Administration and Forms for CSFP

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CSFP Forms

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Form Name	Form Number	Program Name
2024 Income Eligibility Guidelines for the Elderly	H1666	CSFP Forms
Agreement Between Contracting Entity and Site	H1501	CSFP Forms
Agreement Between Contracting Entity and Subdistributing Agency	H1505	CSFP Forms
Agreement Between Contracting Entity and Texas Department of Agriculture	H1502	CSFP Forms
Annual Audit	AUDIT	CSFP Forms
Annual Inventory Report (USDA Foods)	H1526	CSFP Forms
Application for Texas Identification Number	AP-152	CSFP Forms
Application Notification	H1515	CSFP Forms
Certification Expiration Notice	H1507	CSFP Forms
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts	H2048	CSFP Forms
Certification Regarding Federal Lobbying	H2049	CSFP Forms
CSFP Missed Distribution Poster - Landscape Layout		CSFP Forms
CSFP Missed Distribution Poster - Portrait Layout		CSFP Forms
Direct Deposit Authorization	74-176	CSFP Forms
Disclosure of Lobbying Activities		CSFP Forms
Disclosure of Lobbying Activities Continuation Sheet		CSFP Forms
F&N Complaint Form - English		CSFP Forms
F&N Complaint Form - Spanish		CSFP Forms
FND-136 Security Authorization for WBSCM Users	FND136	CSFP Forms
Instructions for Authorization to Transfer USDA Foods	H4529	CSFP Forms
Micro-Purchase Log		CSFP Forms
Participant Application	H1504	CSFP Forms
Participant Rights and Responsibilities	H1516	CSFP Forms
Participant Transfer Form		CSFP Forms
Payee Change Request	74-157	CSFP Forms
Proxy Form		CSFP Forms
Report of Loss of USDA Foods	H1638	CSFP Forms
Request for Emergency USDA Foods	H1579	CSFP Forms
Site Information	H1503	CSFP Forms
Small Purchase Log		CSFP Forms
Temperature Record	H1639	CSFP Forms
Temporary Certification	H1509	CSFP Forms
USDA Foods Complaint Form - English		CSFP Forms
USDA Foods Complaint Form - Spanish		CSFP Forms
CSFP Missed Distribution Poster - SPANISH - Landscape Layout		CSFP Forms
CSFP Missed Distribution Poster - SPANISH - Portrait Layout		CSFP Forms
Written Notification to Participants Checklist		CSFP Forms
Pre-Award Civil Rights Compliance Review		CSFP Forms
Written Notice of Beneficiary Rights		CSFP Forms
Written Notice of Beneficiary Rights - SPANISH		CSFP Forms
Equipment Inventory Form		CSFP Forms

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Assistance available in English and Spanish. Please call 877-TEX-MEAL (877-839-6325) for help. Additional translations services available as well.

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:

1. Mail:

U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or

2. Fax: (833) 256-1665 or (202) 690-7442; or

3. Email: program.intake@usda.gov.

This institution is an equal opportunity provider.