Administration and Forms for TEFAP

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TEFAP Forms

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Form Name	Form Number	Program Name
2024-2025 TEFAP Income Eligibility Guidelines	H1640	TEFAP Forms
2023-2024 TEFAP Income Eligibility Guidelines	H1640	TEFAP Forms
Annual Audit	AUDIT	TEFAP Forms
Application for Texas Identification Number	AP-152	TEFAP Forms
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts	H2048	TEFAP Forms
Certification Regarding Federal Lobbying	H2049	TEFAP Forms
Direct Deposit Authorization	74-176	TEFAP Forms
Disclosure of Lobbying Activities		TEFAP Forms
Disclosure of Lobbying Activities Continuation Sheet		TEFAP Forms
F&N Complaint Form - English		TEFAP Forms
F&N Complaint Form - Spanish		TEFAP Forms
FND-136 Security Authorization for WBSCM Users	FND136	TEFAP Forms
Household Application for USDA Foods/Solicitud domestica de los alimentos del USDA	H1555	TEFAP Forms
Household Application for USDA Foods-Alternate	H1555B	TEFAP Forms
Household Application for USDA Foods-Alternate (Spanish)	H1555B	TEFAP Forms
Instructions for Authorization to Transfer USDA Foods	H4529	TEFAP Forms
Micro-Purchase Log		TEFAP Forms
Payee Change Request	74-157	TEFAP Forms
Report of Loss of USDA Foods	H1638	TEFAP Forms
Request for Emergency USDA Foods	H1579	TEFAP Forms
Small Purchase Log		TEFAP Forms
TEFAP Agreement Between Contracting Entity and Site		TEFAP Forms
TEFAP Agreement Between Contracting Entity and Subdistributing Agency		TEFAP Forms
TEFAP Agreement Between Contracting Entity and Texas Department of Agriculture		TEFAP Forms
TEFAP Participant Rights and Responsibilities		TEFAP Forms
TEFAP Site Information	H1510	TEFAP Forms
Temperature Record	H1639	TEFAP Forms
USDA Foods Complaint Form - English		TEFAP Forms
USDA Foods Complaint Form - Spanish		TEFAP Forms
Pre-Award Civil Rights Compliance Review		TEFAP Forms
Written Notice of Beneficiary Rights		TEFAP Forms
Written Notice of Beneficiary Rights - SPANISH		TEFAP Forms
Equipment Inventory Form		TEFAP 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.