If you have any questions please contact me at (828) or toll free My is

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1 DATE: September, 2017 TO: FROM: RE: All TEFAP Agencies Pat Williams TEFAP packet TEFAP information for the 4th quarter of 2017, running October through December, can be downloaded from our website in its entirety the last week of September. Please make copies of the reporting form to use for each month, and please get your reports in to me by the 15 th of each following month. Be sure to use the new Client Eligibility form for and fill it out in its entirety once per year. Partial addresses are not acceptable. This is required by NCDA. Clients must sign for their TEFAP box/s each time they pick up. Always ask if anything has changed in their household. Client sheets must be stored at your pantry for a time period of FIVE years per NCDA. Freezer/Refrigerator temperatures must also be recorded daily. Your Civil Rights poster must be displayed in your pantry. If you do not have one please contact me and I will get one to you. All pantry staff and volunteers need to be aware of Civil Rights requirements and need to have had the Civil Rights Training. You must do this training one (1) time per year. All training and forms can be found on our website. See the last column of the monthly report for reporting TEFAP ending inventory for the month. You need to report this inventory in individual cans/units, not cases. It is important that we know your ending inventory each month to complete our tracking ability. TEFAP foods are eligible for the client choice program. If you chose to use client choice in your pantry, please advise the clients that they can choose which of the TEFAP items they would like to receive. When reporting clients served, please report only those clients who received TEFAP. TEFAP may be distributed to eligible clients as often as is needed but not more than once per week. NCDA and MANNA recommend that you use up all your last quarter items before ordering from the next quarter. When ordering, please do not order more than you need! The goal is to give out all you have by the end of each quarter. Please follow this guideline. YOU CAN DOWNLOAD THE ENTIRE PACKET FROM OUR WEBSITE. WE WILL BE UPLOADING IT THE LAST WEEK OF SEPTEMBER. IF YOU WOULD LIKE A PACKET MAILED/ ED PLEASE NOTIFY ME BY PHONE OR . Items allocated for this quarter are applesauce cup, block cheese, ground beef, beef stew, cranberry sauce, canned chicken, apple juice, fresh apples, spaghetti pasta, spaghetti sauce, peanut butter, and raisins. We will be getting fresh eggs in November and each pantry will be allocated 18 cases which will result in 270 dozen per. If you cannot use your allocation let us know and we will adjust the distribution. If you have any questions please contact me at (828) or toll free My is pwilliams@mannafoodbank.org. Thank you very much. Pat MANNA FoodBank phone Swannanoa River Rd fax Asheville, NC mannafoodbank.org Involving, education, and uniting people in the work of ending hunger in Western North Carolina.

2 TEFAP 04a REVISED 9/18/17 MANNA FoodBank TEFAP DISTRIBUTION REPORT REPORT OF COMMODITIES FOR MONTH OF, 2017 AGENCY NAME AGENCY # PHONE # FAX # ADDRESS NAME AND TITLE OF PERSON COMPLETING THIS FORM REPORT DUE BY THE 15 Th OF THE NEXT MONTH *Reporting period runs from the 1 st day of the month to the last day of the month. *Fill in the invoice number and date in the grid below. Report the item/amount received in CASES. Record this amt in units/cans Week 1 Week 2 Week 3 Week 4 Week 5 END OF MONTH-inventory MONTH ENDING PHYSICAL INVENTORY auce Cup auce Cup auce Cup auce Cup auce Cup (actual can/bag count) COMMODITY auce Cup ENDING INVENTORY IN IND UNITS / CANS **PLEASE RECORD ACTUAL NUMBER OF INDIVIDUALS SERVED **RECORD ENDING MONTHLY INVENTORY IN LAST COLUMN NUMBER OF HOUSEHOLDS TOTAL NUMBER OF INDIVIDUALS - TOTAL **PLEASE RETURN THIS FORM TO THE FOOD BANK NO LATER THAN THE 15 TH OF THE NEW MONTH. IF YOU HAVE ANY QUESTIONS, PLEASE CALL PAT WILLIAMS AT (828)

3 ITEMS FROM LAST QUARTER Page 2 ( ) Item ( ) Item MONTH ENDING PHYSICAL INVENTORY (actual can/bag count) Ending Inventory

4 MANNA FOODBANK, ASHEVILLE, N.C. October, November, December 2017 TEFAP BALANCED DISTRIBUTION RATES Case lot distribution to agencies based on columns (4) (9) below will help assure that families get full variety and amounts based on N.C.D.A. guidelines. Agencies should distribute to families the full range of items the agency has in stock in the unit amounts per item listed in column (3). A balanced box assures you will run out of all products at the same time. Keep in mind that TEFAP foods are eligible for the client choice program. If you chose to use client choice in your pantry, please advise the clients that they can choose which of the TEFAP items they would like to receive. REVISED 12/13/2016 ITEM PACKAGING UNITS PER FAMILY SIZE 1-3 / 4+ ITEM NUMBER OF FAMILIES AGENCY PLANS TO SERVE (1) (2) (3) (4) (5) (6) (7) (8) (9) APPLES, FRESH 12/3 # 1 / 2 APPLES (NOV & DEC) APPLESAUCE CUP 96/4.5 OZ 4 / 8 APPLESAUCE CUP BEEF, GRND, FRZ 1 / 2 BEEF, GRND, FRZ BEEF STEW, CHUNKY 24/24 OZ 1 / 2 BEEF STEW, CHUNKY CHEESE, BLOCK 1 / 2 CHEESE, BLOCK CRANBERRY SAUCE 24/# 300 CAN 1 / 2 CRANBERRY SAUCE CHICKEN, CANNED 24/15 OZ 1 / 2 CHICKEN, CANNED **EGGS, CARTON 15/1 DOZ 1 / 2 EGGS, CARTON CARTON JUICE, APPLE 8/64 OZ 1 / 2 JUICE, APPLE PASTA, SPAGHETTI 1 / 2 PASTA, SPAGHETTI PEANUT BUTTER 12/18 OZ 1 / 2 PEANUT BUTTER RAISINS 24/15 OZ 1 / 2 RAISINS SPAGHETTI SAUCE 1 / 2 SPAGHETTI SAUCE DISTRIBUTE ALL ITEMS FROM LAST QUARTER AT THE RATE OF 1 FOR HOUSEHOLDS OF 1 3 AND 2 FOR HOUSEHOLDS OF 4 OR MORE OR MAKE ALL BOXES THE SAME (one item per box) EXCEPT FOR APPLESAUCE WHICH IS 4/8 PER HOUSEHOLD. TO BE ABLE TO ORDER 144 YOU MUST BE THE ONLY TEFAP DISTRIBUTION SITE IN YOUR COUNTY. ***IF YOU WANT TO SERVE MORE CLIENTS YOU CAN PREPARE ALL BOXES USING THE 1-3 FAMILY SIZE REGARDLESS AS TO HOW MANY ARE IN THE FAMILY BUT YOU MUST STAY CONSISTENT WITH THIS DISTRIBUTION RATE THROUGH-OUT THE QUARTER. **EACH PANTRY WILL BE ALLOCATED 18 CASES OF EGGS. The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or if all or part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at or at any USDA office, or call (866) to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C , by fax (202) or at program.intake@usda.gov. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) ; or (800) (in Spanish). USDA is an equal opportunity provider and employer.

5 TEFAP Eligibility Form October 1, 2017 September 30, 2018 Name: Address: City: County: Number of People in Household: Foodstamps yes no Effective October 1, 2017 through September 30, 2018 (Household gross income must be at or below for appropriate size household.) HOUSEHOLD SIZE PER YEAR PER MONTH PER WEEK 1 $24,210 $2,010 $464 2 $32,496 $2,708 $625 3 $40,848 $3,404 $786 4 $49,200 $4,100 $946 5 $57,576 $4,798 $1,107 6 $65,928 $5,494 $1,268 7 $74,280 $6,190 $1,428 8 $82,656 $6,888 $1,590 EACH ADDITIONAL FAMILY MEMBER (+$8,376) (+$698) (+$161) The above table shows a yearly gross income for each family size. If your household income is at or below the income listed for the number of people in your household, you are eligible to receive food. A household is defined as a group of people who live together and share money and other resources in order to get food. OR, if you currently participate in a Food & Nutrition Services Program (i.e. Food Stamps) you are automatically eligible to receive TEFAP and do not need to look at the income scale. Note: The above may be read to persons who are unable to read. People who are unable to sign their name may sign by using an X. Please read the following statement carefully, then sign the form and write in today s date. I understand that any misrepresentation of need, sale, or misuse of the foods I have received is prohibited and could result in a fine, imprisonment, or both. (Sec. 211 E, PL and Sec. 4C, PL as amended.) The section below is only for homebound individuals The following persons are authorized to pick up my food (if applicable): Authorized Representative: Authorized Representative: (Client Signature) () In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) Submit your completed form or letter 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 ; (2) Fax: (202) ; or (3) program.intake@usda.gov This institution is an equal opportunity provider.

6 FNS Yearly Income Monthly Income Weekly Income Agency Representative Signature Client Signature Yes No If you do not receive FNS Benefits (i.e. food stamps), write in your yearly, monthly, or weekly income if there has been a change In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) Submit your completed form or letter 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 ; (2) Fax: (202) ; or (3) program.intake@usda.gov This institution is an equal opportunity provider.

7 FORMA DE ELEGIBILIDAD PARA TEFAP Octubre 2017 Septiembre 2018 Nombre: Dirección: Ciudad: Condado: Número de personas en el hogar: Cupones de alimentos? si no Efectivo desde 1 de Octubre 2017 hasta 30 de Septiembre de 2018 (Los ingresos gruesos tienen que estar en o abajo para el tamaño apropiado del hogar.) TAMAÑO DE HOGAR POR AÑO POR MES POR SEMANA 1 $24,210 $2,010 $464 2 $32,496 $2,708 $625 3 $40,848 $3,404 $786 4 $49,200 $4,100 $946 5 $57,576 $4,798 $1,107 6 $65,928 $5,494 $1,268 7 $74,280 $6,190 $1,428 8 $82,656 $6,888 $1,590 CADA MIEMBRO ADICIONAL DE LA FAMILIA (+$8,376) (+$698) (+$161) La tabla abajo muestra los ingresos gruesos anuales para cada tamaño de familia. Si sus ingresos de hogar están en o debajo los ingresos en la tabla para el número de personas en su hogar, usted es elegible para recibir los alimentos. Un hogar es definido como un grupo de personas que viven juntos y comparten dinero y otros recursos a fin de conseguir el alimento. O, si usted participa en una programa de estampillas de alimentos, usted es automáticamente elegible para recibir TEFAP y no tiene que mirar la escala de ingresos. Nota: Los siguiente puede ser leído a personas que no saben leer. La gente que es incapaz de firmar su nombre puede firmar usando un X. Por favor lea la declaración siguiente con cuidado, luego firme la forma y escriba la fecha de hoy. Entiendo que cualquier falsificación de necesidad, venta, o mal uso de la comida que he recibido es prohibida y podría causar multas, el encarcelamiento, o ambos. (Sec. 211 E, PL y Sec. 4C, PL 93-86, según enmendado.) La siguiente sección es sólo para los individuos recluidos Las siguientes personas están autorizadas a recoger a mi comida: Representante Autorizado: Representante Autorizado: Firma de persona recogiendo alimentos: (Firma de Cliente) (Fecha) De conformidad con la Ley Federal de Derechos Civiles y los reglamentos y políticas de derechos civiles del Departamento de Agricultura de los EE. UU. (USDA, por sus siglas en inglés), se prohíbe que el USDA, sus agencias, oficinas, empleados e instituciones que participan o administran programas del USDA discriminen sobre la base de raza, color, nacionalidad, sexo, discapacidad, edad, o en represalia o venganza por actividades previas de derechos civiles en algún programa o actividad realizados o financiados por el USDA. Las personas con discapacidades que necesiten medios alternativos para la comunicación de la información del programa (por ejemplo, sistema Braille, letras grandes, cintas de audio, lenguaje de señas americano, etc.), deben ponerse en contacto con la agencia (estatal o local) en la que solicitaron los beneficios. Las personas sordas, con dificultades de audición o discapacidades del habla pueden comunicarse con el USDA por medio del Federal Relay Service [Servicio Federal de Retransmisión] al (800) Además, la información del programa se puede proporcionar en otros idiomas. Para presentar una denuncia de discriminación, complete el Formulario de Denuncia de Discriminación del Programa del USDA, (AD-3027) que está disponible en línea en: y en cualquier oficina del USDA, o bien escriba una carta dirigida al USDA e incluya en la carta toda la información solicitada en el formulario. Para solicitar una copia del formulario de denuncia, llame al (866) Haga llegar su formulario lleno o carta al USDA por: (1) correo: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C ; (2) fax: (202) ; o (3) correo electrónico: program.intake@usda.gov. Esta institución es un proveedor que ofrece igualdad de oportunidades.

8 El programma de estampillas de alimentos Por Ano Por Mes Por Semana Firma de Representante de la Agencia Fecha Firma Si No Si usted no recibe estampillas de comida, escribir en tu anual, mensual, semanal o ingresos

9 MANNA FoodBank 627 Swannanoa River Rd Asheville, NC TEFAP Loss Report for Month of, 2017 (a) (b) (c) (d) Product Pack Units Lost Explain in Detail Cause of Loss (a) Self Explanatory (b) Self Explanatory (c) List the number of blocks, bags, containers, cans or boxes which have been lost due to damage, pilferage, lack of accountability, etc. (d) Explain in detail the cause of the loss, such as damage in shipping, hidden damage, loss through lack of accountability, etc. (Name of Emergency Feeding Organization) (County) (Signature) (Title) () (Please attach this form to the TEFAP-4)