Administration and Forms for SFMNP

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SFMNP Forms

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Form Name	Form Number	Program Name
2024-2025 SFMNP Income Eligibility Guidelines	H1668	SFMNP Forms
2023-2024 SFMNP Income Eligibility Guidelines	H1668	SFMNP Forms
Annual Audit	AUDIT	SFMNP Forms
Application for Texas Identification Number	AP-152	SFMNP Forms
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts	H2048	SFMNP Forms
Certification Regarding Federal Lobbying	H2049	SFMNP Forms
Claim for Reimbursement Vouchers and Administrative Expenses		SFMNP Forms
Direct Deposit Authorization	74-176	SFMNP Forms
Disclosure of Lobbying Activities		SFMNP Forms
Disclosure of Lobbying Activities Continuation Sheet		SFMNP Forms
F&N Complaint Form - English		SFMNP Forms
F&N Complaint Form - Spanish		SFMNP Forms
Farmers' Market Review		SFMNP Forms
Farmers' Voucher Redemption List		SFMNP Forms
Participant Application - English	H1430	SFMNP Forms
Participant Application - Spanish	H1430S	SFMNP Forms
Participant Voucher Issuance Log		SFMNP Forms
Payee Change Request	74-157	SFMNP Forms
S/FMNP Farmers' Market, Roadside Stand, and Certification/Issuance Site Information Form	H1420	SFMNP Forms
Senior Farmers' Market Nutrition Program Allowed-Disallowed Foods	H1440	SFMNP Forms
SFMNP Agreement Between Contracting Entity and Famers’ Market Association	SFMNP-03	SFMNP Forms
SFMNP Agreement Between Contracting Entity and Sub-Distributing Agency	SFMNP-02	SFMNP Forms
SFMNP Agreement Between TDA and Contracting Entity	SFMNP-01	SFMNP Forms
SFMNP Farmer Profile and Agreement Between Farmer and Farmers’ Market Association	SFMNP-04	SFMNP Forms
SFMNP Farmer Profile and Bulk Purchase Agreement	SFMNP-05	SFMNP Forms
SFMNP Site Review		SFMNP Forms
Vendor Integrity Evaluation Report		SFMNP Forms
Voucher Receipt Log	H1451	SFMNP Forms
SFMNP Agreement Between TDA and Contracting Entity – AMENDMENT	SFMNP-01A	SFMNP 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.