food assistance - washington state department of … · the month/quarter selected is required for...

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Food Assistance

Contractor Review Form Commodity Supplemental Food Program (CSFP) Emergency Food Assistance Program (EFAP) The Emergency Food Assistance Program (TEFAP)

Contractor’s Name:

SFY:

FFY:

Review Date:

Reviewer:

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Purpose

Food Assistance (FA) has the responsibility to monitor the contractor’s performance, compliance and assurance that services funded by FA are being delivered properly to help alleviate hunger in local communities. If the contractor also provides direct client services then they must follow all subcontractor requirements.

FA does this by assisting the contractor in complying with the terms and conditions of the contract(s), applicable laws, regulations, and policies. Our objectives for this review are:

• To verify program and financial management. • To verify agency and administration compliance. • To test if program costs and services are allowable and eligible. • To ensure qualifying eligible client requirements and services are being met. • To verify other contract compliance including subcontractor compliance. • To share with other partners the results of this review.

To accomplish the objectives of the program reviews, FA may conduct an on-site or a desk review, as required. Please have the documents highlighted in yellow, ready for the FA staff to review on-site. Financial backup documentation for the month/quarter selected is required for the review.

Please look at the Contractor Pre-Review Checklist on the next page for information on what to send to your FA Regional Representative prior to the review as well as what to have available for your on-site review. Fill in the blanks in the Contractor Information sheet on pages 4 and 5 and FA staff will fill in the remaining responses. FA used the following documents to develop this form. For these questions you will find the requirement(s) in at least one of these program required documents:

• WSDA’s FA Combined Contract(s) • WSDA’s EFAP Application and Handbook • WSDA’s Procedures Manuals for EFAP, TEFAP, CSFP • WSDA’s EFAP Subcontractor’s Application • Applicable Code of Federal Regulations (CFR) that include:

o Part 247 – Commodity Supplemental Food Program o Part 250 – Distribution of Donated Food o Part 251 – The Emergency Food Assistance Program

• Applicable RCW’s and WAC’s o RCW 43.23.290 o Chapter 16-740 WAC

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Pre-Review Checklist:

FA Staff Pre-Review If information is inaccurate or missing, please ask the contractor to provide the most current record:

Insurance expiration date and all additional insured endorsements

Secretary of State nonprofit registration date

Date of last audit on file (single/exemption form/verification form/other)

Federal Funding Accountability and Transparency Act (FFATA) (Has their financial situation changed and they need to fill out a new form?)

IRS Form 990 (including suspension/debarment)

Contractor Pre-Review Items needed prior to the review:

Fill in the Contractor Information for All Programs on page 4 and 5. FA staff will fill in the remaining responses.

Send FA staff all contractor policies prior to review date (Sect. A/Q3)

If contractor does not provide full financial backup documentation with each report, please have ready or provide in advance, all backup documentation for the month and quarter indicated by FA staff. Please provide backup for the period of (Sect. A/Q23)

Additional Information Needed – Please send FA staff

Items to have available for the on-site review:

Current signed contract (Sect. A/Q1)

Reviews from other organizations (Health Dept., Food Lifeline, etc.) (Sect. A/Q6)

Current signed subcontracts (Sect. A/Q7)

Civil rights training records (Sect. A/Q15)

Copy of current IRS Form 990 on file

Have on file ALL subcontractor documents referenced on the compliance log located in Section A

Contractor Information – All Programs

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Contractor Information:

Program(s) Being Reviewed CSFP

Biennial Contract Amount(s): Contract Number(s):

EFAP

TEFAP

Agency Name:

Agency Physical Address:

Agency Mailing Address:

Warehouse Address: (if different than agency)

Offsite/Other Address:

Program Contacts:

Board Chair or Equivalent:

Name: Email:

Address: Phone:

City/State/ZIP

Executive Director:

Name: Phone:

Email:

Fiscal Director:

Name: Phone:

Email:

CSFP Fiscal Program Staff:

Name: Phone:

Email:

EFAP Fiscal Program Staff:

Name: Phone:

Email:

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TEFAP Fiscal Program Staff:

Name: Phone:

Email:

CSFP Program Manager/Coordinator:

Name: Phone:

Email:

EFAP Program Manager/Coordinator:

Name: Phone:

Email:

TEFAP Program Manager/Coordinator:

Name: Phone:

Email:

Warehouse Manager/Coordinator:

Name: Phone:

Email:

24-Hour Emergency Contact Warehouse/Food Recalls/Disaster:

Name: Email:

Phone: Cell:

Home:

General Contact: (for clients seeking services)

Phone: Website Address:

Email:

Comments: (other contacts or information)

Section A – General FA Questions – All Programs

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SECTION A – GENERAL FA QUESTIONS:

ADMINSTRATION – CONTRACTOR: COMMENTS

Yes No 1. Does the contractor have a current signed contract(s) with the state on file? Contractors: have available for review on-site. (Good practice for FA is to have the contract available for reference.)

Yes No 2. Does the contractor retain all of its program related paperwork and records for a period of six years after the end of the contract period as noted on the face sheet?

3. Does the contractor have current written administrative policies for: Contractors: Send to reviewer prior to review date.

Yes No • Equipment Procurement Policy

Yes No • Travel Policy (Should be with consistent with state policies and/or federal policies)

Yes No • Client Privacy Standards Policy

Yes No • Corrective Action Policy for subcontractors:

Yes No • Dispute Policy for subcontractors:

Yes No 4. Did the contractor have any organizational changes in administrative, fiscal, program or warehouse staff in the last year? If yes, please describe in the “comments” column.

Yes No 5. Does the contractor submit the required paperwork in a timely manner? (Expenditure Reports with backup, Inventory Reports, Bills of Lading, Demographics, Closeout Reports, Risk Assessments, etc.)

Yes No

6. Has another agency that provides funding or food or that regulates the contractor’s activities done a review in the last year? (Such as the city, county, Health Dept., Northwest Harvest, Second Harvest, Food Lifeline or others.)

Contractors: have reviews available for FA staff to review on-site if applicable.

Were there any deficiencies noted? Yes No N/A

If yes, please explain in the “comments” column.

If deficiencies were noted, have they been corrected? Yes No N/A

If no, explain in the “comments” column.


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ADMINSTRATION – SUBCONTRACTORS: COMMENTS

7. How many sites operate under the contractor’s WSDA Food Assistance network?

If applicable, how many do they include of the following?

• Number of CSFP subcontractors

• Number of EFAP subcontractors

• Number of TEFAP subcontractors

o Number of subcontractor’s sponsored sites

o Number of contractor sponsored sites (not operated by contractor - satellites, temporary distribution sites, drop sites)

o If sponsored site: Number of Memos of Understanding FA will spot check a minimum of 10 subcontracts or 25%, whichever is greater, for compliance.

8. Does the contractor have a review schedule in-place that complies with the programs it runs as required under the contract? (FA will check list of subcontractors to be reviewed and spot-check completed reviews. Check for findings, including any reference to SS# and inconsistencies in client counts. For TEFAP if any findings that need corrective action, instruct contractor to send reviews with resolutions to FA if they haven’t done so already. Contractors have reviews available on-site for FA staff.

EFAP: Yes No (every 2 years required under EFAP)

TEFAP: Yes No (minimum of 10% of subcontractors annually)

Yes No 9. Of the subcontractors reviewed, have any corrective actions been identified?

If yes, has subcontractor taken corrective action? Yes No N/A

Explain in the “comments” column.

Yes No 10. During subcontractor reviews, does the contractor verify that their subcontractors comply with the policy of not allowing payment from clients for food, materials or services, or in connection with, the receipt of any food whether donated, including federal commodities, and/or purchased with state funding? Review contractor reports to show they monitored subcontractors for this.

Yes No 11. During subcontractor reviews, does the contractor verify that their subcontractors comply with the policy of not requiring participation in a religious activity as a condition for receiving emergency food assistance?

Review contractor reports to show they monitored subcontractors for this.


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Yes No 12. During subcontractor reviews, does the contractor verify that their subcontractors comply with the policy of not distributing food as a means for furthering the political interest of any person or party? Review contractor reports to show they monitored subcontractors for this.

Yes No 13. During subcontractor reviews, does the contractor verify that their subcontractors have current income guidelines displayed?

Yes No 14. Does the contractor monitor their subcontractors for compliance with the FA equipment policy for equipment with an original cost of $5,000 or more per unit?

N/A No FA Purchases

CIVIL RIGHTS: N/A EFAP Only Contractor – skip to Client Information and Systems COMMENTS

Yes No 15. Can the contractor show that all their staff and volunteers, and those of their subcontractors who have access to clients or client records, are trained annually on civil rights as required and outlined in FNS Policy Memo FD 113?

Contractors have training records available for FA staff review.

N/A EFAP Only

Yes No 16. Are civil rights complaints being handled in accordance with the procedures outlined in the Food Assistance Civil Rights Training Tool?

N/A EFAP Only

Yes No 17. Is the USDA non-discrimination statement being included on all printed materials such as applications, pamphlets, forms or any other materials distributed to the public?

N/A EFAP Only

Yes No 18. Is the “Justice for All” poster in a visible location to clients?

N/A EFAP Only

CLIENT INFORMATION AND SYSTEMS: COMMENTS

Yes No 19. Are current Income Guidelines posted for clients to view?

N/A EFAP Only

Yes No 20. Do all of your subcontractors have client tracking systems?

21. Are subcontractors collecting social security numbers from clients?

• For any WSDA FA program Yes No

• For other programs Yes No

(Reminder, agencies cannot deny services for any of the FA programs for not giving identifying information.)

Yes No 22. Has there been any significant increases or decreases in the number of clients during the last year?


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FISCAL AND INTERNAL CONTROLS: COMMENTS

Yes No 23. Does the contractor send in full backup documentation with reports?

If contractor doesn’t send in full backup, please have ready for FA staff to review the original backup documentation for all expenditures directlycharged to the program funds for the month of: Documents must include the following:• The EFAP, TEFAP & CSFP detailed general ledgers • Revenue and Expense Report that shows the total food pantry and

food bank expenses for each budget category• All receipts/invoices for purchases for contractor and subcontractor.• Staff timesheets for contractor and subcontractor.• If contractor has a federally approved indirect rate, a copy of the

letter from the identified federal agency.

24. For the month expenses were selected for review, the following appliesto both contractor and subcontractor’s expenditures billed to FAprograms:

Yes No • Does the contractor review backup documentation fromsubcontractors to determine which costs are allowable prior toauthorizing payment?

Yes No • Does the contractor have required backup documentation for allexpenses charged to FA?

Yes No • Are shared costs allocated based on the percentages charged toFA?

Yes No • Are all costs charged allowable? Including Items such as:o Salaries: Are there signed time sheets to support the breakout

by program?o Benefits: Does the percentage charged to the program

correspond with the salaries that are charged to the program?o Staff Travel: (including mileage and per diem) Do amounts

requested correspond with the rates allowed by the state?o Other: Office and warehouse supplies, telephone & postage,

office and warehouse rent, utilities, equipment maintenanceand repairs, and/or food purchases.

Yes No 24. Does the contractor, if administering other programs, have a cost allocation plan or other method to accurately allot expenses between programs?N/A No other

programs

FA has audit on file for period of:

25. What kind of audit does the contractor receive?

Single Audit (< $750,000) Financial (> $750,000)

Yes: Current Accounting System Verification Form (> $20,000 in state funding and < $750,000 in federal funding)

No: Due Single Audit Exemption Form (> $750,000 in federal funding)

Please provide audit if FA does not have the most current one on file.


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Yes No 26. Were there any audit findings?

If yes, did the contractor submit to FA its response sent to the auditor? Yes No N/A – no findings

Please provide FA with a copy of your response if not sent.

Yes No 27. Are all funding sources identified in the audit?

Yes No 28. Does the audit apply the correct CFDA numbers?TEFAP: 10.568 Admin; 10.569 FoodCSFP: 10.565N/A EFAP only

Yes No 29. Does the contractor track equipment with original cost of $5,000 or more per unit purchased in part or entirely with FA funding? N/A: No FA

purchases

Yes No 30. Was there pre-approval by FA for equipment costing $5,000 or morepurchased with FA program funds? N/A: No FA

purchases

Yes No 31. Is all of the equipment listed on the FA Equipment Inventory Formstill in use?

Yes No 32. Is there any new equipment to be added to this list?

Yes No 33. Do inventory records maintained for equipment purchased with FAfunds identify the following: description, funding source andpercentages used for the purchase, ownership & location?

Contractors have inventory records available for FA staff to review.

N/A: No FA purchases

INVENTORY AND COMMODITY DELIVERY: COMMENTS

Yes No 34. Does the contractor operate any kind of food storage?

Contracted Contractor Operated

Yes No 35. Does the contractor maintain an inventory of all WSDA Food?

Yes No 36. In the reviewer’s assessment of inventory records, is it easy to identifythe following items?

• Beginning balance• Received items• Distributed items

• Damaged items• Ending Balance

37. How often does the contractor reconcile inventory with physicalcounts?

Monthly Semi-Annually

Quarterly Annually


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Yes No 38. Does the contractor follow all guidance on storing food as outlined inFA procedures manuals?

• “FIFO”• Commodity loss procedures• Receiving notification

COMMENTS WAREHOUSING AND STORAGE: N/A No storage

Applies to all food pantries and/or food banks. If any storage areas are located off-site, list address - all storage areas must be inspected.

Yes No 39. Frozen: Does contractor have frozen (0°) storage?• Current Temperature

• Thermometer Accurate (±1°) Yes No• Approximate square footage

• Pallets can be stacked high

Yes No 40. Cold: Does contractor have refrigerated (33°- 40°) storage?

• Current Temperature

• Thermometer Accurate (±1°) Yes No

• Approximate square footage


Yes No 41. Is a temperature log being maintained for frozen and cold storage?

(Logs required in order to adhere to good food safety practices so that foods are storedin a manner to protect them from spoilage, infestation, damage or other condition that may jeopardize the wholesomeness or safety of the food.)

Yes No 42. Dry: Does contractor have dry storage?

• Current Temperature

• Thermometer Accurate (±1°) Yes No

• Approximate square footage


Yes No 43. Does contractor have a Continuity of Operations Plan (COOP)?

44. If contractor does not have a COOP plan, what plans or actions are inplace to ensure the continued distribution of food in the case of anatural disaster, power outage, freezer breakdown, etc.?

Yes No 45. Does the food stored in the warehouse meet storage requirements?(i.e. food stored off the floor and 4”-6” away from all walls; adequate air circulation)

Yes No 46. Are fertilizers, toxic chemicals, and other potential adulterantsadequately separated from human food storage areas?

N/A: No Storage

N/A: No Storage

N/A: No Storage

N/A: No Storage

N/A: No Storage

N/A: No Storage

N/A: No Storage

N/A: No Storage


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Yes No 47. Is storage area free of evidence of current insect, rodent, bird, etc.,activity?

N/A - No Storage

N/A - No Storage 48. Is pest control self-applied or professional?(check for traps if self-applied or 2 months records for professional)

Self-applied Professional

Yes No 49. Do inspections include any problems with pests?

If yes, have those issues been corrected? Yes No N/A – No problems identified

N/A - No Storage

Yes No 50. Is the building of suitable construction and generally in good physicalrepair?

N/A - No Storage

Yes No 51. Are food products and processing areas protected againstcontamination from breakage of light bulbs and other glass fixtures?

N/A - No Storage

Yes No 52. Are floors, walls and ceiling constructed of easily cleanable materials?

N/A - No Storage

Yes No 53. Is interior lighting sufficient to allow adequate inspection and cleaningof premises?

N/A - No Storage

Yes No 54. Are facilities clean? N/A - No Storage

Yes No 55. Are windows screened? Are doors and loading doors kept closed whennot in use?

N/A - No Storage

Yes No 56. Are outside premises free from spillage, trash, brush, etc., that mayattract or harbor rodents or other pests?

N/A - No Storage

Yes No 57. Is cleaning of facilities done in such a manner as to avoid contaminationof food products?

N/A - No Storage

Yes No 58. Is refuse/garbage properly stored and protected from insects, rodentsand other pests and disposed of in an adequate manner?

N/A - No Storage

Yes No 59. Are restrooms and dressing rooms in good repair, clean, properlyventilated and adequately separated from storage area?

N/A - No Storage

Yes No 60. Are hand-washing facilities clean and supplied with soap, hot water andsanitary towels?

N/A - No Storage


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Responses to Subcontractor Compliance Questions

Instructions: FA Staff to spot check a minimum of 10 subcontracts or 25%, whichever is greater. (Add rows as needed) If issues are found, check all subcontract files for compliance.

FA Program - Subcontractors Subcontractor Client Information & Systems

Food Pantry Name E or T Put dates where required or “N/A” where not required Yes or No

ABC Food Pantry Example Only

E & T 7/5/85 5/1/10 12/31/09 7/01/13 12/31/12 5/25/13 10/29/13 Yes Yes Yes

Expiration Date For Current WA Secretary Of State Registration

(N/A churches)

EFAP Or

TEFAP Subcontract

501(c)3Issue Date

(N/A Churches)

Expiration Date Of Liability

Insurance

Signature And Date On

Subcontracts

Date Last Audit

Completed(If Required)

Accounting Verification

Date (If Required)

Monitoring Date

Completed Or Scheduled

Uses A Client Information

Release Form

Has A Client Confidentiality

Policy

Has A Client Eligibility Policy In

Place


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FA Program - Subcontractors Subcontractor Client Information & Systems

Expiration Date For Current WA Secretary Of State Registration

(N/A churches)

Food Pantry Name E or T Put dates where required or “N/A” where not required Yes or No

EFAP Or

TEFAP Subcontract

501(c)3Issue Date

(N/A Churches)

Expiration Date Of Liability

Insurance

Signature And Date On

Subcontracts

Date Last Audit

Completed(If Required)

Accounting Verification

Date (If Required)

Monitoring Date

Completed Or Scheduled

Uses A Client Information

Release Form

Has A Client Confidentiality

Policy

Has A Client Eligibility Policy In

Place


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SECTION A, GENERAL FA QUESTION SUMMARY:

Check Applicable Box:

SATISFACTORY May include recommendations.

SATISFACTORY WITH FOLLOW-UP REQUIRED All Required Follow-up Listed Below Yes No If No, then a follow-up letter or email will be sent

CORRECTIVE ACTION A corrective action letter or email will be sent

List Follow-Up Required:

List Recommendations or Notes:

Section B – CSFP

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SECTION B – CSFP PROGRAM SPECIFIC QUESTIONS

CERTIFICATION PROCESS AND FORMS:

PROCESSING STANDARDS: COMMENTS

Yes No 1. When there are no funds available to provide additional program benefits,the contractor shall maintain a wait list of individuals who visit thecontractor to apply for the program. Is such a list being properlymaintained?

Yes No 2. To enable the contractor to contact the individuals when caseload spacebecomes available, the wait list shall include the name of the applicant, thedate placed on the list, an address or phone number of the applicant andage. Does the wait list contain these components?

Yes No 3. Individuals shall be notified of their placement on a wait list within 10 daysafter they visit the contractor during office hours to request programbenefits. Is this being done on a regular basis?

CERTIFICATION FORMS AND PERIODS: COMMENTS

Yes No

4. All certification data for each applicant must be recorded on anapplication form. At a minimum, does the form contain the following:

• The date of the initial visit to apply for participation and the date ofthe certification or denial.

Yes No • The criteria used to determine the person’s eligibility or ineligibilityand the signature and title of the persons making the eligibilitydetermination.

Yes No • The person’s name and address.

Yes No • The number of people in the person’s household (note: informationnot needed when the applicant is determined to automatically beeligible.)

Yes No • Other eligibility-related information (age for new certifications andre-certifications for seniors, as applicable.)

Yes No • The following statement must be located directly above theapplicant’s signature line and must be read by or to the applicant, orthe applicant’s parent or caretaker, before the application is signed:

“This certification form is being completed in connection with thereceipt of Federal assistance. Program officials may verify informationon this form. I am aware that deliberate misrepresentation maysubject me to prosecution under applicable State and Federalstatutes.”

Section B – CSFP

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Yes No

5. Are program benefits based upon certifications established in accordancewith the following timeframes:

• Elderly persons shall be certified at intervals prescribed by the StateAgency, provided such intervals do not exceed 6 months in length.

Yes No • A formal certification of elderly persons shall be done for each CSFPparticipant once every 24 months.

NOTIFICATION REQUIREMENTS: COMMENTS

6. Are the following responsibilities performed by the contractor:

Yes No • Each applicant shall be informed during the certification process ofthe right to a fair hearing and of the illegality of participation in theprogram in more than one contractor area.

Yes No • Each participant shall receive an explanation of how the food deliverysystem in the contractor’s area operates.

Yes No • Is the contractor (operating), in accordance with 7 CFR Part 16.4(f),faith-based or religious organizations that receive USDA Foods oradministrative funds for TEFAP or CSFP must give written notice in themanner prescribed by FA Procedures Manuals, to all beneficiaries andprospective beneficiaries of the right to be referred to an alternateprovider when available?

Yes No • Are referral forms being retained?

APPLICANT’S RIGHTS: COMMENTS The following sentences shall be read by, or read to, the applicant or caretaker at the time of certification. When a significant proportion of the population served by the contractor is comprised of non-English or limited English speaking persons who speak the same language, the sentences shall be stated to such persons in a language they understand.

7. Are the following sentences read by, or read to, the applicant or caretakerat the time of certification:

Yes No • If your application is approved, the contractor will make nutritioneducation information available to you and you are encouraged toparticipate.

Yes No • You may appeal any decision made by the contractor regarding yourdenial or termination from the program.

Yes No • Standards are applied without discrimination by race, color, nationalorigin, sex, disability, age, and reprisal or retaliation for prior civilrights activity in any program or activity conducted or funded byUSDA.

TRANSFER OF CERTIFICATION: COMMENTS

Yes No 8. When a participant is relocating to another CSFP area, does the contractorhave a method in place to verify certification to ensure that theparticipant’s benefits will not be interrupted?

Section B – CSFP

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PARTICIPATION: When issuing supplemental foods, the contractor shall check the identification of each participant. COMMENTS

Yes No 9. Does the contractor check the identification of each participant as shownon the certification form?

DISQUALIFICATION: COMMENTS

Yes No 10. Have any applicants or participants been terminated from the programwithin the last 12 months?

If yes, were proper procedures followed pursuant to 7 CFR Part 247.20(c)of the regulations?

Yes No N/A – No participants were terminated

Yes No 11. Did any participant get terminated for participating in CSFP under falsecircumstances?

If yes, what was the circumstance: Participant made false statements either orally or in writing in order to

obtain CSFP benefits to which they would not have otherwise been eligible. Participant concealed information in order to obtain CSFP benefits to

which they would not have otherwise been eligible. Participant altered program documents for the purpose of receiving

increased benefits for which they would not have been eligible, or for the purpose of transferring benefits to an unauthorized individual. Participant used the CSFP foods in an unauthorized manner such as

trading or selling the food.

COMMODITY DISTRIBUTION PROCEDURES:

ORDERING: COMMENTS

12. What method is used by the contractor to determine the amount ofproducts needed for monthly ordering? Describe to FA staff the process.

COMMODITY DISTRIBUTION AND ISSUANCE: COMMENTS

Yes No 13. Does the contractor have a system in place to deliver donated foods tohomebound recipients? Describe to FA staff the process.

14. How many CSFP drop sites do you currently distribute through?

15. What is the process to ensure that supplemental food is in accordancewith the regulations and FNS food package instructions? Describe to FAstaff the process.

Section B – CSFP

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INVENTORY CONTROL The reviewer should verify the beginning balance, receipts, distributions, and gains/losses of pre-selected commodities on a current FNS-153. The ending balance of each commodity verified on the FNS-153 should be compared to the contractor’s perpetual/monthly inventory records and warehouse physical count records. The reviewer should use worksheet 2 found at the end of the review.

RECORDED INVENTORY LEVELS AND COMMODITY LOSS PROCEDURES: COMMENTS

16. Does the ending balance for each commodity verified on current FNS-153reconcile with:

Yes No • The contractor’s perpetual or monthly inventory records?

Yes No • The contractor’s physical inventory records?

• Explain verification results:

NUTRITION EDUCATION: COMMENTS

Yes No 17. Do participants receive an explanation of the importance of theconsumption of the supplemental foods by the participant for whom theyare prescribed rather than by other family members?

Yes No 18. Do participants receive an explanation that the program providessupplemental food rather than being a total food program?

Yes No 19. Do participants receive information on the use of the supplemental foodsand on the nutritional value of these foods?

Yes No 20. Are participant advised of the importance of participating in ongoingroutine health care, the types of health services available, where they arelocated, and how they may be obtained.

Yes No 21. Do participants receive information regarding other resources andassistance?

22. What other nutrition education is provided to clients?

(Reminder, only food related items such as recipes, nutrition information can be put in boxes.)

Yes No 23. Does the contractor review the nutrition education information andresources available on the FA website annually?

24. How does the contractor solicit participant input on the nutritioneducation plan?

Section B – CSFP

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CSFP Certified Participant File Review – Worksheet 1

Case File No. or Participant's Name: Guardian (if applicable, and optional): Participant Category: Application Date: Applicant/Guardian Signature? Household Size:

Check box if eligible based on participation in other program: Name of Other Program:

Check box if eligible based on income: Amount of Income Recorded in File? Type of Income Recorded in File? Income Within Guidelines for HH Size? Certification Decision Indicated? Correct Certification Period Assigned? Signed by Authorized Certifier? Certification Date:

No. Days, App Date to Cert Date (calculated cell):

For Elderly Participant Date of Birth Recorded in File?

Food Issuance Issuance Receipts on File? Receipt Dates Indicated? Receipt Signatures?

If box above is checked, testing income is just unneeded extra work. Did certifier omit income test?

Section B – CSFP

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WORKSHEET 2 – INVENTORY SPOT CHECK

To complete this chart, use inventory records, shipping receipts, and distribution records. No need for physical inventory.

COMMODITY NAME/CODE

MONTH/YEAR

BEGINNING BALANCE

AMOUNT RECEIVED

AMOUNT DISTRIBUTED

ENDING BALANCE

AGREE WITH INVENTORY REPORTS (Y/N)

COMMENTS/SUGGESTIONS:

Section B – CSFP

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SECTION B, CSFP SUMMARY







Section C – EFAP

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SECTION C – EFAP PROGRAM SPECIFIC QUESTIONS

ADMINSTRATION AND PROGRAM GENERAL – CONTRACTOR COMMENTS

Yes No 1. Are funds being distributed to each food pantry based on the formula that wasdecided on at the biennial community meeting?

Describe this formula:

Yes No 2. Does the contractor share information on the food procurement policy andprocess for obtaining product from resources?

(Food pantries have an obligation to be good stewards of public funds, procuring food inthe most cost-effective manner possible. FA monitors for compliance with this policy.)

Food pantries should attempt to acquire food in the following order whenutilizing state funds:

1. Donations2. Not-for-profit distributors3. Wholesalers or food brokers4. Discount retailers

Local retailers

Yes No 3. Does the contractor monitor the subcontractors regarding compliance withthe food procurement policy?A best practice is reviewing the back-up documentation to see where the food pantries purchase food.

If yes, do the subcontractors meet the food procurement systemrequirements?

Yes No N/A If not, explain why:

N/A: FP do not receive EFAP funding to procure food

ADMINISTRATION – SUBCONTRACTORS COMMENTS

4. As the contractor, please tell FA staff how you provide technical assistance to subcontractors to assist them in carrying out the policies and procedures of theEFAP subcontract?

CLIENT INFORMATION & SYSTEMS: COMMENTS

Yes No 5. Are the subcontractor’s consistently applying their client eligibilitypolicies/standards?

Section C – EFAP

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FISCAL: COMMENTS

6. How does the contractor determine the in-kind value for labor and food?Please explain to FA staff.

7. How does the contractor keep track of all donated goods and services? Please explain to FA staff.

Yes No 8. Based on the contractor’s application and invoices, does the contractor take theallowable amount of admin and/or indirect?

10% is allowed if contractor only. 15% if they are the contractor plus food bank and/or food pantry.

Section C – EFAP

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SECTION C, EFAP SUMMARY







Section D – TEFAP

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SECTION D – TEFAP PROGRAM SPECIFIC QUESTIONS

BONUS REDISTRIBUTION: COMMENTS

Yes No 1. Is the contractor being notified of bonus availability?

2. Does the contractor pick up commodities or are they delivered

Yes No 3. Does the contractor accept all products offered? If not, why?

FISCAL: COMMENTS

Yes No 4. Does the contractor adhere to Policy Memo FD-126, Review ofAdministrative Funds Provided to Eligible Recipient Agencies (ERA) in TEFAPand Instruction 716-3, The Emergency Food Assistance Program (TEFAP):Administrative Costs?

DISTRIBUTION: COMMENTS

5. How is the TEFAP food split amongst food pantries and meal programs?Describe to FA staff how percentages are being determined.

Food Pantries: Meal Programs:

Yes No 6. Has there been any significant change in the way TEFAP is being distributedduring this last year? Explain in the comments section:

7. Average number of clients/members served each month:

Food Pantries: Clients (signers): Household Members (all):

Meal Programs: Client Meals:

Yes No 8. Do all food pantries have the option to offer TEFAP commodities to clientsmore than once a month?

Yes No 9. Does the contractor review food pantry subcontractor’s client intake formsfor compliance with the requirement of: requesting but not requiring morethan self-declaration of income, service area?

Review contractor reports to show they monitored subcontractors for this.

PAPERWORK: COMMENTS

Yes No 10. Is the contractor (operating), in accordance with 7 CFR Part 16.4(f), faith-based or religious organizations that receive USDA Foods or administrativefunds for TEFAP or CSFP must give written notice in the manner prescribedby FA Procedures Manuals, to all beneficiaries and prospective beneficiariesof the right to be referred to an alternate provider when available.

Yes No • Are referral forms being retained?

Yes No • Are posters conspicuously displayed at all applicable sites?

Section D – TEFAP

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SECTION D, TEFAP SUMMARY







Review Participants – All Programs

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REVIEW PARTICIPANTS