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Administration and Forms for FMNP

FMNP Forms

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Annual Audit  AUDIT Download File  Download File      FMNP Forms
Application for Texas Identification Number  AP-152 Download File        FMNP Forms
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts  H2048 Download File  Download File      FMNP Forms
Certification Regarding Federal Lobbying  H2049 Download File  Download File      FMNP Forms
Claim for Reimbursement    Download File  Download File  Download File  Download File   FMNP Forms
Direct Deposit Authorization  74-176 Download File        FMNP Forms
Disclosure of Lobbying Activities    Download File        FMNP Forms
Disclosure of Lobbying Activities Continuation Sheet    Download File        FMNP Forms
F&N Complaint Form - English    Download File    Download File    FMNP Forms
F&N Complaint Form - Spanish    Download File    Download File    FMNP Forms
Farmers' Market Nutrition Program Allowed-Disallowed Foods  H1442 Download File  Download File      FMNP Forms
Farmers' Market Review    Download File  Download File  Download File    FMNP Forms
Farmers' Voucher Redemption List    Download File  Download File  Download File    FMNP Forms
FMNP Agreement Between Contracting Entity and Famers’ Market Association  FMNP-02 Download File  Download File      FMNP Forms
FMNP Agreement Between TDA and Contracting Entity  FMNP-01 Download File  Download File      FMNP Forms
FMNP Agreement Between TDA and Contracting Entity – AMENDMENT  FMNP-01A Download File  Download File      FMNP Forms
FMNP Farmer Profile and Agreement Between Farmer and Farmers’ Market Association  FMNP-03 Download File  Download File      FMNP Forms
Food Calendar  H1443 Download File  Download File      FMNP Forms
Participant Voucher Issuance Log    Download File  Download File  Download File  Download File   FMNP Forms
Payee Change Request  74-157 Download File        FMNP Forms

Assistance available in English and Spanish. Please call 877-TEX-MEAL (877-839-6325) for help.

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

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

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-0508-0002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:

1. Mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
2. Fax: (833) 256-1665 or (202) 690-7442; or
 
This institution is an equal opportunity provider.
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