THE EMERGENCY FOOD ASSISTANCE PROGRAM (TEFAP) HANDBOOK

THE EMERGENCY FOOD ASSISTANCE PROGRAM (TEFAP) HANDBOOK Revised January 2017 Food Distribution Program Page 1

INDEX What Is TEFAP?...3 Civil Rights Compliance...4 Written Notice and Referral Requirements for Religious Organizations...7 Sample Poster Written Notice of Beneficiary Rights...9 Sample Poster Beneficiary Referral Requests...10 Pantry and/or Soup Kitchen Eligibility...11 Take Home Eligibility Guidelines...12 Form FDP-105...13 Form FDP-105 Spanish...14 Accepting Recipient Signatures Electronically...15 Form Proxy Consent...16 Form Proxy Consent - Spanish...17 Site Storage Information...18 USDA Food Losses/Spoilage...19 USDA Food Complaints/Record Keeping...20 Form Temperature Log...21 Form Complaint USDA Donated Commodities...22 Instructions for Completion of Forms FDP-101 and FDP-102...23 Form FDP-101 Disposal of Federally Donated Foods...24 Form FDP-102 Transfer of Federally Donated Foods...25 Contact Information & Resources...26 Page 2

What Is TEFAP? The Emergency Food Assistance Program (TEFAP) USDA buys the food, including processing and packaging, and ships it to the States. The amount received by each State depends on its low-income and unemployed population. State agencies work out details of administration and distribution. They select local organizations that either directly distribute to households or serve meals, or distribute to other local organizations that perform these functions. USDA Foods Distribution: Under TEFAP, USDA foods are made available by the U.S. Department of Agriculture to States. States provide the food to local agencies that they have selected, usually food banks, which in turn, distribute the food to soup kitchens and food pantries that directly serve the public. Households that meet State eligibility criteria: Each State sets criteria for determining what households are eligible to receive food for home consumption. Income standards may, at the State s discretion, be met through participation in other existing Federal, State, or local food, health, or welfare programs for which eligibility is based on income. Income criteria: States can adjust the income criteria in order to ensure that assistance is provided only to those households most in need. However, recipients of prepared meals are considered to be needy and are not subject to a means test. TEFAP is administered at the Federal level by the Department of Agriculture s Food and Nutrition Service. State agencies receive the food and supervise overall distribution. Page 3

CIVIL RIGHTS COMPLIANCE Civil Rights Training Food and Nutrition Services (FNS) requires civil rights training for people involved in all levels of the administration of programs that receive Federal financial assistance. Training is required so that people involved in all levels of administration of programs that receive Federal financial assistance understand civil rights related laws, regulations, procedures, and directives. Persons responsible for reviewing CR compliance must receive training to assist them in performing their review responsibilities. This training may be carried out as part of ongoing technical assistance. The FNS Regional Office and State agencies will be responsible for training State agency staffs. State agencies are responsible for training local agencies. Local agencies are responsible for training their sub recipients, including frontline staff. Frontline staff that interacts with program applicants or participants, and those persons who supervise frontline staff, must be provided civil rights training on an annual basis. Specific subject matter must include, but not be limited to: 1. Collection and use of data, 2. Effective public notification systems, 3. Complaint procedures, 4. Compliance review techniques, 5. Resolution of noncompliance, 6. Requirements for reasonable accommodation of persons with disabilities, 7. Requirements for language assistance, 8. Conflict resolution and customer service. Public Notification All FNS assistance programs must include a public notification system. The purpose of this system is to inform applicants, participants, and potentially eligible persons of the program availability, program rights and responsibilities, the policy of nondiscrimination, and the procedure for filing a complaint.. A Basic Elements of Public Notification. The public notification system must include the following three basic elements: 1) Program Availability. Each State agency, local agency, or other sub recipient that distributes program benefits and services must take specific action to inform applicants, participants, and potentially eligible persons of their program rights and responsibilities and the steps necessary for participation. Page 4

2) Complaint Information Applicants and participants must be advised at the service delivery point of their right to file a complaint, how to file a complaint, and the complaint procedures. (And Justice for All poster) 3) Nondiscrimination Statement All information materials and sources, including Web sites, used by FNS, State agencies, local agencies, or other sub recipients to inform the public about FNS programs must contain a nondiscrimination statement. It is not required that the nondiscrimination statement be included on every page of the program information Web site. At the minimum, the nondiscrimination statement, or a link to it, must be included on the home page of the program information. The authorized nondiscrimination statement reads as follows: 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, religious creed, disability, age, political beliefs, 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) 877-8339. 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: http://www.ascr.usda.gov/complaint_filing_cust.html, 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) 632-9992. 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. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. This institution is an equal opportunity provider Page 5

If the material to be included is too small to permit the full statement, the material will at a minimum include the statement, in print size no smaller than the text that This institution is an equal opportunity provider. Each site must also display an "And Justice for All" poster, which is furnished by the FDP office. Guidelines for Processing Civil Rights Complaints The State of Nebraska DHHS will: 1. Provide information at the program delivery site advising program applicants/participants of the option to file a complaint with the Secretary of Agriculture, FNS Administrator, or the State agency. (the And Justice for All poster) 2. Accept and acknowledge complaints filed with the State agency informing the complainant of the action planned or requesting additional information needed for clarification. 3. Refer all discrimination complaints to FNS Regional Office. 4. Gather facts that will either support or refute the complainant s allegation(s), ensuring that all relevant sources of information are investigated. 5. Review and evaluate the facts gathered. 6. Write decision letters informing the complainant of closure or follow-up action. Include the complainant s right to appeal to the Secretary of Agriculture. 7. Implement corrective action, when necessary. 8. Submit a report to FNSRO of each complaint processed, prior to issuing a decision letter to the complainant for the purpose of oversight and concurrence. Page 6

WRITTEN NOTICE AND REFERRAL REQUIREMENTS FOR RELIGIOUS ORGANIZATIONS Effective July 5, 2016 - In accordance with 7 CFR Part 16.4(f), faith-based religious organizations that receive USDA Foods for T.E.F.A.P. must give written notice to all beneficiaries and prospective beneficiaries of the right to be referred to an alternate provider when available. The written notice must state that: (i) (ii) (iii) (iv) (v) The organization may not discriminate against beneficiaries on the basis of religion or religious belief, a refusal to hold a religious belief, or a refusal to attend or participate in a religious practice; The organization may not require beneficiaries to attend or participate in any explicitly religious activities that are offered by the organization, and any participation by beneficiaries in such activities must be purely voluntary; The organization must separate in time or location any privately funded explicitly religious activities from activities supported by direct Federal Financial assistance; If a beneficiary objects to the religious character of the organization, the organization will undertake reasonable efforts to identify and refer the beneficiary to an alternate provider (refer to page 5 referral requirements) to which the prospective beneficiary has no objection; the organization may not be able to guarantee, however, that in every instance, an alternate provider will be available; and Beneficiaries may report violations of these protections (including denials of services or benefits) by an organization to the State agency. The State agency will respond to the complaint and report the alleged violations to their respective USDA FNS Regional Office (http://www.fns.usda.gov/fns-regionaloffices). Organizations must provide the written notice to applicants prior to the time they enroll in the program or receive services from such programs. Exception: When the service provided to the beneficiary involves only a brief interaction between the provider and the beneficiary, and the beneficiary is receiving what may be a one-time service from the provider (such as a meal at an emergency kitchen or food for home consumption at a food pantry), the service provider may post the written notice of beneficiary protections in a prominent place, in lieu of providing individual written notice to each beneficiary. The posted written notice must be visible to all TEFAP beneficiaries and prospective beneficiaries upon entrance into the distribution site. A sample poster for posting written notice of beneficiary protections is included in this handbook. Page 7

Referral Requirements: In accordance with 7 CFR Part 16.4(g), If a beneficiary or prospective beneficiary of TEFAP objects to the religious character of an organization that provides services under the program, that organization must promptly undertake reasonable efforts to identify and refer the beneficiary to an alternate provider, if available, to which the prospective beneficiary has no objection. A sample form for recording a beneficiary referral request is included in this handbook. In making the referral, the organization must comply with all applicable State and local privacy laws and regulations. A referral may be made to another faith-based organization, if the beneficiary has no objection to that provider. But if the beneficiary requests a secular provider, and a secular provider is available, then a referral must be made to that provider. The referral must be to an alternate provider that is in reasonable geographic proximity to the organization making the referral and offers services that are similar in substance and quality to those offered by the organization, if one is available. The alternate provider also should have the capacity to accept additional clients, if one with a capacity to accept additional clients is available. A referral may be made to non-usda funded organizations, including non-tefap providers, if necessary and available. If the organization determines that it is unable to identify an alternate provider, the organization must promptly notify the State agency, or local or eligible recipient agency with which it has an agreement. That agency must determine whether there is any other suitable alternate provider to which the beneficiary may be referred. A local or eligible recipient agency that receives a request for assistance in identifying an alternate provider may requests assistance from the State agency. The State agency is ultimately responsible for ensuring an alternate provider is identified, if available. Page 8

The Emergency Food Assistance Program (TEFAP) Written Notice of Beneficiary Rights Name of Organization: Contact Information for Program Staff: Name Phone Number Email Address Because TEFAP is supported in whole or in part by financial assistance from the Federal Government, we are required to let you know that We may not discriminate against you on the basis of religion or religious belief, a refusal to hold a religious belief, or a refusal to attend or participate in a religious practice; We may not require you to attend or participate in any explicitly religious activities that are offered by us, and any participation by you in these activities must be purely voluntary; We must separate in time or location any privately funded explicitly religious activities from activities supported with USDA direct assistance; If you object to the religious character of our organization, we must make reasonable efforts to identify and refer you to an alternate provider to which you have no objection. We cannot guarantee, however, that in every instance, an alternate provider will be available; and You may report violations of these protections (including denials of services or benefits) by an organization to the State agency (http://www.fns.usda.gov/fdd/food-distribution-contacts). The State agency will respond to the complaint and report the alleged violations to their respective USDA FNS Regional Office (http://www.fns.usda.gov/fns-regional-offices). We must provide you with this written notice before you enroll in TEFAP or receive services from TEFAP, as required by 7 CFR part 16. Alternate Service Location(s) or State Agency Contact Information: Name of Organization and Contact Person Phone Number Email Address This Institution is an Equal Opportunity Provider Page 9

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PANTRY AND/OR CONGREGATE FEEDING SITE ELIGIBILITY Definitions: Food Pantry means a public or private nonprofit organization that distributes food to lowincome and unemployed households, including food from sources other than the Department of Agriculture, to relieve situations of emergency and distress. Food pantries distributing USDA foods to households for home consumption must limit the distribution of USDA foods provided to those households meeting the eligibility criteria established by the State agency. Soup Kitchen/Congregate Feeding Site means a public or charitable institution that, as an integral part of the normal activities of the institution, maintains an established feeding operation to provide food to needy homeless persons on a regular basis. Soup kitchens/congregate feeding sites providing prepared meals must demonstrate, to the satisfaction of the State agency, they serve needy persons. Suspension, Debarment and Tax Exempt Monitoring Food pantries and/or soup kitchens/congregate feeding sites must have documented taxexempt status by: 1. Currently operating another Federal program requiring tax-exempt status under the Internal Revenue Code, or 2. Possessing documentation from the Internal Revenue Service recognizing taxexempt status, or 3. If not in possession of such documentation, be automatically tax exempt as organized or operated exclusively for religious purposes under the Internal Revenue Code, or 4. Have made application for recognition of such status and be moving toward compliance with the requirements for recognition of tax-exempt status. Sub recipient Agencies must be monitored at least annually so as be in compliance with USDA Policy Memo FD-118. The IRS Automatic Revocation of Exemption List (List), which is organized by State, may be found at: http://www.irs.gov/charities-&-non- Profits/Automatic-Revocation-of-Exemption-List Agencies that are listed must be notified. ERA s (Eligible Recipient Agencies) are responsible for ensuring Sub recipient Agencies are not excluded or disqualified. This is done by checking the Excluded Parties List System (EPLS) available at www.sam.gov. Records documenting suspension and debarment monitoring must be retained for three federal fiscal years after the end of the federal fiscal year to which they pertain. The forms are to be kept in the ERA s file. Page 11

TAKE HOME ELIGIBILITY GUIDELINES The following guidelines regarding the distribution of USDA foods are provided for ERAs (Food Banks/Pantries) to use in determining which individual households are eligible for take home USDA foods. Geographic Requirement Household must be located within the State of Nebraska. Income Standards Recipient eligibility will be based on 180% of the federal poverty guidelines during each fiscal year or current participation in one of the following Social Services programs automatically meet the income guidelines: Supplemental Nutrition Assistance Program, (SNAP), Aid to Dependent Children (ADC), Low Income Emergency Assistance Program (LIEAP), Aid to the Aged, Blind, and Disabled (AABD), Medical Assistance, Refugee Resettlement Program, or State Disability Program. If the household is not participating in one of these programs, the following income guidelines apply: Effective Date: 07/01/2016 Size of household Monthly Income Size of Household Monthly Income 1 1,782.00 4 3,645.00 2 2,403.00 5 4,266.00 3 3,024.00 6 4,887.00 For each additional household member ADD $624 If the household s primary wage earner has been unemployed for thirty days or more, income is determined by using an average of the household s last three months total gross weekly income rather than the earnings over the last year. If the primary wage earner of the household has just started a job, current income is determined by using the monthly income guideline as appropriate. Instructions for Completing Declaration Form for USDA Foods (FDP-105) Use: The Declaration Form for USDA Foods (FDP-105) is used to record information pertaining to the recipient. Signature: Signature of recipient. Address: Address of recipient Number in Household: Number of persons residing in recipient s household. Month: Month in which recipient received USDA donated foods. Year: Year in which recipient received USDA donated foods. Retention: The completed forms are to be retained for three (3) federal fiscal years after the end of the federal fiscal year to which they pertain. The forms are kept in the agency s file. Page 12

Department of Health & Human Services N E B R A S K A Division of Children and Family Services Emergency Food Assistance Program (TEFAP) Eligibility to Take Food Home I, the undersigned, agree to indemnify and hold harmless this Agent and the State of Nebraska, their Departments, officers, agencies, and employees, from any and all claims, demands, damages, costs, expenses, actions, and causes of action out of any act or occurrence pertaining to the issuance and acceptance of the USDA commodity items. I further certify that my household's current gross income is equal to or below the following amounts, or that I am participating in one of the following: SNAP, ADC, State Supplemental (AABD), Energy, Medical only, State Disability, or Refugee program. I understand that if I provide incorrect information to obtain these food items, my household may be permanently suspended from this program. I also understand that, if eligible, my household can only receive these items once a month. Size of Household Current Monthly Income Size of Household Current Monthly Income 1 $ 1,782.00 4 $ 3,645.00 For each additional 2 $ 2,403.00 5 $ 4,266.00 household member add $624.00 3 $ 3,024.00 6 $ 4,887.00 Signature Address No. in Household Month Year In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write USDA, Office of the Assistant Secretary for Civil Rights,1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-2600 (voice and TDD). This institution is an equal opportunity provider. FDP-105 Rev. 7/16 (4036) (Previous version 4/15 should NOT be used) Department of Health & Human Services N E B R A S K A Division of Children and Family Services Emergency Food Assistance Program (TEFAP) Eligibility to Take Food Home I, the undersigned, agree to indemnify and hold harmless this Agent and the State of Nebraska, their Departments, officers, agencies, and employees, from any and all claims, demands, damages, costs, expenses, actions, and causes of action out of any act or occurrence pertaining to the issuance and acceptance of the USDA commodity items. I further certify that my household's current gross income is equal to or below the following amounts, or that I am participating in one of the following: SNAP, ADC, State Supplemental (AABD), Energy, Medical only, State Disability, or Refugee program. I understand that if I provide incorrect information to obtain these food items, my household may be permanently suspended from this program. I also understand that, if eligible, my household can only receive these items once a month. Size of Household Current Monthly Income Size of Household Current Monthly Income 1 $ 1,782.00 4 $ 3,645.00 For each additional 2 $ 2,403.00 5 $ 4,266.00 household member add $624.00. 3 $ 3,024.00 6 $ 4,887.00 Signature Address No. in Household Month Year In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write USDA, Office of the Assistant Secretary for Civil Rights,1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-2600 (voice and TDD). This institution is an equal opportunity provider. FDP-105 Rev. 7/16 Page (4036) 13 (Previous version 4/15 should NOT be used)

Department of Health & Human Services N E B R A S K A División de Servicios para el Bienestar Familiar y de Menores Programa Temporal de Asistencia de Alimentos de Emergencia (TEFAP, por sus siglas en inglés) Elegibilidad para llevar alimentos al hogar Yo, el abajo firmante, eximo a la presente Agencia al igual que al Estado de Nebraska, sus departamentos, oficinas, agencias y empleados de cualquier responsabilidad en cuanto a todos los reclamos, daños, costos, gastos, y derechos de causas de acción, de cualquier acto u ocurrencia que tenga que ver con la expedición y aceptación de los productos y artículos proporcionados por el USDA (Departamento de Agricultura de los Estados Unidos). Certifico además que el ingreso bruto actual de mi hogar es igual o está por debajo de las siguientes cantidades, o que estoy participando en uno de los siguientes programas: Cupones para alimentos, SNAP, ADC, programas Suplementarios del Estado (State Supplemental o también conocido como AABD), programa de energía (Energy), programas médicos solamente (Medical only), de discapacidad (State Disability), o de refugiados (Refugee.) Entiendo que si proporciono información incorrecta con el fin de obtener estos productos alimenticios, mi hogar puede ser suspendido permanentemente del programa. Entiendo además que, si califico y soy elegible, mi hogar recibirá estos productos solo una vez al mes. Cantidad de personas que habitan en el hogar Ingreso mensual actual Cantidad de personas que habitan en el hogar Ingreso mensual actual 1 $ 1, 4 $ 3,6 Por cada miembro 2 $ 2, 5 $ 4,26 del hogar adicional, agregue $624.00 3 $ 3,0 6 $ 4,88 Firma Dirección No. de personas en el hogar Mes Año Conforme con la ley federal y las políticas del Departamento de Agricultura de los Estados Unidos, a esta institución se le prohíbe discriminar según la raza, color, origen nacional, sexo o discapacidad. Para presentar una queja por discriminación, escriba al USDA, Office of the Assistant Secretary for Civil Rights,1400 Independence Avenue, SW, Washington, D.C. 20250-9410 o llame al (202) 720-2600 (teléfono de voz y de texto). Esta institución es unproveedor de igualdad de oportunidades. FDP-105-S Rev. 7/16 (4036) (Previous version 4/15 should NOT be used) Department of Health & Human Services N E B R A S K A División de Servicios para el Bienestar Familiar y de Menores Programa Temporal de Asistencia de Alimentos de Emergencia (TEFAP, por sus siglas en inglés) Elegibilidad para llevar alimentos al hogar Yo, el abajo firmante, eximo a la presente Agencia al igual que al Estado de Nebraska, sus departamentos, oficinas, agencias y empleados de cualquier responsabilidad en cuanto a todos los reclamos, daños, costos, gastos, y derechos de causas de acción, de cualquier acto u ocurrencia que tenga que ver con la expedición y aceptación de los productos y artículos proporcionados por el USDA (Departamento de Agricultura de los Estados Unidos). Certifico además que el ingreso bruto actual de mi hogar es igual o está por debajo de las siguientes cantidades, o que estoy participando en uno de los siguientes programas: Cupones para alimentos, SNAP, ADC, programas Suplementarios del Estado (State Supplemental o también conocido como AABD), programa de energía (Energy), programas médicos solamente (Medical only), de discapacidad (State Disability), o de refugiados (Refugee.) Entiendo que si proporciono información incorrecta con el fin de obtener estos productos alimenticios, mi hogar puede ser suspendido permanentemente del programa. Entiendo además que, si califico y soy elegible, mi hogar recibirá estos productos solo una vez al mes. Cantidad de personas que habitan en el hogar Ingreso mensual actual Cantidad de personas que habitan en el hogar Ingreso mensual actual 1 $ 1,7 4 $ 3,6 Por cada miembro 2 $ 2, 0 5 $ 4,26 0 del hogar adicional, agregue $624.00 3 $ 3,0 6 $ 4,88 0 Firma Dirección No. de personas en el hogar Mes Año Conforme con la ley federal y las políticas del Departamento de Agricultura de los Estados Unidos, a esta institución se le prohíbe discriminar según la raza, color, origen nacional, sexo o discapacidad. Para presentar una queja por discriminación, escriba al USDA, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 o llame al (202) 720-2600 (teléfono de voz y de texto). Esta institución es unproveedor de igualdad de oportunidades. Page 14 FDP-105-S Rev. 7/16 (4036) (Previous version 4/15 should NOT be used)

Accepting Recipient Signatures Electronically The acceptance of Electronic Recipient Signatures are acceptable for ERAs (Food Banks/Pantries) to use for individual households that are eligible for take home USDA foods. The concept of electronic signatures provides flexibility in terms of the methods available to capture and maintain a recipient s signature electronically. ERAs must ensure that any electronic signature used meets the following criteria: 1) The signature will be maintained by the ERA s electronically three (3) federal fiscal years after the end of the federal fiscal year to which they pertain. 2) The following statement is included at Acceptance at the location of the electronic signature: I, the undersigned, agree to indemnify and hold harmless this Agent and the State of Nebraska, their Departments, officers, agencies, and employees, from any and all claims, demands, damages, costs, expenses, actions, and causes of action out of any act or occurrence pertaining to the issuance and acceptance of the USDA commodity items. I further certify that my household s current gross income is equal to or below the Current Eligible Income Limits or that I am participating in one of the following: SNAP, ADC, State Supplemental (AABD), Energy, Medical only, State Disability, or Refugee program. I also understand that, if eligible, my household can only receive these items once a month. Examples of electronic signatures include: a. Handwritten signature input onto an electronic signature pad b. Handwritten signature, mark, or command input on a display screen (e.g. stylus device used to sign a document displayed on a touch screen) c. Digitized image of a handwritten signature that is attached to an electronic record d. Typed name (e.g. online application) e. Unique identifier (e.g. code, password, or PIN) f. The process of using a mouse to click a button (such as clicking an I Agree button) g. Digital signature Page 15

Please Complete (TEFAP) Emergency Food Assistance Program Beneficiary Information Below Proxy Consent Form Beneficiary Name Address City and Zip Code Phone Number I hereby designate: First (Name of Proxy) Last To serve as my proxy to sign required documents, and pick up my food benefits from the following agency: Name of Agency City I understand that I take full responsibility for the actions of my proxy. I will inform him or her of the proper procedures when acting on my behalf. My signature declares my continued eligibility for food benefits. Beneficiary Signature Proxy Signature Date Date Agency Use Only Approved By: Print Name Signature Date 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) 877 8339. 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: http://www.ascr.usda.gov/complaint_filing_cust.html, 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. Send your completed form or letter to us by mail at U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights; 1400 Independence Avenue, SW; Washington, D.C. 20250 9410. By fax: (202) 690 7442 or email at program.intake@usda.gov. This Institution is an Equal Opportunity Provider Page 16

Formulario para consentimiento de apoderado Por favor llene la información a continuación del Beneficiario para el Programa de Asistencia para Emergencias (TEFAP por sus siglas en ingles) Nombre del Beneficiario Dirección Ciudad y Código Postal Número de teléfono Por la presente nombro a Primer Nombre (Nombre de Apoderado) Apellido Como mi apoderado para firmar los documentos necesarios, y recoger mis beneficios alimenticios de la siguiente agencia: Nombre de Agencia Ciudad Entiendo que asumo la responsabilidad total por las acciones de mi apoderado. Le informaré de los procedimientos apropiados cuando actúe en representación mía Mi firma confirma mi elegibilidad continúa para beneficios alimenticios. Firma de Beneficiario Firma de Apoderado Fecha Agency Use Only Approved By: Print Name Signature Date En conformidad con la ley Federal de derechos civiles y las regulaciones y políticas de derechos civiles del Departamento de Agricultura de los EE. UU. (USDA), el USDA, sus Agencias, oficinas y empleados, y las instituciones que participen en o administren programas del USDA tienen prohibido discriminar por motivos de raza, color, origen nacional, sexo, discapacidad, edad, o represalias o retaliación por actividades previas en derechos civiles, para cualquier programa o actividad realizada o financiada por el USDA. Las personas con discapacidades que requieren medios alternos de comunicación para la información del programa (p. ej. Braille, macrotipo, reproducciones en audio, lenguaje de señas americano, etc.) deben contactar a la agencia (del Estado o local) donde solicitaron los beneficios. Las personas que sean sordas, tengan problemas de audición o discapacidades del habla pueden comunicarse con el USDA a través del Federal Relay Service (Servicio Federal de Retransmisión) al (800) 877 8339. Adicionalmente, la información sobre el programa se puede hacer disponible en idiomas que no sean inglés. Para presentar una queja por discriminación, llene el formulario USDA Program Discrimination Complaint Form, (AD 3027) disponible en línea en: http://www.ascr.usda.gov/complaint_filing_cust.html, y en cualquier oficina de USDA o escriba una carta a USDA y provea en la carta toda la información que se pide en el formulario. Envíe el formulario lleno o carta por correo postal a U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 202509410; Por fax: (202) 690 7442 o por correo electrónico a program.intake@usda.gov. Fecha Esta institución es un proveedor que ofrece igualdad de oportunidades. Page 17

SITE STORAGE INFORMATION Standards for storage facilities. Distributing agencies, sub distributing agencies and recipient agencies shall provide facilities for the handling, storage and distribution of donated foods which: 1. Are sanitary and free from rodent, bird, insect and other animal infestation; 2. Safeguard against theft, spoilage and other loss; 3. Maintain foods at proper storage temperatures per USDA foods fact sheets posted here: https://whatscooking.fns.usda.gov/fdd/household-material-fact-sheets 4. Store frozen items at a required maximum of zero degrees Fahrenheit, store dry items ideally between 50 degrees Fahrenheit and 70 degrees Fahrenheit, and store cooler items ideally between 36 degrees Fahrenheit and 40 degrees Fahrenheit. 5. Store all grain products such as pasta, rice, oats, and flour in the cooler if ideal conditions are not available in the dry storage warehouse. 6. Be sanitary and free from rodent, bird, insect, and other animal infestation. 7. Stock and space foods in a manner so that USDA donated foods are readily identified; 8. Store donated food off the floor in a manner to allow for adequate ventilation; and 9. Take other protective measures as may be necessary. Distributing agencies, sub-distributing agencies and recipient agencies shall ensure that storage facilities have obtained all required Federal, State and/or local health inspections and/or approvals and that such inspection/approvals are current. Page 18

Below are some best practices to ensure clean and safe storage of USDA food items. Check USDA foods at least twice per week Keep USDA foods away from chemicals Keep USDA foods away from water and direct sunlight Keep USDA foods free from insects Keep USDA foods under lock and key Check refrigerator and freezer temperatures daily First-In-First-Out Concept The most basic rule of inventory management is first-in-first-out (FIFO) foods delivered to the warehouse first (first in) should be the first items (first out) distributed to recipient agencies, households and used in congregate feeding sites. You can achieve an acceptable level of accuracy by marking the pallets, or cases if you receive mixed pallets, with the date you receive them and practicing FIFO. This will significantly reduce the risk of product going out of condition. Also, consider the amount of product already in inventory. Excessive inventory increases the risk of product going out of condition. Storage conditions can have a significant impact on the quality of food products. The same product will last for different periods of time depending on the temperature of the warehouse, the humidity level, and air circulation. In general, cool temperatures and low humidity provide the best storage conditions. Food should be stored off the floor, out of direct sunlight, and away from contact with walls and ceilings. USDA Food Losses/Spoilage In those instances in which USDA foods may become damaged, spoiled, or lost while in the possession of a pantry, soup kitchen, or food bank, a representative of the organization is to contact the Food Distribution Program office at the Nebraska Department of Health and Human Services to inform us of the loss. Our telephone number is (402) 471-9351. This contact is to be made before any USDA foods are destroyed. The disposal form must be filled out by the person authorized to destroy any out-of-condition USDA foods and a witness. After considering the circumstances surrounding the loss of the USDA foods and the dollar value involved, this agency or the U.S. Department of Agriculture may make a financial claim against the agency involved. It is, therefore, very important that you as the authorized representative of your agency be sure that the USDA foods are properly stored, secured, and that supporting documentation is on hand with reference to USDA foods received and distributed by your organization. The above described policies with reference to a claim also are in effect should a review of your records by this agency indicate that USDA foods have been lost. Page 19

Complaints All food product and program complaints should be directed to: Food Distribution Program, Nebraska Health and Human Services, P.O. Box 95026, Lincoln, NE 68509. Forms are also available from the Food Distribution Program (FDP). These forms must be filled out completely including contract number and lot number from the case. Record Keeping The recipient agency (food bank, pantry or emergency feeding organization) will keep complete and thorough records of all shipments, issuance and transfers for all USDA food products received under this program for a period three (3) federal fiscal years after the end of the federal fiscal year to which they pertain. The recipient agency will maintain accurate receipts of all shipments. These receipts will contain the following information: 1. Date of transaction 2. Name of delivery carrier 3. Name of food product and size 4. Quantity received 5. Signature of delivery agent 6. Signature of receiving agent When a quantity of product is moved from a food bank to a pantry or from one location to another, the same data needs to be collected by both the sending and receiving entities. Each recipient agency must keep records of households receiving USDA foods. The records must reflect the following information: 1. The name of the household member receiving USDA foods 2. The address of the household (to the extent practicable) 3. The number of persons in the household, and 4. The basis for determining that the household is eligible to receive USDA foods for home consumption If product should be exchanged from one recipient agency to another, i.e., one pantry to another facility, this transaction must be approved in advance by the Food Distribution Program office and the proper transfer forms completed prior to the actual transfer of the USDA foods. Page 20

Nebraska Food Distribution Program STORAGE TEMPERATURE LOG MONTH: YEAR: DAY TIME COOLER 32-40 F 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 7/1/15 FREEZER 0 F or below DRY STORAGE 50-70 F INITIAL Page 21

RECIPIENT AGENCY USE ONLY Recipient Agency Name: Complaint Form USDA Donated Commodities Address: (Include Street, City, State, And Zip) Contact Person: Title: Phone #: Date: Commodity: Contract #: Lot #: Case/Box #: Can Code: Pack Date: Date Received: Amount Received Vendor: Location Of Product: Amount Product Remaining: Reason For Complaint: Seeking Replacement: { } For Information Only: { } Isolated Incident: { } Other: { } Vendor Response Requested: { } Description Of Problem/Complaint: (Hand Written Or Typed) Return this completed form to: Or Fax to: cynthia.milholland@nebraska.gov NE Food Distribution Program NE Food Distribution Program 402-742-2328 PO Box 95026 Lincoln, NE 68509 Page 22

INSTRUCTIONS FOR COMPLETION OF FDP-101 AND FDP-102 FDP-101: Disposal of Federally Donated Foods This form is to be used when disposing of any USDA foods, which have spoiled or are out of condition for some other reason. When this occurs, you are to first receive permission to destroy these products by contacting Food Distribution at the Department of Health and Human Services. USDA foods may not be disposed of until permission is received from Food Distribution to do so. The items are to be disposed of by separating the food itself from the package and destroying both separately. The FDP-101 must be filled out, signed by the person disposing the food and a witness. The original form is sent to Food Distribution of the Department of Health and Human Services. We will co-sign the FDP-101 and return a copy to your office for your files. The form is to be kept on file for three Federal Fiscal years from the year to which it pertains. FDP-102: Transfer of Federally Donated Foods This form is used when USDA foods are transferred to another agency or office of this Department (i.e., pantry to pantry). Following a determination that it is necessary to transfer the items, contact Food Distribution to receive verbal permission to do so. At the time of the transfer, a representative of the agency releasing the food signs the first signature line and a representative of the agency receiving the food signs the second signature line. The form is then sent to Food Distribution where it will be counter-signed. A copy will then be provided to you as well as the other agency involved for each of your files. Page 23

FOOD DISTRIBUTION PROGRAM FORM FDP-101 Rev. 5/2016 DISPOSAL OF FEDERALLY DONATED FOODS Name and Address of Recipient Date Approval for disposal of Foods Listed Below: Food Type /Item No. Amount Manuf. Lot Number Packing Date Date received CNP Invoice No. Value Example: Peaches 100219 1 30# Case 35262016-0716 04-01-2014 01-09-2015 14816 $30.61 Reason for Disposal Instruction for Disposal: Either put in disposal, or Empty container and place in separate bags with either bleach or ammonia. Authorized Recipient Agency Representative Signature Date Witness for Recipient Agency Signature Date Food Distribution Program Representative Signature Date PLEASE keep ONE COPY with your records. RETURN ONE COPY TO: FOOD DISTRIBUTION PROGRAM, P.O. BOX 95026 LINCOLN, NE 68509-5026 Claim Reimbursement Information Must Be Complete Page 24

Date: FOOD DISTRIBUTION PROGRAM Transfer of Federally Donated Foods Name and Address of Recipient Agency Releasing Donated Food Name and Address of Recipient Agency Receiving Donated Food Approval for transfer of foods listed in the amounts below: Reason for transfer: Instructions for transfer: PREAPPROVED TRANSFER FORM (Upon completion of transfer, return completed form to: NE DHHS Food Distribution Program, P.O. Box 95026, Lincoln, NE 68509-5026) I hereby certify that the foods listed hereon have been transferred in accordance with the instructions listed below. Sign Here Signature and Title of Authorized Representative Releasing Food Date Sign Here Signature and Title of Authorized Representative Receiving Food Date Sign Here Signature of Food Coordinator, NE DHHS Food Distribution Program Date Please retain your completed copy with your records until September 30, 20 Page 25 FDP-102 Rev. 6/16

CONTACT INFORMATION AND RESOURCES Food Distribution Program Nebraska Department of Health and Human Services Division of Children & Family Services P.O. Box 95026 Lincoln, NE 68509-5026 www.dhhs.ne.gov Chad Mohr, Program Coordinator Telephone: 402-471-9644 Fax: 402-742-2328 Email: chad.mohr@nebraska.gov Cynthia Milholland, Business Manager I Telephone: 402-471-9351 Fax: 402-742-2328 Email: cynthia.milholland@nebraska.gov Brian Gerkensmeyer, Staff Assistant II Telephone: 402-471-9377 Fax: 402-742-2328 Email: brian.gerkensmeyer@nebraska.gov USDA, Food Safety Information http://www.choosemyplate.gov/sites/default/files/misc/foodproductdating.pdf USDA, Food and Nutrition Services http://www.fns.usda.gov/tefap/emergency-food-assistance-program-tefap Food Bank for the Heartland 10525 J Street Omaha, NE 68127 Telephone: 402-331-1213 Website: www.foodbankheartland.org Food Bank of Lincoln 4840 Doris Bair Circle Lincoln, NE 68504 Telephone: 402-466-8170 Website: www.lincolnfoodbank.org Page 26

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