Administration and Forms for Summer Meal Programs

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USDA SFSP Reference Materials/Sample Forms and TDA SFSP Forms

USDA’s SFSP Administrative Guidance for Sponsors (AGS) has a section titled Reference Materials where USDA has provided documents that can be used by contracting entities (sponsors) and sites. In addition, the USDA SFSP Sponsor Monitor’s Guide and the Nutrition Guide also have sample forms that can be used. You can find the USDA SFSP handbooks at http://www.fns.usda.gov/sfsp/handbooks. Forms provided by TDA for use in SFSP are available in the table below.

SFSP Forms

Enter Search Value:
- without any prefix or suffix to find all records where a column contains the value you enter, e.g. Net
- with | prefix to find all records where a column starts with the value you enter, e.g. |Network
- with | suffix to find all records where a column ends with the value you enter, e.g. Network|
- with | prefix and suffix to find all records containing the value you enter exactly, e.g. |Network|

Form Name	Form Number	Program Name
2021 - 2022 School Data for Area Eligibility	SCHOOL DATA	SFSP Forms
2022 - 2023 School Data for Area Eligibility	SCHOOL DATA	SFSP Forms
Addendum - Option to Renew IFB and Contract for Purchased Meals SFSP	IFB - RENEW SFSP	SFSP Forms
Addendum - Option to Renew IFB and Contract for Purchased Meals SFSP & At-Risk	IFB - RENEW SFSP & AT-RISK	SFSP Forms
Additional Assurances for Camps and Other Enrollment Programs that Charge Separately for Meals; Collection of Payment Options for Programs that Charge Separately for Meals	H1506-A	SFSP Forms
Application for Texas Identification Number	AP-152	SFSP Forms
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts	H2048	SFSP Forms
Certification Regarding Federal Lobbying	H2049	SFSP Forms
Child Nutrition Programs Waiver Request		SFSP Forms
Daily Menu Production Worksheet		SFSP Forms
Direct Deposit Authorization	74-176	SFSP Forms
Disclosure of Lobbying Activities		SFSP Forms
Disclosure of Lobbying Activities Continuation Sheet		SFSP Forms
F&N Complaint Form - English		SFSP Forms
F&N Complaint Form - Spanish		SFSP Forms
Gender Separation Exception Request Form		SFSP Forms
Payee Change Request	74-157	SFSP Forms
Permanent Agreement Contracting Entity Specific Amendment - Name		SFSP Forms
Permanent Agreement Contracting Entity Specific Amendment - Programs		SFSP Forms
Pre-Award Civil Rights Compliance Review		SFSP Forms
Prototype Letter: Health Department Notification		SFSP Forms
Racial/Ethnic Participant Data Collection Prototype		SFSP Forms
Record of Leftover/Recycled Food	H1568	SFSP Forms
SFSP - Claim for Reimbursement - Site Level		SFSP Forms
SFSP and At-Risk Invitation for Bid (IFB) and Contract for Purchased Meals	IFB - SFSP AND AT-RISK	SFSP Forms
SFSP Invitation for Bid (IFB) and Contract for Purchased Meals	IFB - SFSP	SFSP Forms
Shared Eligibility Form		SFSP Forms
Temperature Record	H1639	SFSP Forms
Texas Department of Agriculture Food and Nutrition Division Permanent Agreement		SFSP Forms
USDA Foods Agreement Between Contracting Entity and Texas Department of Agriculture		SFSP Forms
Participant Notification of SFSP Meals - Closed Enrolled Site - AREA ELIGIBLE		SFSP Forms
Participant Notification of SFSP Meals - Closed Enrolled Site - NON-AREA ELIGIBLE		SFSP Forms
Participant Notification of SFSP Meals - Closed Enrolled Site - CAMP SITE		SFSP Forms
SFSP Household Application for Closed Enrolled and Camp Sites (Prototype)		SFSP Forms
Sample First Two Weeks Site Visit Form		SFSP Forms
Sample Site Review Form		SFSP Forms
Request to Provide Non-Congregate Feeding during Extreme Heat		SFSP Forms
Milk Flexibility for Emergency Conditions Notification Form		SFSP Forms
Micro-Purchase Log		SFSP Forms

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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

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

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