNP (§ 249.7(a)(1))

Yes

No

4. Does the State agency use the following statement in radio and television public service
announcements?
“This institution is an equal opportunity provider.”
FMNP (§ 248.7(a)(1))

Yes

No

SFMNP (§ 249.7(a)(1))

Yes

No

B. Hearing Procedures and Program Complaints
1. The State agency must provide a fair hearing procedure whereby local agencies,
participants, and farmers/farmers’ markets/roadside stands/CSA programs adversely
affected by certain actions of the State agency may appeal those actions. A local agency
may appeal an action of the State agency disqualifying it from participating in the
SFMNP/FMNP. A participant may appeal disqualification of SFMNP/FMNP benefits. A
farmer, farmer’s market, roadside stand or farmers’ association may appeal an action of
the State agency denying its application to participate, imposing a sanction, or
disqualifying it from participating in the SFMNP/FMNP. If a State agency has agreements

50

with farmers’ markets, then a farmer may appeal such actions to the farmers’ market or
farmers’ association. Expiration of a contract or agreement shall not be subject to appeal
through the SFMNP/FMNP State agency. The State agency must also provide procedures
for addressing complaints about program operations.
a. Describe the State agency’s procedures for offering, conducting, and rendering final
decisions on fair hearings requested by local agencies, participants, and
markets/farmers/roadside stands/CSA programs. The opportunity to request a fair
hearing regarding certain adverse actions taken by the State agency must be provided
to all farmers and/or farmers’ markets/roadside stands/CSA programs and participants
against whom such adverse action is taken.

b. Describe the State agency’s procedures for handling program complaints from
participants, non-participants, markets, farmers, roadside stands, bulk purchase, and
CSA programs.

2. Drug Free Workplace - Describe the State agency's plans to maintain a drug-free
workplace and otherwise comply with 2 CFR 421.

3. Local Agency Debarment/Suspension – Per 2 CFR 417. Does the State agency have on
file either 1) a current local agency certification in a format established by the State
agency; or, 2) a local agency contract including assurance on debarment/suspension,
which may be satisfied by the local agency debarment/suspension certification provided
for another program if it covers the same period as the SFMNP/FMNP local agency
contract; or, 3) a record showing that the SFMNP/FMNP State agency had checked the
Excluded Parties List System (EPLS) for each local agency?
Yes

No

4. SF-LLL on File - Does the State agency have on file the current SF-LLL, Disclosure Form
to Report Lobbying, if lobbying occurs with non-federal funds, for each SFMNP local
agency with a sub-grant exceeding $100,000, if any? (This may be satisfied with local
agency lobbying disclosures provided for CSFP or Aging services only if the State agency
– local agency contract covers both CSFP and Aging Services or in the case of WIC only
if the State agency – local agency contract covers both WIC and FMNP.)
Yes

No

51

5. SF-LLL Transmission – Has the State agency provided a copy of any such disclosures to
the FNS Regional Office?
Yes

No

6. Have there been any fair hearings in the previous year?
Yes

No

If yes, how many? Indicate for which program.
7. Have there been participant complaints in the previous year?
Yes

No

If yes, how many? Indicate for which program.

52

Appendices
Include all of your appendices here. Please clearly identify any pages according to the lettering
system used in this format.
Required
Please indicate
the fiscal year
of the last
approved
appendix

Please indicate if a
change (Y) or if no
change (N) has
occurred since the
last applicable
approved appendix

A.

Administrative forms, including the FederalState Supplemental Nutrition Programs
Agreement (FNS-339; expiration of 6/30/2025)
and, if applicable, the Certification Regarding
Lobbying and the Disclosure of Lobbying
Activities (SF-LLL)

B.

Job Descriptions

C.

Copies of signed agreements between the State
agency and another State agency (delineating the
functions to be performed)

D.

Copies of cooperative agreements with other
entities for authorizing and/or training farmers,
farmers’ markets, roadside stands, or CSA
programs, or for conducting bulk purchases, if
applicable

E.

Supporting documentation for State agency,
private, in-kind, or similar program funding

F.

Instructions to SFMNP participants, including
rights and responsibilities (rights and
responsibilities for FMNP participants should
take place during the WIC certification visit per
7 CFR 246.7(j))

G.

List of fruits, vegetables and/or fresh herbs that
are eligible in SFMNP/FMNP

H.

Samples of reporting forms for record keeping (if
available)

I.

Copy of the log or other forms used to record and

53

report food instrument issuance and inventory
J.

Copy of the SFMNP/FMNP food instrument
(coupon, check, e-solution benefit, etc.)

K.

Map outlining service areas and proximity of
farmers’ markets, roadside stands, and/or CSA
programs from the prior year’s operation to
SFMNP/FMNP local agencies

L.

List of criteria used to authorize farmers’
markets

M.

List of criteria used to authorize farmers

N.

List of criteria used to authorize roadside stands

O.

List of criteria used to authorize farmers for bulk
purchase programs

P.

Copy of prototype agreements for farmers,
farmers’ markets, CSAs and bulk purchases (if
applicable)

Q.

Training materials for farmers, farmers’ markets,
roadside stands and CSAs (if applicable)

R.

State agency’s monitoring tool(s) to review
farmers, farmers’ markets, roadside stands, and
CSA programs (if applicable)

S.

Sample State agency-wide application form for
FMNP and SFMNP interested farmers, farmers’
markets, roadside stands

T.

Sample notification of ineligibility for SFMNP
participation (notification for WIC (and FMNP)
ineligibility must take place during a WIC
certification visit per 7 CFR 246.7(j)(5))

U.

State agency’s monitoring tool to review
SFMNP/FMNP local agencies/clinics

V.

Copy of SFMNP application and signed statement
to affirm income eligibility

W.

List of criteria for certifying SFMNP participants

X.

List of criteria used to authorize CSA programs
(if applicable)

Y.

List of SFMNP certification/issuance sites

54

Optional (Any forms/materials used in the SFMNP/FMNP that are different from what is
used in the WIC Program)
Please indicate the
fiscal year of the
last approved
appendix

Please indicate if
a change (Y) or if
no change (N) has
occurred since the
last applicable
approved
appendix

1.

State agency training tools for local agencies

2.

Sample proxy form

3.

Examples of nutrition education materials

4.

Copy of form to request an appeal/fair hearing
and procedures

5.

Copy of other agency’s nutrition education plans
for SFMNP/FMNP participants

Please list any other attachments or appendices:

55