HomeMy WebLinkAbout940991 RESOLUTION
RE: APPROVE DONATED FOODS AGREEMENT FOR COMMODITY SUPPLEMENTAL FOOD PROGRAM
BETWEEN HUMAN SERVICES AND COLORADO DEPARTMENT OF HUMAN SERVICES AND
AUTHORIZE CHAIRMAN TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado,
pursuant to Colorado statute and the Weld County Home Rule Charter, is vested
with the authority of administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Donated Foods Agreement for
Commodity Supplemental Food Program between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on
behalf of the Weld County Division of Human Services, and the Colorado Department
of Human Services, commencing October 1, 1994, and ending September 30, 1995,
with further terms and conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said
agreement, a copy of which is attached hereto and incorporated herein by
reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Donated Foods Agreement for Commodity Supplemental
Food Program between the County of Weld, State of Colorado, by and through the
Board of County Commissioners of Weld County, on behalf of the Weld County
Division of Human Services, and the Colorado Department of Human Services be, and
hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chairman be, and hereby is,
authorized to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded,
adopted by the following vote on the 10th day of October, A.D. , 1994, nunc pro
tunc October 1, 1994.
BOARD OF COUNTY COMMISSIONERS
ATTEST: WELD COUNTY, COLORADO
,,dY � U
Weld County Clerk to the Board (C /�/'�y ��LL ��/'Q=
Web Ater; Chairman
C n
BY: 1 �- 1145_11„
�� W.
C�
eputy erk to the Board Dale K. Hall,
P Y S
APPROVED AS TO FORM:
George Baxter
ounty or ey Constance L. Harbert9
%bthS /&r
940991
i ipr,•,t )a Lye. . k� (3642e.9.)
DF-2B (Rev. 09/94
COLORADO DEPARTMENT OF HUMAN SERVICES
1575 Sherman Street, 3rd Floor
Denver, CO 80203-1700
Donated Foods Agreement
Commodity Supplemental Food Program
(Serving Low Income Women, Infants, Children and Elderly)
This agreement is made this (Enter today's date) day of 19 by
and between the Colorado Department of Human Services, 1575 Sherman Street, 3rd Floor,
Denver, CO 80203-1700 (hereinafter referred to as the "Department"), and the (Enter your
agency's name) Weld County Division of (hereinafter referred to as the "Recipient
Agency"). Human Services
Whereas, the Department is a distributing agency under a contract with the U.S.
Department of Agriculture (hereinafter referred to as "USDA"). The Contract with USDA
is subject to all federal laws and regulations. USDA controls the amount and types of
commodities available to the Department.
Whereas, the Department has the responsibility for administering the Food
Distribution Programs in Colorado in accordance with its Contract with USDA, and;
Whereas, the Recipient Agency desires to participate in the Donated Foods Program
in accordance with the terms of this Agreement; and
Whereas, as of the date of execution of the Agreement, Recipient Agency meets all
requirements for participation in this program.
NOW, THEREFORE, it is hereby agreed:
1. The Recipient Agency is operating a Commodity Supplemental Food Program which
provides supplemental foods to low income pregnant and postpartum women,infants,
children and elderly; and
Complete the following questions:
The Recipient Agency has the following types of storage facilities available:
Dry Yes x No_
Cooler Yes x No
Frozen Yes x No
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2. Recipient Agency shall participate in the Donated Foods Program in accordance with the
terms of the Agreement and applicable legal requirements described below.
3. The term "legal requirements" as it is used throughout this Agreement includes federal
and state statutes, federal and state regulations program requirements as identified in the
Food Distribution Unit Recipient Agency User's Handbook, State Plan of Operation and
Administration attached hereto and incorporated herein as Exhibit A and any amendments
thereto, which are applicable to the Food Distribution Programs, which are in effect when
this Agreement is executed. The Recipient Agency agrees to fully comply with all legal
requirements defined above, and to submit any reports requested by the Department or
USDA in a prompt and complete manner, and to enforce such legal requirements against
any sub-distributing agencies which are under contract with the Recipient Agency.
4. Recipient Agency shall receive, store and distribute donated foods. In addition, the
Recipient Agency agrees to comply with the following terms and conditions:
A. Use of Donated Foods
Donated food will be used only in connection with Recipient Agency's established
feeding operation for the sole benefit of persons served by the Recipient Agency
and will not be sold,exchanged,or otherwise disposed of by the Recipient Agency
without express written approval being obtained by the Recipient Agency from the
Department.
B. Storage Facilities
The Recipient Agency and any sub-distributing agencies under contract with the
Recipient Agency shall provide adequate facilities for the handling, storage and
distribution of donated foods. These facilities shall be such as to properly
safeguard against damage, theft, spoilage, or other loss as recommended in the
"Food Storage Guide for Schools and Institutions" in the Food Distribution Unit
User's Handbook. The Recipient Agency shall provide facilities and services that:
1. Are sanitary and free from rodent, bind,insect and other animal infestation;
2. Safeguard against theft, spoilage and other loss;
3. Maintain foods at proper storage temperatures;
4. Stock and space foods in a manner so the USDA-donated foods are readily
identified;
5. Rotate stock utilizing "First-In/First-Out" inventory practices;
6. Store donated food off the floor and away from walls in a manner to allow
for adequate ventilation;
7. Maintain accurate inventory records of product issuance; and
8. Take other protective measures as may be necessary.
The Department reserves the right to inspect the facilities, without the
benefit of prior notification, to ensure these standards are met.
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C. Responsibility for Damage. Spoilage. Theft or Other Loss
Once the donated foods have been delivered to the Recipient Agency or its carrier agent,
the Recipient Agency is responsible to the Department for said food. In the event of
damage, spoilage, theft or other loss, the Recipient Agency will promptly notify the
Department. In case of spoilage, the Recipient Agency shall furnish a certificate from the
County or the State Health Department representative confirming such spoilage.
The Recipient Agency assumes full responsibility for reimbursing the Department for the
USDA dollar value of any donated foods improperly used or disposed of or any loss or
damage to donated foods due to the failure of the Recipient Agency or its agents to
provide proper storage, care or handling. The Recipient Agency may be required by the
Department to submit documentation regarding the loss.
D. Physical Inventory
Recipient Agencies shall take an annual physical inventory of USDA commodities the last
working day of September and submit the inventory to the Department, not later than the
5th of October, in a format prescribed by the Department. Such inventory shall be
reconciled with the Recipient Agency's book inventory records and maintained on file by
the Recipient Agency.
In no event, may the inventory level of each donated food in storage exceed a six-month
supply unless sufficient justification for additional inventory has been submitted and
approved by the Department.
E. Complaints
The Recipient Agency shall immediately advise the Department in writing of any
complaints regarding the donated foods. The Recipient Agency shall provide appropriate
information regarding the product and nature of the complaint so that an investigation can
by pursued by the Department or USDA. In addition, any complaints regarding the
commercial distribution system shall be provided to the Department in writing for
appropriate action.
F. Utilization and Redistribution
Available donated foods will be requested only in such quantities as will be fully utilized
and will be receipted for by the authorized representative of the Recipient Agency. The
Department reserccs the right to redistribute any USDA donated foods in possession of
the Recipient Agency.
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G. Records
The Recipient Agency will accurately maintain records of donated foods received and
such accountability records as may be prescribed by the Department. Such records shall
include, but not be limited to, accurate and complete records with respect to the receipt,
disposal, and inventory of donated foods and with respect to any funds which arise from
the operation of the program. The Recipient Agency shall also keep accurate and
complete records showing the certification and eligibility determination of those making
application for program participation. All records must be retained for a period of three
years from the close of the federal fiscal year to which they pertain.
H. Audits and Inspections
The Recipient Agency shall allow representatives of the Department and/or USDA to
inspect and inventory donated foods in storage, the facilities used in the handling or
storage of such donated foods inspect and audit all records, including financial records
and reports pertaining to the distribution of donated foods, and to review or audit the
procedures and methods used in carrying out the audit requirements at any reasonable
time with or without the benefit of prior notification.
All Recipient Agencies receiving more than $25,000 in federal financial assistance per
fiscal year shall have an audit matte by an independent auditor, that complies with the
audit requirements established by the Office of Management and Budget Circular Number
A-128 or A- 133. The audit standards to be followed can be found in the Standards for
Audit of Governmental Organizations.Programs.Activities and Functions (1988 revision)
issued by the U.S. General Accounting Office, and the Guidelines for Audits of Federal
Awards to Nonprofit Organizations (April 1989) published by the Department of Health
and Human Services. For this purpose, the term independent auditor means a state or
local government auditor who meets the independence standards specified in generally
accepted government auditing standards; or, certified public accountant who meets such
standards.
Financial
1. Quarterly Statements of Expenditures
As required in the State Plan of Operation and Administration the Recipient Agency shall
submit to the Department by the 15th of the month following the close of the quarter, a
Quarterly Statement of Expenditure report reflecting an accurate amount of funds
expended for the quarter. The Department will reimburse the Recipient Agency their fair
share percentage of federal funds available based upon each Recipient Agency's actual
expenditures submitted for the previous quarter. The reimbursement portion of federal
funds will be disbursed to the Recipient Agency based on actual cases of"bonus" donated
foods distributed during the previous quarter. Quarterly Statements of Expenditures shall
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be kept current and available for audit and review purpose at the Recipient Agency.
2. Distributor Charges
The Recipient Agency shall pay the quoted price per case directly to the contracted
regional distributor as billed for the number of cases received on each shipment. The
Recipient Agency shall comply with the distributor's credit policy and payment terms.
In the event a Recipient Agency falls more than 60 days in arrears in payments to the
distributor, the Department and the distributor may jointly agree to suspend issues of
donated foods and the distributor may take necessary action to pursue collection of the
account. The Recipient Agency shall request reimbursement for payments made to the
distributor on a form prescribed by the Department.
J. Civil Rights and Nondiscrimination
The Recipient Agency at all times during the execution of this agreement shall strictly
adhere to all applicable federal and state laws and implementing regulations as they
currently exist and may hereafter be amended. This includes protection of the
confidentiality of all applicant/recipient records, papers, documents, tapes and any other
materials that have been or may hereafter be established which relate to this agreement.
The Recipient Agency acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964, 42 U.S.C.
Sections 2000d-1 et. sea. and its implementing regulation, 45 C.F.R. Part 80 et.
s and
Section 504 of the Rehabilitation Act of 1973,
29 U.S.C. Section 794, and its implementing regulation, 45 C.F.R. Part 84;and
the Age Discrimination Act of 1975, 42 U.S.C. Sections
6101 et. sea. and its implementing regulation, 45 C.F.R. Part 91-and
Title VII of the Civil Rights Act of 1964; and
the Age Discrimination in Employment Act of 1967;
and
the Equal Pay Act of 1963; and
the Education Amendments of 1972.
Immigration Reform and Control Act of 1986, P.L.
99-603
The Recipient Agency shall comply with all regulations applicable to these laws
prohibiting discrimination because of race, color, national origin, age, sex and handicap,
including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions,
covered in Section 504 of the Rehabilitation Act of 1973, as amended, cited above. This
assurance is given in consideration of and for the purpose of obtaining any and all federal
and/or state financial assistance. Any person who feels that she/he has been discriminated
against has the right to file a complaint either with the Colorado Department of Human
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The Recipient Agency shall comply with all regulations applicable to these laws
prohibiting discrimination because of race, color, national origin, age, sex and
handicap, including Acquired Immune Deficiency Syndrome (AIDS)or AIDS related
conditions, covered in Section 504 of the Rehabilitation Act of 1973, as amended,
cited above. This assurance is given in consideration of and for the purpose of
obtaining any and all federal and/or state financial assistance. Any person who feels
that she/he has been discriminated against has the right to file a complaint either
with the Colorado Department of Human Services or with the U.S. Department of
Agriculture, Office for Civil Rights.
The Recipient Agency is responsible for any additional Civil Rights reporting
requirements as set forth in the State Plan of Operation and Administration.
K. ' Indemnification
To the extent authorized by law, the Recipient Agency shall indemnify, save and hold
harmless the State, its employees and agents, against any and all claims, damages,
liability and court awards including costs, expenses, and attorney fees incurred as a
result of any act or omission by the Recipient Agency, or its employees, agents,
subcontractors, or assignees pursuant to the terms of this Agreement.
L. Enforcement
If the Recipient Agency fails to comply with the provisions of this Agreement, it may,
at the discretion of the Department, be disqualified from further participation in the
Program. The Recipient Agency or the Department may seek judicial relief for any
provision of this Agreement.
M. Effective Date
This Agreement will become effective on the date of approval by the Executive
Director of the Department or authorized designee, and shall remain in effect until
September 30, 1995. The Recipient Agency or the Department may terminate this
Agreement at any time by giving thirty days notice in writing. Upon such termination
by either the Recipient Agency or the Department, the Recipient Agency shall, at its
expense, return all unused donated foods in its possession to such place within the
State of Colorado as may be designated by the Department.
N. Assignment
The Recipient Agency agrees not to assign its rights or to delegate its obligations
under this Agreement without prior approval in writing from the Department.
0. Future Effect
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This Agreement is binding upon the present and future elected or employed officials
of the Recipient Agency and the State of Colorado.
P. Authorized Representative
It shall be the duty of the Recipient Agency to promptly notify, in writing, the
Department of any change in its Agency Head or authorized representative or
change in legal address.
Q. Signatures
The individual signing this Agreement as the "Agency Head" or "Authorized
Representative" (as attested if a corporation) certifies that his/her signature legally
binds the Recipient Agency to the terms of this Agreement.
TYPE OR PRINT ALL INFORMATION BELOW:
DATE: /0//0/91/
NAME OF RECIPIENT AGENCY:
WELD COUNTY BOARD OF COMMISSIONERS
ADDRESS:
915 10th Street STATE OF COLORADO
P.O. Box 758
Greeley, CO 80632 DEPARTMENT OF HUMAN
SERVICES
PHONE #: (303) 356-4000 DATE /6 9 APPROVED
SIGNATURE AND n ILE OF AGENCY HEAD
OR AUTHORIZED REPRESENTATIVE:
W. H. Webster, Chairman /o/; ly't{ BARBARA McDONNEL
EXECUTIVE DIRECT
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STATE PLAN OF OPERATION AND ADMINISTRATION
COMMODITY SUPPLEMENTAL FOOD PROGRAM
FEDERAL FISCAL YEAR 1995 (FFY95)
TABLE OF CONTENTS
GOALS AND OBJECTIVES FOR PROGRAM IMPROVEMENTS FY95 1
•
13301.100 STATE AGENCY IDENTIFICATION AND AUTHORITY 1
PURPOSE OF THE PROGRAM 1
PURPOSE AND OBJECTIVE OF THE STATE PROGRAM 1
13301200 LOCAL AGENCY PARTICIPATION AND APPLICATION 2
LOCAL AGENCY APPLICATION 3
13310300 CERTIFICATION 3
ELIGIBILITY REQUIREMENTS 4
PROCESSING STANDARDS 5
NOTIFICATION-REQUIREMENTS 6
VERIFICATION OF CERTIFICATION 6
CERTIFICATION PERIODS 7
APPLICANTS RIGHTS 7
DUAL PARTICIPATION 7
DISQUALIFICATION 7
13301.400 CASELOAD MANAGEMENT 8
MAXIMUM CASELOAD ASSIGNMENT 8
IDENTIFICATION OF ELDERLY POPULATION 8
PRIORITY WAITING LIST 10
13301300 OUTREACH 10
PROGRAM EXPANSION 10
PUBLIC NOTIFICATION REQUIREMENTS 10
REFERRALS TO OTHER PROGRAMS 11
13301400 NUTRITION EDUCATION 11
GOALS 11
METHODS 11
STAFFING AND FREQUENCY 12
EVALUATION 13
FUNDING 13
PARTICIPANT INVOLVEMENT 13
TECHNICAL ASSISTANCE 13
FOOD DEMONSTRATIONS 14
REVIEWS 14
13301.700 FOOD DELIVERY SYSTEM 14
ORDERING 14
PROCEDURES 15
RECORDS 16
PROTECTION OF FOODS 16
COUNTY FOOD DISTRIBUTION POINTS 16
13301.800 PROGRAM MONITORING 19
13301.900 STATE PLANNING 19
13301.1000 FINANCIAL MANAGEMENT 19
STATE AGENCY RESPONSIBILITY 19
LOCAL AGENCY RESPONSIBILITY 20
ADMINISTRATIVE COSTS 21
PROPERTY MANAGEMENT 22
ADMINISTRATIVE EXPENDITURE PLAN 22
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13301.1100 COMPLAINTS 22
13301.1200 AUDITS 22
STATE AGENCY AUDIT 22
LOCAL AGENCY AUDITS 22
13301.1300 CIVIL RIGHTS 23
13301.1400 FAIR HEARINGS 25
13.910.100 CSFP - FORMS SECTION 27
DF-4 SUPPLEMENTAL FOODS AUTHORIZATION 28
DF-5 CSFP SUPPLEMENTAL FOOD ID CARD 29
DF-5B CSFP VERIFICATION OF CERTIFICATION 30
DF-14 NOTICE OF ADVERSE ACTION/RIGHTS OF APPEAL 31
DF-5D CSFP SUPPLEMENTAL FOOD ID CARD DENVER COUNTY
ONLY 32
DF-5G CSFP SUPPLEMENTAL FOOD ID CARD WELD COUNTY
ONLY 32
13.910.107 DONATED FOODS USED FOR CSFP FOOD DEMONSTRATIONS 33
13.910100 CSFP DISTRIBUTION FORMS 34
DF-7 DAILY RECORD OF ISSUES 35
FNS-153 MONTHLY INVENTORY REPORT 36,36a,36b,36c,36d
CSFP ORDER FORM - DISTRIBUTOR 37
DF-13 CSFP GAIN OR LOSS REPORT 38
DF-15 CSFP EXPIRATION OF CERTIFICATION 39
CHART CSFP MAXIMUM MONTHLY DISTRIBUTION
RATES 40,40a,40b, 40c
13.910300 CSFP AGREEMENT FORMS 41
CSFP STATE/LOCAL AGENCY AGREEMENT COVERING
CERTIFICATION FOR AND DISTRIBUTION OF FOOD
COMMODITIES 42, 42a, 42b,42c, 42d, 42e,42f
CSFP PROGRAM APPLICATION FOR LOCAL
AGENCIES 43, 43a,43b, 43c, 43d
LETTER OF AGREEMENT FOR DETECTION AND PREVENTION OF
DUAL PARTICIPATION BETWEEN THE COLORADO COMMODITY
SUPPLEMENTAL FOOD PROGRAM AND THE COLORADO SPECIAL
SUPPLEMENTAL FOOD PROGRAM FOR WOMEN, INFANTS,AND
CHILDREN (WIC) 44
STATE AND LOCAL DEPARTMENT/AGENCY INDIRECT COST
NEGOTIATION AGREEMENT 45, 45a, 45b
13.910.400 CSFP ADMINISTRATION INFORMATION FORMS 46
CSFP ADMINISTRATION REVIEW
FORM 47,47a, 476, 47c, 47d, 47e, 47f, 47g, 47h
CSFP STATEMENT OF EXPENDITURE-LOCAL AGENCY 48
COLORADO DEPARTMENT OF HUMAN SERVICES-
ORGANIZATIONAL CHART 49
CSFP STATE AND LOCAL EXPENDITURE PLAN 50
SUMMARY OF NUTRITION EDUCATION PLANS 51
LISTING OF CSFP LOCAL AGENCY
EQUIPMENT 52, 52a, 526, 52c; 52d,52e, 52f
APPROVAL AUTHORITY 53
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GOALS AND OBJECTIVES FOR PROGRAM IMPROVEMENTS FY95
I. Assessment of Current Operations
A. Status of automation of FNS-153 Report
1. State Agency completed development and testing of the Lotus 1-2-3 software for the automation of
the 153 Report.
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2. Local Agencies have been provided hard copies of the new report format for the 153 Report.
3. Local Agencies will be provided diskette copies of the software programs for installation and
implementation.
4. Local Agencies are purchasing computer modems for the electronic transmission of the 153 Report
to the State Agency.
B. Program Expansion
1. Weld County is expanding into Larimer County and in September will start serving over 200
participants who are already eligible for food bank participation.
In January, 1994 Weld County began a tailgate distribution in New Raymer,which is in Weld
County, 63 miles from Greeley.
2. Rio Grande County is now providing prepacked box service in Saguache County the first three
Thursdays of the month.
IL Goals & Objectives
A. Delegate responsibility to Local Agencies for computation and submission of the annual expenditure
report to the State Agency for submission to USDA.
1. Each Local agency will complete a report which incorporates the actual expenditures for CSFP for
the previous FY.
2. The State Agency will develop the format necessary for the report.
3. This information will be accumulated by the State Agency and submitted to USDA as required.
B. Delegate responsibility to Local Agencies for preparation and submission of Quarterly Estimates to
Agency to be used for purposes of ordering commodities from USDA for CSFP.
1. This process will allow for Local Agencies to have more input into the ordering process and control
of shipments.
2. The State Agency will continue to be responsible for carloading (ordering full trailer load
shipments) and drop shipments to direct receiver operations)
C. Provide information and support to Local Agencies for nutrition education.
1. Provide information and hand-outs to promote knowledge about the Food Guide Pyramid and ensure
that participants know what foods should make up their daily diet.
940991
Goals and Objectives
Page two
2. Assist Locals in planning, obtaining and developing materials, and training of participants for the
dietary guidelines.
3. Promote information and opportunity to incorporate more fresh fruits and vegetables in diets of
adults and children to enhance nutritional foods being provided by CSFP.
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D. In order to maximize available caseload,the State Agency will continue to review and approve requests
for elderly expansion as the women,infant and children available caseload slots become fully dtilized.
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DONATED FOODS PROGRAM - Commodity Supplemental Food Program
13301.100 STATE AGENCY IDENTIFICATION AND AUTHORITY
A. Identification
1. Name of Agency: Colorado State Department of Human
Services (hereinafter called the State Agency)
2. Mailing Address: 1575 Sherman 3rd Floor •
Denver, CO 80203-1700
B. Authority
The Commodity Supplemental Food Program,herein known as CSFP,is administered
by this agency on the basis of section 26-1-109, of the Colorado Revised Statutes
(CRS) as amended.
13301.110 PURPOSE OF THE PROGRAM
The Commodity Supplemental Food Program is established to provide an opportunity
for low income persons that are especially vulnerable to malnutrition (women during
and for 12 months after pregnancy, children under six years of age, and elderly
persons age 60 or over to receive specified nutritional foods that will provide them
with a more adequate diet necessary to assure good health.
13.301.120 PURPOSE AND OBJECTIVE OF THE STATE PLAN
a. The State Plan of Operation is to record and incorporate the procedures to be used
in certifying persons in need of supplemental foods, in making distribution to
certified persons,and in providing an opportunity for a fair hearing to persons who
are denied participation in the program or whose request for participation is not
acted upon with reasonable promptness.
b. The State Plan is required by Food and Nutrition Service (herein referred to as
FNS), USDA regulation 7 CFR Part 247 to be submitted by August 15 to FNS for
approval for the following fiscal year. The annual State Plan of Operation and
Administration is the basis for support for the Program.
c. The State Plan will be a part of the agreement between the State Agency and local
agencies participating in the Program and will be used to monitor State and local
agency performance to assure Program goals are reached. State and local agencies
shall enter into written agreements, copies of which shall be kept on file at all
agencies. The agreement shall provide assurance that the local agencies will comply
with the Federal Regulations (7 CFR Part 247), the State Plan of Operation and
Administration,and requirements of Title VI of the Civil Rights Act of 1964 (FNS -
Instruction 113.2).
d. If the local agency cannot comply with any part of the requirements of the above
regulations, they shall enter into agreements with another appropriate
agency/agencies in order to meet the requirements. The written agreement shall: (1)
identify the Program responsibilities; (2) be approved by the State Agency; and (3)
provide for copy to be maintained on file at both the State and local agency.
940991
e. The agreement between the State Agency and the State Health Department with
respect to Dual Participation in the Special Supplemental Food Program (WIC) is
included in the Forms Section of the State Plan. There are no other agreements with
any other agencies. (Reference 13.910303)
f. All forms utilized for the CSF Program are identified in Section 13.910 of the manual.
113301.200 LOCAL AGENCY PARTICIPATION AND APPLICATION
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The following counties have currently signed agreements with the State Agency to
operate the commodity Supplemental Food Program:
Conejos County Board of Commissioners
County Courthouse
Conejos, Colorado 81129
Costilla County Board of Commissioners
Costilla County Courthouse
San Luis, Colorado 81152
Manager, Denver Department of Social Services
80 South Santa Fe.
Denver, CO 80223
Mesa County Board of Commissioners
P.O. Box 897
Grand Junction, Colorado 81501
Administrator, Tri County Senior Citizens and Housing, Inc.
311 Washington
Monte Vista, Colorado 81144
Weld County Board of Commissioners
Post Office Box 758
Greeley, Colorado 80631
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13301.210 LOCAL AGENCY APPLICATION
The following procedures are prescribed for local agency initial application and
program expansion of an existing CSFP local agency:
a. Written application shall be submitted to the State Agency for determination
of approval or denial.
b. The State Agency shall approve or deny the application in writing within 30
days after receipt of the application. If the application is denied,the agency
shall be advised of the right to appeal the decision.
c. An agency approved for Program initiation or expansion shall be notified
within 30 days. If there are no administrative funds available for their
program, the State Agency shall notify the approved agency when funds
become available.
d. When the local agency has been approved for CSFP Program in an area
served by the Special Supplemental Food Program (WIC),the State Agency
shall maintain documentation justifying the need for two programs in the
same service area.
e. Local agencies requesting program expansion shall follow the above
procedures and be given approved/disapproved status by the State Agency.
13301300 CERTIFICATION
Names and locations of the local agencies which will be responsible for the
certification of persons is as follows:
a. Conejos County Nursing Agency
Post Office Box 78
La Jara, Colorado 81140
b. Conejos/Costilla Community Action Agency
Post Office Box 299
San Luis, Colorado 81152
c. Denver Department of Social Services
Food Assistance Programs
80 South Santa Fe
Denver, Colorado 80223
d. Mesa County Health Department
515 Patterson Road
Grand Junction, Colorado 81501
e. Rio Grande County Tri County Senior
Changing Needs Food Program Citizens Housing, Inc
520 Spruce Street 311 Washington Street
Del Norte, CO 81132 Monte Vista, CO 81144
(This address is for shipping only)
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f. Weld County Department of Human Resources
Post Office Box 1850
1500 2nd Street
Greeley, Colorado 80632
13.301.310 ELIGIBILITY REQUIREMENTS
To be certified as eligible to receive supplemental foods under the authority of the Commodity
Supplemental Food Program, each applicant shall meet the following requirements:•
a. Categorical eligibility as an infant, child (up to 6 years), pregnant,
postpartum or breastfeeding women, or elderly person 60 years of age or
older.
At certification, the local agency shall check the identification of each
participant. For a child participant, an immunization record, birth
certificate or other records that the local agency personnel consider adequate
identification shall be acceptable. When issuing supplemental foods, the
distribution agency shall check the identification of the parent,or caretaker
through the viewing of the ID card. (Reference 13.910.102)
b. Income-The prospective woman,infant,or child participant must be eligible
to receive benefits under an existing Federal, State, or local food,health or
other program for low income persons which includes the Food Stamp
Program, free or reduced price school meals, free or reduced price health
care, Aid to Families with Dependent Children (AFDC), Aid to Needy
Disabled (AND), Supplemental Security Income (SSI), or a general
assistance program. A woman,infant,or child not participating in any such
program will meet income eligibility requirements for CSFP participation if
the income of the household does not exceed the current income standard for
whichever program for low income persons the local agency has established
for determining financial eligibility. A prospective elderly participant's
household income must meet the income criteria of 130 percent of the
poverty level or below. Certification agency personnel shall document on the
(DF.4) Authorization form (Reference 13.910.101) or other State Agency
approved form in the space provided,which of the above criteria was used
to determine eligibility and what source was used to verify the
applicant's/caretaker's income,such as viewing paycheck stubs,(count gross
pay), letter from employer, eligibility documents or telephone verification
from an appropriate official of participation in Federal, State or local food,
health or other program for low income persons. The maximum income
guidelines are indicated below and are updated each July 1.
Household Size Women & Children - 185% Elderly - 130%
1 1,135 798
2 1,517 1,066
3 1,900 1,335
4 2,282 1,604
5 2,664 1,872
6 3,047 2,141
7 3,429 2,410
8 3,811 2,678
For each additional family For each additional
member add$383 family member add$269
4
940991 I
c. The prospective participant must reside in the area served by the local CSFP
Agency to which the request for certification is made. However, no
citizenship or durational residence requirements are to be imposed as a
condition of eligibility.
d. No nutritional risk requirement shall be imposed on the prospective woman,
infant, or child participant as a condition of eligibility,but may be used for
a prospective elderly participant at the discretion of the local agency with
prior approval by the State Agency. •
13301320 PROCESSING STANDARDS
a. The certification is accomplished after the eligibility determination has been
made with the use of the OF-4 or other State Agency approved document
which consists of all the family household information and also serves as a
prescription document to be used by the issuance agency. Homebound
elderly will be certified through home visits if there are no other means to
transport the individual to a certification site.
b. All certification data for each applicant shall be recorded on the certification
form (DF.4) or other State Agency approved form which shall include the
following.
1. The person's name and address.
2. The date of initial visit to apply for participation and the date of
certification.
3. The criteria used to determine the person's eligibility and the
signature and title of person/s making the eligibility determination.
c. The following statement shall be located directly above the applicant's
signature and shall be read by or to the applicant or applicant's parent or
caretaker before the certification form is signed.
"This certification form is being made in connection with the receipt of
Federal assistance. Program officials may verify information of this form.
I am aware that deliberate misrepresentation may subject me to prosecution
under applicable State and Federal statutes. I have been advised of my
rights and obligations under the program. I certify that the information I
have provided for my eligibility determination is correct to the best of my
knowledge.
I, the undersigned, certify that I have not applied for or received benefits
from any other Commodity Supplemental Food Program (CSFP) or the
Special Supplemental Food Program(WIC)in the month of application;nor
will I apply for and receive CSFP or WIC benefits in subsequent months at
the same time as I am receiving benefits under this application if I am
certified."
Signature Date
5
940991
13301330 NOTIFICATION REQUIREMENTS
a. The local agency shall either certify the applicant or notify the applicant of
ineligibility for CSFP within 15 calendar days of the applicant's first visit to
the local agency to apply for participation in the Program. A person who is
determined to be eligible shall be given an explanation of how the food
delivery system in the local agency operates,and'shall receive supplemental
foods within 10 calendar days of notification of eligibility. •
b. A person found ineligible for program benefits during an application visit,
shall be advised in writing of the agency's decision, of the reasons for the
decision, and of the right to a fair hearing. This notification shall be
accomplished by use of Form DF-14 Notice of Adverse Action/Rights of
Appeal.
c. A person found ineligible for the Program at any time during the
certification period shall be advised in writing at least 15 calendar days
before termination of eligibility, of the reasons for ineligibility, and of the
right to a fair hearing.
d. Each participant shall be notified not later than 15 calendar days prior the
to certification period, that eligibility for the Program is about to expire,
using form (DF-15) Expiration of Certification. This information should
also appear on the Certification form (DF-4) and the Identification Card
(DF-5).
e. Each participant shall be advised of the importance of participating in
ongoing health care and where such health service facilities providing health
care for low income persons are located. Local agencies in existence prior
to March 3, 1978 shall maintain the same level of health ties available prior
to that date.
13301340 VERIFICATION OF CERTIFICATION
a. The local certifying agency shall issue a Verification of Certification (DF-5B)
to CSFP participants who intend to relocate during the certification period
and continue participation in the CSFP. The local certifying agency shall
accept Verification of Certification forms from participants who have been
participating in the CSFP or the Special Supplemental Food Program(WIC)
and prepare a Certification Form (DF-4).
b. The Verification of Certification is valid until the certification period expires,
and shall be accepted as proof of eligibility for Program benefits.
c. The Verification of Certification (DF-5B) shall include the following
information: (Reference 13.910.103)
1. Name of participant.
2. The date the certification was performed.
3. The date the certification expires.
4. The signature and printed name of the local agency official who
issued the card, the name and address of that agency, and an
identification number or some other means of accountability.
6
OA non..
13301350 CERTIFICATION PERIODS
a. Eligible pregnant women shall be certified for the duration of their
pregnancy and for postpartum period of one year.
b. Postpartum and breastfeeding women,eligible infants, children and elderly
persons 60 years of age or older shall be certified at the time of their
entrance into the program and at intervals not to exceed six months in
length.
c. Benefits should be continued through the end of the last month of eligibility.
13301360 APPLICANTS RIGHTS
The following sentences shall be read by or read to the applicant or the applicant's
parent or caretaker at the lime of certification. Where a significant proportion of the
population served by a local agency is composed of non-English or limited English
speaking persons who speak the same language,the sentences shall be stated to such
persons in a language they understand:
a. 'Standards for participation in the Program are the same for everyone
regardless of race,color,national origin,sex,age, or handicap.
b. You may appeal any decision made by the local agency regarding your
written denial or termination from the program.
c. If your application is approved, the local agency will make nutrition
education available to you and you are encouraged to participate."
13301370 DUAL PARTICIPATION
a. As part of the certification process of the detection and prevention of dual
participation within each local agency and between local agencies,applicants
shall be informed of the illegality of simultaneous participation in the
Special Supplemental Food Program (WIC) and the CSF Program, or of
simultaneous participation in more than one CSF Program. A statement of
this nature will be on the DF-4 Authorization Form, which the applicant
will sign and date.
b. In areas where a local agency serves the same area as a Special
Supplemental Food Program (WIC) Agency,an agreement will be made for
the detection and prevention of dual participation. Such an agreement is
outlined in the Forms Section of the State Plan of Operation and
Administration.
13.301380 DISQUALIFICATION
a. The local agency may disqualify applicants and participants from Program
participation for a period not to exceed three months if it is established that
the applicant,participant,parent or caretaker,fraudulently applied for and
obtained Program benefits. However,if the disqualification would result in
a serious health risk and the participant is currently eligible, the
disqualification may be waived.
7
940991
b. Participants may request a fair hearing as described in 13301.1400 to contest
the disqualification.
c. For purposes of determining disqualification,the definition of fraud is:
Anyone knowingly, willfully, and deceitfully with the intent of obtaining
benefits to which they are not entitled by:
•
1. Making false statements orally or in writing.
2. Concealing information.
3. Altering program documents for the purpose of receiving increased
benefits or transferring benefits to an unauthorized individual.
4. Committing dual participation. (Reference 13.910303)
13301.400 CASELOAD MANAGEMENT
13301.410 MAXIMUM CASELOAD ASSIGNMENT
The maximum number of participants that may receive benefits at each Project Area are as follows:
• MAXIMUM CASELOAD
PROJECT WOMEN, INFANTS. & CHILDREN ELDERLY
Conejos 346 381
Costilla 200 327
Denver 12,187 6,969
Mesa 1,700 650
Rio Grande 500 644
Weld 3500 1 000
Total 18,433 9,971
The totals for each project area are maximum caseload limits and cannot be exceeded. The
distribution agencies shall monitor their participation through the use of the DF-7 (Daily Record
of Issues) or other State Agency approved form. The maximum caseload limit is based on the
average year-to-date monthly participation. As long as the local agency cumulative total
participation is not exceeded dining the fiscal year the local agency will not be found out-of-
compliance. USDA,FNS will impose a claim on the state as the maximum caseload is exceeded,and
this claim will then be imposed on the local agency in violation. Therefore,it is the responsibility
of each local agency to maintain their participation within the assigned maximum caseloads.
Caseload slots are assessed by the State Agency biannually and adjusted accordingly.
IDENTIFICATION OF ELDERLY POPULATION
Coneios County:
Elderly population-482 persons from current Old Age Pension rolls. Approximately 386 are eligible
for CSFP. Homebound elderly are identified through the County's Home & Community Based
Services (HCBS) program. Currently there are 65 clients being served through HCBS.
Transportation and deliveries are accomplished through proxies or commodity staff. When food
packages are issued, the back of the certification form is to be signed and dated by the recipient
under the appropriate month and initialled by the person making the delivery.
Mesa County:
The elderly population in Mesa County increased by 50%between 1990 and 1993,justifying the need
for an elderly program which was started in February,1994. Participants are served Tuesday through
8
940991
Friday,with Thursday being set aside for elderly only. Distribution site is 715 South 4th Avenue in
Grand Junction, and homebound delivery is accomplished by the staff. When food packages are
issued, the back of the certification form is to be signed and dated by the recipient under the
appropriate month and initialled by the person making the delivery.
Costilla County:
Elderly population - 298 persons from current Old Age Pension rolls and Public Healiji records.
Homebound elderly are identified through the county's Home&Community Based Services (HCBS)
program. When food packages are issued, the back of the certification form is to be signed and
dated by the recipient under the appropriate month and initialled by the volunteer making the
delivery.
Denver County.
County statistics for 1985 show an elderly population of 87,208 persons over 60 years of age. In 1979,
the last year for which statistics were available for the number of elderly at 125 percent of the
poverty level was 14,977. (Provided by Reed Reynolds, State Demographer (303)866-3120. Denver
Department of Social Services has approximately 8,000 persons currently receiving Old Age Pensions.
Homebound elderly are defined as those persons who have no relatives or friends and are unable
to pick up their food supplements on a monthly basis by themselves. They are referred by the
Departments of Social Services with all referrals being followed by telephone and home visits.
Training of volunteers will be in the following areas:
1) Ability to explain programs, eligibility requirements,
2) Review of eligibility and certifications at even numbered periods 247.7(g)(1)(iii) for
homebound elderly.
3) Knowledge of nutritional needs of seniors.
Certification is accomplished in the same manner as currently used for women,infants,and children
at the current certification site and low income senior high rises through-out the county.
Rio Grande Countv/Tri County Senior Citizens & Housing. Inc.:
Out of five homes for the elderly, and statistics from the nonprofit housing authority, there are
approximately 400 eligible recipients for this program. Certification is accomplished at the present
site by trained certification workers. Personal visits are made to the homebound. Transportation
and deliveries are accomplished by friends,neighbors, or current commodity staff. Documentation
of issuance is accomplished as described for the other counties.
Weld County:
Identification and documentation of need for the elderly population in Weld County is accomplished
through the Area Agencies Older Americans Act programs, Weld County Rural Senior Aide
Coordinator program, and Weld County Long Term Care Coordinator Committee agencies.
Certification is accomplished at the current CSFP site, and agreements are set up with designated
home health care agencies and home delivered meals programs for referrals and certification
procedures. Food distribution occurs at the current Greeley site on Monday,Wednesday,Thursday
and Friday. Every Tuesday food is distributed at 104 11th Avenue,Ft.Lupton,Colorado. Volunteers
and agency representatives are designated to pick up and deliver to certified homebound. The Weld
County Area Agency on Aging (AAA) is integrated with the current Supplemental Food Program to
provide information, outreach, certification, and food distribution. AAA is currently providing all
other available services to the elderly in Weld County.
9
94099i
13.301.430 PRIORITY WAITING LIST
If the maximum caseload has been reached, local agencies shall notify the State Agency of their
implementation of priority waiting list procedures.
a. If it is necessary to implement a priority waiting list,the following designated priorities will
be assigned to participants according to their category:
•
Priority 1 - Pregnant, breastfeeding women and infants through 11 months of age
Priority 2 - Children ages one through three years
Priority 3 - Children ages four through five years
Priority 4 - Postpartum women
Priority 5 - Elderly
b. When vacancies occur, the following action will be taken to determine which individual will
become an active participant
1. Determine the highest priority group for which a name appears(i.e.if priority 1 has
no names listed, go to priority 2, etc.)
2. Within the priority group from which names are to be chosen,select the individual
who has been on the list longest (i.e. earliest date assigned to the list).
3. Contact the participant and determine if they are still eligible for that priority
group: (i.e. women may no longer be breastfeeding their infant or infants have
reached age one, etc.) (a) If they are still eligible in the same priority group,
provide them with the required foods. (b) If they no longer qualify in the priority
group, reassign them to the next lowest priority group using the original date
assigned to the priority list.
Local agencies must place transferring participants with current Verification of Certification
cards ahead of all waiting applications.
Local agencies may request written approval from the State Agency(and FNS) to use income
and/or nutritional risk screening as a subcategory for the priority list.
Applicants shall be notified within 15 calendar days of application (if approved) of their
placement on the priority waiting list.
13301.500 OUTREACH
13301.510 PROGRAM EXPANSION
Request for program expansion will be evaluated by the State Agency with consideration given to
available caseload and administrative funds.
13301320 PUBLIC NOTIFICATION REQUIREMENTS
Through advertisement in the newspapers, the State Agency will notify the general public on an
annual basis of a 30 day opportunity to comment on the development of the State Plan.
Reference Section 13301.1300 which incorporates outreach and public notification requirements as
required by Civil Rights FNS, Instruction 113.2.
10
•
940991
13301330 REFERRALS TO OTHER PROGRAMS
The State Agency will ensure that written information concerning food stamps, AFDC and child
support enforcement is provided to local agencies. Local agencies will provide this information at
least one time to each adult applying for CSFP benefits.
The State Agency will provide each local agency with materials showing the maximum income limits
according to family size,applicable to pregnant women,infants,and children up to age six under the
Medicaid program. Local agencies will provide this information to each pregnant,breastteeding and
postpartum woman and adult applying on behalf of infants and children at each certification and
recertification. Medicaid program referrals should be made to agencies authorized to determine
presumptive eligibility for the Medicaid program if the individuals are not participating in the
Medicaid program.
The State Agency will ensure that written information concerning food stamps, SSI and medical
assistance, including Medicare, is provided to local agencies. Local agencies will provide this
information at least one time to each CSFP elderly participant or applicant.
13301.600 NUTRITION EDUCATION
This space intentionally left for additions
13301.610 GOALS
So that the Commodity Supplemental Food Program (CSFP)will provide both immediate and long
term improvement in the health status of participants, the local agency shall make nutrition
education available to all adult participants and,where possible,to the children themselves at the
time of certification or recertification. This nutrition education shall be thoroughly integrated into
program operations and shall have the dual purpose of ensuring the CSFP foods are used properly
and of providing knowledge that encourages continued selection and consumption of nutritious foods
necessary to good health.
Additional goals of the nutrition education shall be:
1. To demonstrate the relationship between proper nutrition and good health,with emphasis
on pregnant,postpartum and breastfeeding women,infants,and children up to six years of
age,and elderly persons 60 years of age or older.
2. To effect a positive change in eating habits through maximum use of the supplemental foods
within the context of ethnic, cultural and geographical preferences.
13301.620 METHODS
The State Agency shall ensure that the local agency fully performs the nutrition education
responsibilities as prescribed by this Plan of Operation and Administration. The following
procedure shall be followed by the State Agency providing such ensurance:
a. The local agency shall annually submit to the State Agency a plan for implementation of
nutrition education for CSFP participants. The plan should include a description of
methods, materials and stairmg. It would be appropriate to submit with this plan,
brochures and pamphlets,that will be used for nutrition education of participants. This
11
gan44,
plan shall be submitted by July 1st of each year for local agency implementation for the nest
fiscal year. Nutrition education should,at a minimum,include the(Slowing:
1. An explanation of the importance of the consumption of the supplemental foods by
the participant for whom they are prescribed rather than by other family members;
2. Reference to any special nutritional needs of participants and ways to provide
adequate diets;
•
3. An explanation of the Program as a supplemental rather than a total food program;
4. Information about the use of the supplemental foods and about the nutritional
value of these foods;
5. Information about the benefits of breastfeeding, and
6. An explanation of the importance of health care.
b. The methods used to provide nutrition education at the local agency may include a 24 hour
diet recall, pre and post tests of participant's knowledge of nutrition, basic nutrition
information,such as illustrated in the Food Guide Pyramid,and how the pregnant woman,
mother, or caretaker can use this knowledge in meeting her nutritional requirements and
those of her children. Handout materials are used in English and Spanish for additional
instruction about nutrition and food handling. These materials can be obtained from the
Colorado Dairy Council and other companies, such as Del Monte. Recipes provided by
agencies,such as the Dairy Council and CSU Extension Service are also utilized as handout
materials to instruct participants about how to use supplemental foods for nutritious meals
and snacks.
c. The minimum nutrition education may be provided on an individual interview basis or
instructed nutrition education classes. Most participants are involved in a nutritional
assessment at the initial visit. The frequency of formal nutrition education classes depends
upon the agency's financial ability to provide this service. Whichever method is used,
nutrition education is to be provided on an ongoing basis. The professional expertise to
provide nutrition education may include a Registered Dietitian,Public Health Nutritionist,
Registered Nurse,Physician or a supervised paraprofessional. The paraprofessional could
be supervised by the County Health Department or CSU Extension Service. Local agencies
must include in their Nutrition Education Plans, the classification and number of staff
providing nutrition education.
13301.630 STAFFING AND FREQUENCY
The local agency shall employ, or at least have the service of,a part-time nutritionist to coordinate
the nutrition education program and to train paraprofessionals for implementation of the plan.
a. Nutrition education shall be provided at certification or distribution sites or in homes of
participants as needed.
12
940991
b. Nutritional education lessons should take into consideration ethnic dietary practices,such
as migrant workers, information should be available in Spanish; and the individual
condition of the participant, such as pregnant, breastfeeding,infants,children,
and elderly.
13301.640 EVALUATION
The local agency shall annually evaluate their program to determine the effectiveness of the
nutritional education. This shall be accomplished by participant input,such as questionnaires about
basic nutrition and the use of supplemental foods. Homebound elderly should also be included in
the evaluation process. Information provided by the completed questionnaires or other evaluation
methods shall be considered in formulating future plans for nutrition education. A copy of this data
should be submitted annually(July 1st)with the nutritional education plan.
13301.650 FUNDING
The local agency shall direct program funds for nutritional education for the benefit of participants
and local agency staff members in accordance with USDA Regulations.
13301.660 PARTICIPANT INVOLVEMENT
State and local agencies are required to develop methods to improve participant involvement in
nutrition education. This may include sending notices of nutrition workshops sponsored by the
Dairy Council and CSU Extension Service.
Each local agency shall he required annually to survey their participants about what type of nutrition
education or food handling classes or information they would like to have presented. This
information must he included in the local agency nutrition education plan.
13.301.670 TECHNICAL ASSISTANCE
The State Agency shall utilize the services of the Nutritionist in the Division of Services for the
Aging, Colorado Department of Human Services, to evaluate the nutrition education plans of each
local agency. The nutritionist will provide nutrition education information on an ongoing basis to
the Food Distribution Program, Social Services Specialist II who will in turn,provide information
to the local agencies. The CSU, UNC, Adams State, and Mesa Colleges will be contacted to
determine if students would be interested in developing, implementing, and presenting nutrition
education classes or materials at the local certification and/or distribution agencies. Local agencies
will continue to utilize local resources and any nutrition education materials provided by the State
from USDA to enhance their nutrition education.
13
940991
13301.680 FOOD DEMONSTRATIONS
Any food demonstrations using supplemental foods shall be conducted by the local agency and solely
in conjunction with nutrition education under the program and primarily for CSFP participants.
The majority of the group or class must be participating in CSFP. Supplemental foods may not be
used for outreach,refreshments for participants,or any other such purpose. Supplemental foods
may not be provided to any other community agency or facility for any purpose,unless such agency
has entered into a signed written agreement with the State or local agency to provide nutrition
education services under the program or unless authorized by the State Agency. Approval for
demonstrations using USDA food commodities must be given prior to demonstration. The local
agency shall submit request form 13.910.107 to document food items used,the agency site,and the
purpose for the demonstration. When approval has been granted by the State and the demonstration
has been completed,form 13.910.107 must be submitted with and documented on the FNS-153 report
for the applicable month of the demonstration.
13301.690 REVIEWS
The State Agency shall conduct an annual administrative review of the CSFP projects, including
aspects of nutrition education. The findings from the review will be evaluated by the nutritionist at
the State level to assure the local agency is in compliance with the plan for nutritional education.
(Reference 13.910.406)
13301.700 FOOD DELIVERY SYSTEM
13301.710 ORDERING
The foods donated by the United States Department of Agriculture (USDA) for the CSFP are
received by one commercial distributor and four local agency warehouses. The commercial
distributor is Andrews Produce, Inc., however, orders must be placed with Vanask Warehouse
Company. The local agency warehouses are the Denver County Supplemental Food Program,Mesa
County Supplemental Food Program,Rio Grande Supplemental Food Program and the Weld County
Supplemental Food Program. These warehouses receive commodities in sufficient quantifies to
maintain an adequate inventory at the following locations:
Vanask Warehouse Company
6201 East 42nd Avenue
Denver, CO 80216
Subcontractor
Andrews Produce, Inc.
100 S. Main Street
Pueblo, CO 81002
(serves Conejos
Costilla & Rio Grande
Elderly feeding)
Mesa Supplemental Food Program
715 4th Avenue
Grand Junction, CO 81501
(serves Mesa County)
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940991
Denver County Supplemental Food Program
80 South Santa Fe
Denver, CO 80223
(serves Denver County)
Changing Needs Food Program
311 Washington Street •
Monte Vista, CO 81144
(serves Rio Grande CSFP) •
Weld County Supplemental Food Program
C/O The Weld Food Bank
104 11th Avenue
Greeley, CO 80631
(serves Greeley CSFP)
Commodities are ordered by the State Agency from USDA on form FNS-52 Food Requisition and
form FNS-53 Multi-Food Requisition. Food orders are submitted based on computations of
Quarterly Estimates. Food requirements are estimated based on most recent average three month
participation multiplied by the maximum rate of issue to determine monthly usage for each food
item. Requirements for the ordering period are determined by forecasting the projected inventory
(on hand plus orders due in) less the monthly anticipated usage.
The local agencies shall notify their commercial distributor each contract period, as to how foods
will be distributed to the agency for that period of time. Local agencies will have a choice of picking
up foods from their distributor's warehouse or having them delivered to their issuance site.
There is a per case charge by the distributor for pick up or delivery. This is adjusted monthly
depending on fuel prices. Prices may be adjusted up or down on an annual basis effective October
1st each year, based on the Consumer Price Index (CPI-U).
The distributor charges to local agencies are paid by the local agency and reimbursed by the State
Agency out of Federal administrative funds. Once a local agency notifies the distributor as to how
foods are to be distributed for the State fiscal year (July - June), the decision cannot be reversed
unless mutually agreed upon by the agency and the distributor. In situations of extenuating
circumstances,the State Agency shall act as arbitrator to make final decisions.
The local agency may receive foods as often as every other week provided there is a minimum 10 case
order. Local agencies must notify the distributors of their order seven days prior to the month of
shipment. Foods are delivered in accordance with the distributor's predesignated schedule. Pick
ups may be accomplished at the distributor's warehouses in accordance with their pick up schedules.
13301.720 PROCEDURES
Deliveries may be monthly or less often at the request of the local agency. Local agencies can
request the State Agency to have products delivered directly to the local agency from USDA vendors,
provided local agencies comply with industry practices with respect to receiving,unloading,detention
charges,etc.
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940991
Participants shall be issued prescriptions for supplemental foods, based on "Maximum Monthly
Distribution Rates" (Reference 13.910.207) by personnel designated by the local agency. The local
agency may choose to issue either a one mouth supply of foods each month or a two month supply
every other month. However, local agencies which choose to issue a two month supply every other
month,shall inform participants that they may still receive a one month supply every month if they
so request.
•
When the recipients pick up their food, they must present DF-5 (Identification Card-Supplemental
Food)showing ID number,recipient's name,recipient's signature,proxy,proxy's signature,signature
of authority,effective date and expiration date. (Reference 13.910.102). Homebound elderly will be
issued a proxy, if at all possible. If no proxy is available, the county will deliver foods to those
homebound elderly recipients.
13301.730 RECORDS
The local agency shall maintain accurate and complete records of issuances of food items to
participants,receipt, disposal,and inventory of supplemental foods. Reports of participation and
physical inventory of supplemental foods (FNS-153, DF-13) shall be submitted to the State Agency
once a month,no later than the 5th working day of the following month. Food losses and damages
shall be reported in the food loss column of the FNS-153 with an explanation of the loss documented
in the remarks section of the FNS-153 or DF-13 Gains & Loss Report Adjustments to physical
inventory shall be made in the positive and negative columns of the FNS-153. All reports shall be
retained for a period of three years,subsequent to the dose of the Federal fiscal year to which they
pertain. (References 13.910.202,203,205,204)
13.301.740 PROTECTION OF FOODS
The local agency is required to provide reasonable protection of the donated foods against theft,
spoilage,infestation,fire and other loss. Such reasonable protection shall include,but not be limited
to, the responsibility of(1) keeping doors and windows of the facility locked at all times when an
employee is not in attendance, (2) Rotating the inventory on a first-in/first-out basis, (3) Using an
effective means of pest control on a regularly scheduled basis and(4) Keeping the facilities clear of
trash and other fire causing hazards. (Recipient agencies shall be held responsible for reimbursing
the State Agency for the value of USDA Donated Foods lost due to the fault or negligence on the part
of their staff).
13.301.750 COUNTY FOOD DISTRIBUTION POINTS
a. Conejos County
Distribution is accomplished by a commodity clerk under the direction of-
Conejos County Public Health Department
Lois Booth,Administrator
P.O. Box 78
La Jan, Colorado 81140
The Conejos County CSFP distribution center is presently located in the new Conejos
County Nursing Service Building, 19023 Highway 285 South, LaJara, CO. 81140. The
building is a 100 x 50 sq ft Butler metal building with brick trim. 500 sq ft are allocated
for commodity warehousing. All foods are stored on pallets in an enclosed room with
secured entrances. The food needing cold storage is stored in the 80 sq ft cooler/freezer.
Records are kept in a locked filing cabinet in the warehouse. The computor that is utilized
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940991
for record keeping is located in the commodity clerk's office which is 100 sq ft. Food is
boxed and distributed from behind a counter. The lobby waiting area consists of 120 sq ft.
The certification area lobby is located in the CCNS section of the building and is 150 sq ft.
b. Costilla County
Distribution is accomplished by a commodity clerk under the direction of-
Director, Community Action Agency
•
Community Action Building
P.O. Box 299,Main Street
San Luis, Colorado 81152
The storage and distribution is accomplished in several rooms of the Community Action
Center. All commodities are stored on pallets. Primary storage area - 400 square feet.
Secondary storage area - 400 square feet (as needed). Office area - 256 square feet.
Security- conventional doors,windows and locks. Wire mesh is used to secure windows.
c. Denver County
The distribution is accomplished by a lead worker and a staff of eight warehousemen, 7
certifiers, a nutritionist, a safety specialist, a volunteer coordinator, a secretary and an
administrative assistant under the direction of-
Anthony R Quintana, Program Administrator
Denver Department of Social Services
Food Assistance Program
80 South Santa Fe Drive
Denver, CO 80223
Phone 436-2800, Fax 436-2824
Since 01-94,commodities are distributed to over 20,000 clients in a 42,000 sq foot centrally
located warehouse and distribution site.All commodities are received by direct shipment
from USDA with cheese and butter stored in a drive-in freezer and refrigerator.
Commodities are distributed on site in a grocery store fashion as well as delivery to over
3,000 clients. Clients have direct access to nutrition counseling by a registered dietitian as
well as a book ownership library,stories read to the children,educational videos and a car
seat loaner program.
d. Mesa county
Distribution is accomplished by a Commodity Clerk under the direction of-
Director of Nurses
Mesa County Health Department
715 4th Avenue
Grand Junction, Colorado 81501
The storage and distribution facility is a metal building. Doors are all secured with locks.
The building is patrolled by the local police department. The distribution agency consists
of approximately 7000 square feet. The distribution area is arranged in grocery store
fashion.
17
OS Clan
e. Rio Grande County
Distribution to women,infants,and children is made twice a week for the first three weeks
of the month by Changing Needs Food Program, 520 Spruce Street, Del Norte, CO 81132
under the direction of-
Carol Refior, Administrator
Tri County Senior Citizens & Housing, Inc.
311 Washington Street
Monte Vista, CO 81144
The facility in Del Norte is a brick structure with concrete floors.
The distribution area is arranged as a self service area. Certifications are accomplished in
a separate area. Commodities are stored in a secure area in back of the distribution area.
Distribution to seniors is accomplished under the direction of the -
Carol Refior,Administrator
Tri County Senior Citizens & Housing
311 Washington
Monte Vista, CO 81144
Distributions are made once per week for the first 3 weeks of the month at the senior citizen
center in Monte Vista and also once a month at their Del Norte site. Commodities are
stored in a locked storage closet at. the Monte Vista site. Seniors can also receive
commodities in Del Norte during WIC distribution.
Saquache County
Distributions are the first three Thursdays of the month. Distribution sites are as follows:
The first Thursday is in Saquache,at the Public Health Office. The Second Thursday is in
Center at the Catholic Church, and the Third Thursday's distribution is in Moffat at the
school. Seniors will receive prepacked boxes.
Mineral County
Distribution site is in Creed at the Public Health Office. Seniors receive prepacked boxes.
Weld County
Distribution is accomplished by a commodity clerk under the direction of-
Executive Director
Weld County Department of Human Resources
C/O The Weld Food Bank
P.O. Box 1805
104 11th Avenue
Greeley, Colorado 80632
Supplemental foods are arranged in grocery store fashion.The distribution center in Greeley
is approximately 32 feet by 27 feet with a tile floor. Security is provided by the Greeley
Police Department, who check the building on a regular route.
The distribution center in Fort Lupton is approximately 397 square feet with cement floors,
sheet rock interior walls,brick exterior walls. The distribution site has 1 window with bars
and 3 locked doors. Address is 330 Park Avenue, Fort Lupton, Colorado 80621.
18
940991
Distribution for September expansion into Larimer County will be in the Ft. Collins Food
Bank. The address is 1301 Blue Spruce, #1. Distributions are Mondays and Thursdays of
each month.
In January, 1994 Weld County began a tailgate distribution in New Raymer, 63 miles from
Greeley. Certification is accomplished by direct modem located in Greeley facility.
13301.800 PROGRAM MONITORING
The Food Distribution Programs,Colorado Department of Human Services,will provide monitoring
of the local agencies by having staff members make an annual on-site visit. During this visit,
program operations will be reviewed to determine compliance with the provisions of the State Plan
of Operation and Administration,the agreement between the State Agency and the local agency and
any instructions provided by the Food and Nutrition Service, USDA and/or the State Agency.
a. A review check list which has been approved by the Food and Nutrition Service (FNS) will
be utilized. A written report will be prepared covering findings and recommendations.
(Reference 13.910.406)
b., A summary of findings and recommendations for action will be forwarded to the local
agency for their information and response as to action taken or plans to correct any
deficiencies. Local agencies are required to respond in writing to the results of the review
within thirty (30) days
c. State agency will follow-up by verifying either by telephone or visit that planned corrective
action was taken.
13301.900 STATE PLANNING
Changes in the Federal Regulations and subsequent changes and additions
to the State Plan of Operations are areas of discussion and training incorporated with the annual
administrative review of the local agencies by the Agency. Input from local agencies is evaluated and
utilized in preparing future State Plans.
13301.1000 FINANCIAL MANAGEMENT
13301.1010 STATE AGENCY RESPONSIBILITY
a. Accurate and complete records will be maintained by the State Agency to reflect all
administrative expense funds received,amounts allocated and disbursed to the local agencies
and authorized allocated expenditures by the State Agency from that portion authorized to
be retained for State Agency use.
b. The Financial Status Report, Form SF-269, will be completed by the Office of Accounting,
Colorado Department of Human Services and forwarded to the Regional Office, USDA
within thirty days after the end of each quarter.
c. The procedures related to the Letter of Credit drawdowns and disbursements are: Upon
notification of the Quarterly Letter of Credit authorized,the State Agency shall deduct the
authorized amount for the State retention. In addition,an amount shall be withheld to pay
the distributor for either delivery or pick up of commodities by each local agency. The
administrative portion of the grant is advanced to local agencies based on the Quarterly
19
940991
Statements of Expenditures submitted for the previous quarter. The State does not draw
funds in advance of immediate disbursements.
d. Quarterly Statements of Expenditure from local agencies are verified by the State Agency
to determine that expenses are equal to or exceed the quarterly allocations provided. The
State Agency will make necessary adjustments if it is determined that a local agency has not
used all of the allotted funds, by reducing allocations for the underexpended project and
redisbursing the funds proportionately to other local agencies. If there are any unspent
administrative funds for the State, FNS reserves the right to recover these funds.
(Reference 13.910.402)
e. Any losses experienced by local agencies will be reported to the State Agency for their
decision as to the necessity of a claim determination against a carrier or the local agency
for possible reimbursement.
f. The State Agency shall maintain complete and accurate records with respect to the receipt
and disbursement of all administrative funds received. All program and financial records
shall be retained for a period of three years subsequent to the dose of the Federal fiscal
year to which they pertain. Records shall be available during normal business hours for
representatives of the State Agency and of USDA, FNS, to review and audit.
13.301.1020 LOCAL AGENCY RESPONSIBILITY
a. Each project area will be required to submit by May 15th of each calendar year,an annual
budget for the upcoming Federal fiscal year (October 1 - September 30). This will be
compared against reports of expenditures for the previous fiscal year. Obvious areas of
discrepancy will be negotiated to resolve and reach agreement on budgets proposed. Local
agency anticipated budgets for FY95 total $1,596,656.12.
b. Local agencies will maintain accurate and complete records to reflect all administrative
expense funds received from the State Agency and the authorized expenditures to cover
Program costs. The local agency shall maintain complete and accurate records with respect
to the receipt, distribution, and inventory of supplemental foods.
c. Financial reports (Statement of Expenditures)as required by the State Agency and the Food
and Nutrition Service, USDA will be completed and submitted to Colorado Department of
Human Services, Food Distribution Programs, 1575 Sherman Street, 3rd Floor, Denver,
Colorado 80203.1700,by the 15th of the month following the close of the quarter. (Reference
13410.401). The Statement of Expenditures must reflect the accurate amount of funds
expended. These records and documentations must be kept current and available for audit
and review purpose at the local agency.
d. All program and financial records at the local agencies shall be retained for a period of
three years subsequent to the close of the Federal fiscal year to which they pertain. Records
shall be available during normal business hours for representatives of the State Agency and
of USDA, FNS to review and audit.
20
940991
13301.1030 ADMINISTRATIVE COSTS
All State and local agency costs charged to CSFP are in compliance with the principles of OMB
Circular A-87 (Previous Edition FMC 74-4 "Cost Principles for State and Local Governments")
for determining the allowability and allocability of costs charged to Federal grant programs.
1. Allowable Costs - The following are illustrations of cost allowable under the Program.
(1) The cost of certifying persons; •
(2) The cost of nutrition education services provided to participants and parents and
guardians of participants, and used for training local agency staff members;
(3) The cost of transporting food and of administering the food distribution system;
(4) The cost of interpreters and translators for program materials;
(5) The cost of outreach services;
(6) The cost of audits and fair hearings;
(7) General administration of the State and local agencies including but not limited to
personnel, warehousing and insurance;
(8) The cost of monitoring and reviewing Program operations.
(9) The cost of transportation for participants to and from the local agency when the
local agency has determined and documented the need for such assistance.
2. Restrictions on Allowable Costs - the following costs are allowable only with prior FNS
approval:
(1) Automatic data processing equipment and system purchases whether by outright
purchase, rental-purchase agreement or other method of purchase;
(2) Capital expenditures over$2,500.00 such as cost of the facilities,equipment,other
capital assets and any repairs that materially increase the value of useful life of
capital assets. Provided that any subsequent sale of real or personal properties,
purchased in whole or in part with Program funds,shall be used to reimburse FNS
in an amount computed by applying to the sale proceeds, the percentage of FNS
participation in the original acquisition cost;
(3) Occupancy of space under rental-purchase or a lease with option to purchase
agreement;
(4) Equipment rental costs where the agreement provides for rental-purchase or a lease
option to purchase agreements;
(5) Management studies performed by agencies or departments other than the State or
local agency or those performed by outside consultants under contract with the
State or local agency.
3. Unallowable Costs-the following are unallowable costs for CSFP,in addition to unallowable
costs identified in OMB Circular A-87. (Previous Edition FMC 74-7).
(1) Costs incurred for rearrangement and alteration of facilities not required
specifically of the Program;
(2) Actual losses which could have been covered by permissible insurance (through an
approved self-insurance program or otherwise.)
21
940991
13301.1040 PROPERTY MANAGEMENT
State Agency
Any property acquired for use in the operation of the CSF Program with administrative funds is
assigned a property number. An inventory of all property is taken annually and records are
maintained at the State Department of Social services, Accounting'Office and Food Distribution
Programs.
•
Local Agency
Local agencies shall provide to the State Agency by each July 1 an itemized list of any
property/equipment purchased with CSFP administrative funds. The State Agency shall maintain
records for property/equipment at each agency. The local agency shall notify the State Agency prior
to disposition of any property/equipment acquired with CSFP administrative funds. Local agencies
shall maintain records of inventories or property/equipment. (Reference 13.910.402)
13301.1050 ADMINISTRATIVE EXPENDITURE PLAN
State and local agency expenditures for the Federal fiscal year shall be submitted annually to USDA,
FNS as an amendment to the State Plan. The actual expenditures must be submitted to USDA
within ninety (90) days after the close of the Federal fiscal year. The expenditure plan will be
submitted in the format provided by USDA. (Reference 13.910.405) This format will be utilized to
identify all costs for the operation of all aspects of the CSF Program for the previous Federal fiscal
year. Local agencies shall submit their annual administrative expenditure plan to the State Agency
not later than October 31st of each year after the dose of the Federal Fiscal Year. The report shall
be submitted in the format as prescribed by the State Agency.
13301.1100 COMPLAINTS
Local distributing agencies shall advise the State Agency of any complaints by the participants
regarding the supplemental food items, identifying the participant's name and address and the
nature of the complaint. This information will be forwarded by the State Agency to FNS, Regional
Office for their investigation and final determination on the validity of the complaints._
13301.1200 AUDITS
13301.1210 STATE AGENCY AUDIT
a. Audits of the Department of Human Services are made annually by the State Auditor's
Office using the requirements for financial and compliance audits as established by the U.S.
Office of Management and Budget Circular Number A-128. This Circular is issued
pursuant to the Single Audit Act of 1984, P.L.98-502 which mandated an organization wide
audit. It establishes audit requirements for state and local governments that receive federal
funds and defines the federal and states' responsibility for implementing and monitoring
those requirements.
13301.1220 LOCAL AGENCY AUDITS
a. Audits of local governmental units shall be performed annually; and audits of nonprofit
organizations should be made annually but no less frequent than every two years covering
both years. Audits will be performed using OMB Circular A-128 or A-133 which requires
an expanded scope of both financial and compliance audits. This permits the Department
22
940991
of Human Services to provide assurance to the federal government that federal funds
"passed through" the state to subrecipients were expended in accordance with federal and
state laws and regulations. The local agency will retain an independent auditor to perform
such audits. For this purpose, the term independent auditor means a state or local
government auditor who meets the independence standards specified in the"Yellow Book",
Government Auditing Standards (1988); or a certified public accountant who meets such
standards.
•
b. Audit reports as required by this section will reflect audit findings and questioned costs in
the format specified in the "Yellow Book", Government Auditing Standards (1988). This
manner of presentation will permit the State Agency to take corrective action to resolve the
questioned costs within six months of receipt of the audit report. Audit reports that do not
comply with this format will be returned to the independent auditor for modification. The
State Agency will take appropriate follow up action. A complete copy of the audit of each
subrecipient will be on file at the State Agency for review by USDA.
c. The six participating CSFP projects will be required to have an audit at the end of their
fiscal year in which the close of the Federal Fiscal year 1995 falls.
13301.1300 CIVIL RIGHTS
The Colorado Department of Human Services assures the USDA Food and Nutrition Service that
in its administration of the Commodity Supplemental Food Program in the State of Colorado,it will
comply with all requirements of (Title VI of the Civil Rights Act of 1964 and USDA Regulations 7
CFR Part 15), including requirements of racial and ethnic participation data collection, public
notification of the nondiscrimination policy, and annual reviews of each local agency to assure
compliance with such policy,to the end that no person shall,on the grounds of race,color,national
origin,age,sex,or handicap be excluded from participation in,be denied benefits of,or be otherwise
subject to discrimination under the CSF Program. The Colorado Department of Human Services
further assures USDA, FNS that
a. Program information and publications will be provided in the appropriate language for
minority group areas. The local agency shall ensure that there are bilingual staff members
or interpreters available to serve limited or non-English speaking participants.
b. A statement of nondiscrimination will be printed on the Program authorization form and
on all State CSFP publications.
c. It will promptly adopt effective methods of administration that will insure assigned agency
personnel comply with the requirements imposed by the USDA regulations. Such methods
of administration to include delegation to the local agencies of:
1. Responsibility for providing public notification of benefits of the CSFP and of
State's nondiscrimination policy to the end that no person shall be excluded from
participation on the grounds of race, color, national origin,age, sex, or handicap.
2. Responsibility for advising local minority group organizations in writing that CSFP
is available to all eligible persons without regard to race,color,national origin,age,
sex, or handicap. The local agencies will be instructed to contact minority group
organizations once each year. If there are no minority group organizations in the
project area, the local agency will be instructed to contact prominent minority
leaders, clergymen, and other community spokesmen in the project area. This
23
940991
information can be communicated by newspaper articles, radio, television, letters,
leaflets brochures, bulletins,etc.
3. Responsibility for maintaining a file of all correspondence concerning public notice
of nondiscrimination to be available for inspection during reviews and audits of the
CSFP.
t "
4. Responsibility for supplying copies of the poster "_. and Justice for AB" to all
certification and distribution centers with the request that they be prominently
displayed.
5. Responsibility for collection of racial and ethnic participation data. This data is
to be collected at the distribution center by the distribution clerks marking one of
the following code letters in the lower left hand column of the participant's CSFP
authorization form:
CODE RACIAL GROUP
A BLACK
B HISPANIC
ASIAN OR PACIFIC ISLANDER
AMERICAN INDIAN OR ALASKAN NATIVE
E WHITE, NOT HISPANIC ORIGIN
The group classification shall be determined by observation of the participant.
The coding of ethnic classification can be done by observation or by asking the
participant to self-identify their racial group as long as they have been informed
that this information is strictly for reporting requirements.
The racial/ethnic group data for the reporting months (to be specified by USDA,
FNS) are to be tabulated and submitted on a report form FNS-191 to be supplied
by USDA FNS through the State Agency.
The data reported will be analyzed by the State Agency to compare minority
participation within individual counties to the total minority population and to
evaluate minority participation in relation to minority and/or bilingual staffing at
local agencies.
6. An annual civil rights compliance review will be conducted by the State Department
of Human Services so as to assure that these delegated responsibilities with respect
to nondiscrimination are being performed. During these reviews, specific areas
regarding civil rights are discussed and technical assistance is provided to local
agencies at the time. (Reference 13.910.406)
7. All complaints received by the State or local agencies which allege discrimination
based on race, color, or national origin shall be referred to the Secretary of
Agriculture or the Director,Office of Advocacy and Enterprise,USDA,Washington,
D.C.20250.
24
940991
S. The State or local agencies do not have grievance procedures in place for processing
complaints which allege discrimination based on sex and handicap. Therefore,all
complaints regarding these matters will be forwarded to the Regional Civil Rights
Office for review.
13301.1400 FAIR HEARINGS
The following fair hearing procedures shall apply to all individual CSFP applicants or jecipients:
a. Each potential CSFP recipient shall be informed in writing(by use of DF-14) at the time of
application and at the time of denial or termination,of his or her right to appeal and of the
fair hearing procedures.
b. Any CSFP applicant or his/her parent or guardian may appeal from a decision made by a
local agency,with respect to the eligibility of such person to receive the supplemental foods.
c. A request for a hearing shall be made by an individual or his/her parent or guardian to the
local agency within 60 days from the date the agency mails or gives the applicant or
participant the notice of adverse action to deny or terminate benefits. No particular written
form shall be required; however if the recipient choses to appeal in writing it is sufficient
if the written request identifies the individual and the decision from (DF-14) which the
appeal is being made.
d. The individual may be assisted or represented by an attorney or other person at the hearing.
e. All documents and records supporting the decision under appeal shall be available to the
individual or his agency from the time of written request for a hearing through the time of
the hearing.
f. The hearing shall be held within three weeks from the date of receipt of request and shall
be convenient to the individual. At least 10 days advance written notice shall be given to the
individual or his agent, specifying the time and place of the hearing.
g At the hearing,the individual shall be given an opportunity to present oral or documentary
evidence and arguments supporting his or her position in accordance with the procedures
as hereinafter set forth. These procedures shall be interpreted so as not to be unduly
complex or legalistic and shall take into consideration the individual's background and
education.
h. The individual shall have an opportunity to question or refute any testimony or other
evidence and to confront and cross examine any adverse witnesses.
i. The hearing shall be conducted and the decision shall be made by a hearing official who did
not participate in making the decision under appeal or in any previous conferences thereof.
Such hearing official shall be appointed by the head of the local agency and the appointment
shall be made in writing.
j. The decision of the hearing officer shall be based on the oral and documentary evidence
presented at the hearing and such decision shall be made part of the hearing record.
k. The individual and any designated representative shall be notified in writing of the decision
of the hearing official within 45 days from the date of the hearing record.
25
94O441
A written record shall be prepared with respect to the hearing,which record shall include
the decision under appeal, any documentary evidence submitted,and the summary of any
testimony preasented at the hearing,the decision of the hearing official,including the reason
therefrom and a copy of the notification to the family concerned of the decision of the
hearing official.
m. The written record of the hearing shall be preserved for a period of three years and shall
be available for examination by the person or his representative at any reasonable time and
place during this three year period, subsequent to the dose of the Federal fiscal year to
which they pertain.
n. If the appellant is dissatisfied with decision rendered by the local hearing officer, he/she
may appeal said decision to the Division of Administrative Hearing, 1120 Lincoln, 14th
Floor, Denver,CO 80203. CRS 1973-26-1-106 and 24-4-105. The appellant shall file said
appeal in writing with the Colorado Department of Administration, Division of
Administrative Hearings, 1120 Lincoln, 14th Floor, Denver, CO 80203.
o. No hearing officer shall,in any proceeding,consult any person or party on any fact in issue
unless upon notice and opportunity for all parties to participate. The hearing official may
direct any party to file proposed findings of fact and conclusions of law, briefs or
memoranda of law.
P. A request for a hearing shall not be denied or dismissed unless:
1. The request is not received within the time limit set by the State Agency in
accordance with Paragraph three of this section.
2. The request is withdrawn in writing by the applicant or a representative.
3. The applicant or representative fails, without good cause, to appear at the
scheduled hearing.
q. Participants who appeal the termination of benefits within the 15 day advance adverse notice
period provided by IILD (2) shall continue to receive Program benefits until the hearing
official reaches a decision. Applicants who are denied benefits at initial certification or at
subsequent certifications may appeal the denial but shall not receive benefits while awaiting
the hearing.
26
940991
13.910 COMMODITY SUPPLEMENTAL FOOD PROGRAM - FORMS SECTION
13.910.100 CSFP - CERTIFICATION FORMS
13.910.101 DF -4 SUPPLEMENTAL FOODS AUTHORIZATION
13.910.102 DF - 5 CSFP SUPPLEMENTAL FOOD IDENTIFICATION CARD
•
13.910.103 DF -5B CSFP VERIFICATION OF CERTIFICATION
13.910.104 DF - 14 NOTICE OF ADVERSE ACTION/RIGHTS OF APPEAL
13.910.105 CSFP SUPPLEMENTAL FOOD IDENTIFICATION CARD - DENVER COUNTY ONLY
13.910.106 CSFP SUPPLEMENTAL FOOD IDENTIFICATION CARD -WELD COUNTY ONLY
13.910.107 CSFP DONATED FOODS USED FOR FOOD DEMONSTRATIONS
32
940991
13.910.101
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-33
940991
OF-5(REV r/E01
LO. NO.
IDENTIFICATION CARD—SUPPLEMENTAL FOOD
AUTHORIZING AGENCY
RECIPIENT'S NAME RECIPIENT'5 51`.
PROXY PROXY'S SIG.
SIGNATURE OF CERT IF MO AUTHORITY
You may appeal any decision made by the Local Agency
regarding your denial or termination from the Program.
YOUR AUTHORIZATION FOR SUPPLEMENTAL
FOODS IS GOOD THROUGH:
MONTH YEAR MONTH YEAR
PLEASE DO NOT DESTROY THIS CARD
940991
OF-S(AEV.amai No.
COMMODITY SUPPLEMENTAL FOOD PROGRAM
Verification of Certification
Name bOB
(Participant.Parent.or Caretaker(
•
Signature
(Participant,Parent.or Caretaker,
Names of Eligible Participants: DOB:
•
CERTIFICATION RECORD
Certification Date: Begin End
Local Agency Name:
LJA Address:
State: Phone
Local Agency Official:
Signature:
Print Name:
940991
DF-14 (08/93)
COLORADO DEPARTMENT OF SOCIAL SERVICES
COMMODITY SUPPLEMENTAL SERVICES
NOTICE OF ADVERSE ACTION/RIGHTS OF APPEAL
DATE OF ACTION: •
LOCAL AGENCY:
ADDRESS: PHONE:
NAME OF PARTICIPANT/APPLICANT:
NAME OF PARENT/CARETAKER
ADDRESS: PHONE:
You have been denied participation in the Commodity Supplemental Food Program because:
Your participation in the Commodity Supplemental Food Program has been terminated
because:
If you do not agree with our decision, you may have a conference at your certification office to explain why you
disagree. If you are not satisfied with the outcome on the conference,or if you do not want to have a conference,you
may request a local level hearing at
NAME AND ADDRESS OF LOCAL LEVEL HEARING AUTHORITY:
If you wish,you may request a state level hearing at
ADMINISTRATIVE HEARINGS
1120 LINCOLN - SUITE 900
DENVER, CO 80203
To request a conference and/or hearing,call your certification office or fill out and return the form below within 60
days of the date of this form. If you want to ask any questions or to find out if free legal advice is available, your
certification office will help you.
If your benefits are to be terminated,you can continue to receive benefits at your current rate if you request a hearing
within the 15 day advance notice of adverse action until the hearing is held or the certification period ends,whichever
comes first. To insure continuation of benefits,it is best to request a hearing through your local certification office.
940991
13.910.105
•
IDENTIFICATION CARD-SUPPLEMENTAL FOOD
OF•SO IREV.LODI
I.O. NO.
DENVER DEPARTMENT OF SOCIAL SERVICES
AUTHORIZING >GENCY
RECIPIENTS NAME RECIPIENTS SIG
PROXY PROXY'S SIG
SIGNATURE OF CERTIFIED AUTNORIrY
727.2541 727.2719
•
OPEN WEEK DAYS (ENGLISH) (SPANISH)
THIS PROGRAM IS AVAILABLE TO ALL ELIGIBLE PER-
SONS REGARDLESS OF RACE. COLOR, NATIONAL
ORIGIN. RELIGION, POLITICAL BELIEF. SEX. AGE. OR
HANDICAP.
YOUR AUTHORIZATION FOR SUPPLEMENTAL FOODS
IS GOOD THROUGH:
MONTH YEAR I MONTH YEAR
You may appeal any decision made by the local agency
regarding your denial or termination from the program
265O WEST 3RO AVE (3RO BRYANT)
PLEASE DO NOT DESTROY THIS CARD
1.-
940991
13.910.106
•
•
IDENTIRCATION CARD-SUPPLEMENTAL F000
CFSG(REV Pete
• I.D.NO.
•
WELD COUNTY SUPPLEMENTAL FOODS
AUTHORIZING AGENCY
RECIPIENTS NAME RECIPIENT'S SIG.
PROXY PROXYS SIG.
SIGNATURE OF CERrFIED AUTHORITY
GREELEY(Mon,Wed,Thur,Fri) 356.0676 857-2725
FT.LUPTON(rues) (Greeley) (Ft Lupton)
THIS PROGRAM IS AVAILABLE TO ALL EUGIBLE PERSONS
REGARDLESS OF RACE.COLOR,NATIONAL ORIGIN,
RELIGION.POLITICAL BELIEF,SEX.AGE.OR HANDICAP.
YOUR AUTHORIZATION FOR SUPPLEMENTAL FOODS IS
GOOD THROUGH:
MONTH YEAR MONTH YEAR
You may appeal any decision made by the local agency
regarding your denial or termination from the program.
lost 11TH AVE.,GREELEY
320 PARK AVE.,FT.LUPTON
PLEASE DO NOT DESTROY THIS CARD
940991
13.910.107
COLORADO DEPARTMENT OF SOCIAL SERVICES
DONATED FOODS UNIT
1575 SHERMAN STREET, 3rd FLOOR
DENVER, CO 80203-1700
(303) 866-5100
•
DONATED FOODS USED FOR CSFP FOOD DEMONSTRATIONS
FOOD ITEM QUANTITY
PURPOSE OF DEMONSTRATION:
ATTACH EXTRA PAGES IF NEEDED
DEMONSTRATION SITE USED FOR CSFP FOOD DEMONSTRATIONS
Agency Name:
Name of Demonstrator: /Date
Mailing Address:
Telephone: ( ) FAX ( )
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * w *
IMPORTANT! Any product transferred to any other agency for demonstration purposes must have prior
written approval from the S; :u Agency, 1575 Sherman Street, 3rd Floor, Denver, CO 80203-1700.
APPROVED BY STATE CSFP OFFICE:
If commodities were used for demonstrations a copy of this form must accompany the monthly 153 Report.
940991
13.910.200 CSFP DISTRIBUTION FORMS
13.910101 DF-7 CSFP DAILY RECORD OF ISSUES
13.910.202 FNS - 153 CSFP MONTHLY FOOD INVENTORY AND DISTRIBUTION REPORT
13.910.203 CSFP ORDER FORM - DISTRIBUTOR
•
13.910104 DF - 13 CSFP GAIN OR LOSS REPORT
13.910.205 DF - 15 CSFP EXPIRATION OF CERTIFICATION
13.910.206 CHART CSFP MAXIMUM MONTHLY DISTRIBUTION RATES
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z .
MONTHLY REPORT OF COMMODITY SUPPLEMENTAL FOOD PROGRAM AND QUARTERLY ADMINISTRATIVE FINANCIAL
STATUS REPORT
'port 3. Type of 4. NUMBER OF PARTICIPANTS 5. RFT MEAS'MENTS
. -h/Yr Submission A.-Initial Infants Infants Children Prg/Bre Post P Total I Part Total No Of CASES UNITS
B.-Last Rev 0-3 Hon (4-12) Hon (1-6) Yr Feed Wo Women 4A+B+C+D+E+F Elderly Part (A) (B)
2. State C.-Closeout (A) (B) (C) (D) (E) (F) (G)
Agcy Noe Last Inven-
Dept Of tory ( )PR m( g )
Hunan
Services STATE AND LOCAL DATA
6. 6a. 6B. 7. 8. 9. 10. 11. 12. 13. 14. 15.
STATE fi TOTAL CONM ISSUANCE COMMODITY ACTIVITY TOTAL ADJUSTMENT STATE 6
COMU4'TY CODE PACK LOCAL RECEIPT REDON INV'ORY ACT'VTY LOCAL
NAME SIZE BEGIN'G ATIONS AVAIL Total Issue To Total 1 REDON Food (12a+b+ Posi- Mega- ENDING
INV'ORY IN (7+8+9) Issued ATION Food Demo c+d) tive tive INV
WIC Eldly (11A+B) Out Loss stra ((10-13
tion )+/- 14
(A) (B) (A) (B) (C) (D) (A) (B) a & b)
MILK EV B081 48/12
MILK NFD B090 6/4
----- ------ ----- -------- -- --- ---- --- ---- -----
FKN POWD B167 12/1
FE POWD 8168 6/1
FRM SOY 8162 6/14
------- ---- ------- ------- ------- ----- -------- ------ ------- ----- ----- ---- ------- ------- ------- -------
FRN SOY 8169 6/1
------- ---- ------- ------- ------ ------ -------- ------ ------ ------ ----- ---- ------ ------- ------- -------
POT DEB A196 12/16
------ ------ ----
RICE B510 24/2
MACARONI B425 24/1
SPAGHETT 8835 12/2
SPAGHETT 8839 24/1
FORM 153 06/94 Page 1 of 5
940004
MONTHLY REPORT OF COMMODITY SUPPLEMENTAL REPORTING MONTH & YEAR STATE AGENCY NAME REPORTING MEASUREMENT
' FOOD PROGRAM STATE & LOCAL INVENTORY Co Dept Of Hunan Services CASES ( ) UNITS ( X )
STATE AND LOCAL DATA
6. 6a. 6B. 7. 8. 9. 10. 11. 12. 13. 14. 15.
STATE & TOTAL COMM ISSUANCE COMMODITY ACTIVITY TOTAL ADJUSTMENT STATE &
COMITY CODE PACK LOCAL RECEIPT REDON INV'ORY ACT'VTY LOCAL
NAME SIZE BEGIN'G ATIONS AVAIL Total Issue To Total I AEON Food (12a+b+ Posi- Nega- ENDING
INV'ORY IN (7+8+9) Issued ATIONS Food Deno c+d) tive jive INV
WIC Eldly (11A+B) Out Loss stra ((10-13
tion )+/- 14
(A) (B) (A) (B) (C) (D) (A) (B) a & b)
FARINA B160 24/14
CER CORN B851 14/16
CER CORN 8852 12/17.5
CER CORN 8850 24/18
CER OATS B860 24/15
CER OATS 8861 12/16
CER RICE B867 12/17.5
RICE 8864 24/13
CER RICE 8866 12/13
CERWHEAT 8871 12/16
CERWHEAT 8870 24/18
CERIRICE B161 12/8
EGG HIX A570 48/6
PB CRHY B470 24/2
PINTO BD A914 12/2
ILS A135 12/2
FORM 153 06/94 Page 2 of 5
940991
MONTHLY REPORT OF COMMODITY SUPPLEMENTAL REPORTING MONTH & YEAR STATE AGENCY NAME REPORTING MEASUREMENT
' FOOD PROGRAM STATE & LOCAL INVENTORY Co Dept Of Human Services CASES ( ) UNITS ( X )
STATE AND LOCAL DATA
6. 6a. 6B. 7. 8. 9. 10. 11. 12. 13. 14. 15.
STATE & TOTAL COMM ISSUANCE COMMODITY ACTIVITY TOTAL ADJUSTMENT STATE 6
COMM'TY CODE PACK LOCAL RECEIPT REDON INV'ORY -----------------------------; ACT'VTY ------ ---- LOCAL
NAME SIZE BEGIN'G ATIONS AVAIL Total Issue To Total / REDON Food (12a+b+ Posi- Nega- ENDING
INV'ORY IN (7+8+9) ------------ Issued ATIONS Food Demo c+d) tive five INV
WIC Eldly (11A+B) Out Loss stra ((10-13
------ ---- tion )+/- 14
(A) (B) (A) (B) (C) (D) (A) (B) a & b)
BEEF STW A587 24/24
BEEF STW A589 24/15
BEEF NJ A610 24/29
CHICKEN A562 24/29
PORK NJ A630 24/29
POULTRY 1560 24/29
LUNCH HT A617 24/30
t^"^H NT A619 24/30
CARROTS A095 24/303
CORN CRM A120 24/303
CORN WHK A121 24/303
GREEN B A060 24/303
BEAN VEG A090 24/300
PEAS A145 24/303
POT WHO A169 24/303
POT SWT A221 24/303
SPINACH A166 24/303
TOMATOES A248 24/303
"IN A163 24/303
FORM 153 06/94 Page 3 of 5
.n A nnri.4
MONTHLY REPORT OF COMMODITY SUPPLEMENTAL REPORTING MONTH AND YEAR STATE AGENCY NAME REPORTING MEASUREMENT
'FOOD PROGRAM STATE & LOCAL INVENTORY Co Dept Of Human Services CASES ( ) UNITS ( Y )
STATE AND LOCAL DATA
6. 6a. 6B. 7. 8. 9. 10. 11. 12. 13. 14. 15.
STATE & TOTAL COMM ISSUANCE COMMODITY ACTIVITY TOTAL ADJUSTMENT STATE E
CO N'TY CODE PACK LOCAL RECEIPT REDON INV'ORY , ACT'VTY ------- ------- LOCAL
NAME E SIZE BEGIN'G ATIONS AVAIL Total Issue To Total / REDON Food (12a+b+ Posi- Nega- ENDING
INV'ORY IN (7+8+9) Issued ATIONS Food Demo c+d) tive tive INV
WIC Eldly (11A+B) Out Loss stra ((10-13
tion )+/- 14
(A) (B) (A) (B) (C) (CO (A) (B) a & b)
TUNA A740 24/12.5
TUNA A741 24/1225
APPLESAU A355 24/303
APRICOTS A362 24/303
FRUIT CK A401 24/303
P"'"R CL A412 24/303
PEARS A439 24/303
PINAPPLE A446 24/2
PLUMS A461 24/303
APPLE J A282 12/46
GRAPEFRJ A280 12/46
GRAPE J A285 12/46
ORANGE J A300 12/46
TOMATO J A290 12/46
PIN'PLEJ A286 12/46
FORM 153 06/94 Page 4 of 5
a4noo1
MONTHLY REPORT OF COMMODITY SUPPLEMENTAL REPORTING MONTH & YEAR STATE AGENCY NAME REPORTING MEASUREMENT
'FOOD PROGRAM STATE & LOCAL INVENTORY Co Dept Of Human Services CASES ( ) UNITS ( X )
STATE AND LOCAL DATA
6. 6a. 6B. 7. 8. 9. 10. 11. 12. 13. 14. 15.
STATE & TOTAL COMM ISSUANCE COMMODITY ACTIVITY TOTAL ADJUSTMENT STATE &
COMN'TY CODE PACK LOCAL RECEIPT REDON INV'ORY ---------- ACT'VTY ------- ------ LOCAL
NAME SIZE BEGIN'G ATIONS AVAIL Total Issue To Total / REDON Food (12a+b+ Posi- Mega- ENDING
INV'ORY IN (7+8+9) ----------- Issued ATIONS Food Demo c+d) tive tjve INV
WIC Eldly (11A+B) Out Loss stra ((10-13
-- - — tion )+/- 14
(A) (B) (A) (B) (C) (U) (A) (B) a & b)
DOTTER B050 36/1
CHEESE L B060 6/5
CHEESE L 8061 12/2
CHEESE L B062 15/2
CORNMEAL B137 10/5
HONEY,CN B403 24/24
16. REMARKS (Provide Explanation as Requested by Instructions.) (Attach Additional Sheets as Deemed Necessary.)
17. SIGNATURE 18. TITLE 19. 20. OUTLAYS UNLIQ. TOTAL UNLIQ BAL OF
DATE CSFP (A) OBLIG. (B) (C) ADVANCES (D)
ADMINISTRATION
FORM 153 06/94 Page 5 of 5
940991
13.010.203
COMMODITY SUPPLEMENTAL FOOD PROGRAM ORDER FORM
AGENCY AGENCY it CUSTOMER i
BILL TO: CITY ZIP
•
SHIP TO: CITY ZIP
CONTACT PERSON PHONE it DEL
DATE REQUIRED
(ORDER IN CASES ONLY)
QTY ITEM/ DESCRIPTION QTY ITEM it DESCRIPTION
A282 APPLE JUICE 12/46 B161 CEREAL RICE INF. 12/8
I
A285 GRAPE JUICE 12/46 B160 FARINA 24/14
MOO ORANGE JUICE 12/46 A570 EGGMIX 48/6
A286 PINEAPPLE JUICE 12/46 B137 CORNMEAL 10/5
A280 GRAPEFRUIT JUICE 12/46 B14111 CORNMEAL 5/10
A355 APPLESAUCE CND 24/303 B081 MILK EVAP 48/12
A362 APRICOTS CND 24/303 B090 MILK NFD INSTANT 6/4
A401 FRUIT COCKTAIL 24/303 B162 FORMULA SOY DRY 6/14
A412 PEACHES CLG CM) 24/303 B165 FORMULA INFANT 24/13
A439 PEARS CND 24/303 B167 FORMULA POWDER 12/1
A431 PEARS HALVES 6110 B168 FORMULA POWDER 6/1
A446 PINEAPPLE CND 24/2 B169 FORMULA DRY SOY 6/1
A461 PLUMS CM) 24/303 B050B BUTTER 36/1
A480B PRUNES DRY BONUS 24/1 B403B HONEY PROCESS 24/24
B851 CEREAL CORN DRY 14/16 B470 PEANUT BUTTER 24/2
13852 CEREAL CORN DRY12/17.5 B06013 CHEESE PROCESS 6/5
B860 CEREAL OATS DRY 24/15 13061B CHEESE PROCESS 12/2
B861 CEREAL OATS DRY 12/16 B062 CHEESE PROCESS LF 15/2
B866 CEREAL RICE DRY 12/13 B062B CHEESE PROCESS 15/2
B867 CEREAL RICE DRY12/17.5 B510 RICE MILLED 24/2
940991
13.910104
DF-13 08/93)
•
GAIN OR LOSS REPORT- DONATED FOODS
Name of issuing agency County
This is to advise that an adjustment was made in the Foods Inventory and Distribution Report for the Month of_
, 19
Donated Food Item
Quantity Involved: Loss
Gain
Apparent cause of the gain or loss was as follows:
Prepare this form in duplicate for each item of Donated Food.
Attach one copy to the monthly Foods Inventory and Distribution Report DF-12.
Retain the other copy in file.
440991
13.910205
DF-15 (8/93) •
COMMODITY SUPPLEMENTAL FOOD PROGRAM
EXPIRATION OF CERTIFICATION
Your certification period for Commodity Supplemental Foods will expire the last
working day of
You must contact your local certification office to be recertified for and receive
Commodity Supplemental Foods.
411114441
•
' 13.910.206
FNS INSTRUCTION 835-1
REV. 1
EXHIBIT A-1
MAXIMUM MONTHLY DISTRIBUTION RATES
Infants
•
Package Packages Total Maximum
Size Per Month kmount/Mnnth
INFANTS: 0-3 Months
Infant Formula:
Concentrated Liquid 13-oz can 31 cans 403 ozs
or or
Powdered 1-lb can 8 cans 8 lbs •
INFANTS: 4-12 Months
Infant Formula:
Concentrated Liquid 13-oz can 31 cans 403 ozs
or or
Powdered 1-lb can 8 cans 8 Ibs
Cereal . Infant Rice 8-07 okg 4 okgs 32 ozs
Juices 46-07 ran 2 cans 92 ozs
•
1 Tomato Juice should not be issued to Infants.
940991
13.910.206 '
ENS INSTRUCTION 835-1
REV. i
EXHIBIT A-2
MAXIMUM MONTHLY DISTRIBUTION RATES
Children (1 to 6 Years) 4 , c
/ -a
Package Packa Total Maximum
Size Per Month Amount/Month
2 pkgs 36 ozs
Cereal , Dry Ready-to-Eatl 18-oz pkg or
s
or 14-oz pkg28 ozs
F 6-nz nkg 2 nkgs 12 075
Fog Mix. 2 ok9 Dry 46-oz can 5 cans 230 ozs
Juice 29-oz can 1 can 29 ozs
Meat/Poultry or
or 24-az rrn 1 can 74 075
JM.ethall Stew '
Milk: 2 12-oz can 33 cans 396 ozs
Evaporated to
or 3 12-oz can cans 60 ozs
Evaporated and
and 3 25.6-oz pkg 2 pkgs 51.2 ozs
Instant Nonfat Dry or
4-lb pko I oRg 4 lbs
Peanut Butter 2-lb Jar/can 1 pkg every, 1 lb
Or other month
Pena/Romans. Dry 2-lb pka a4
lb
Potatoes, Dehydrated 1-lb pkg I Pk9 1 lb
or
or 2-lb okn 1 nkg 2 lbs
Rice 15/16-oz can
and/orbles} 20-oz can )7 4 cans 60-116 ozs
and/or
Fruits 27/?9-oz ran
1 Additional package sizes may be available. The distribution rate for all sizes
is 2 packages per month. A combination of 1 package of dry ready-to-eat cereal
and 1 package of farina may be provided.
2 Children 1 year through 2 years of age may receive: 33 12-oz cans of evaporated
milk; or a combination of 5 12-oz cans of evaporated milk and 2 25.6-oz packages
of Instant nonfat dry milk; or a combination of 5 12-oz cans of evaporated milk
and 1 4-lb package of nonfat dry milk.
e may e a 3 Chilre
moilkhandy2a25.6fozg packages cofVinsta tbnonfatn z
3 years dry milk; or5 ca12-oz cans of evaporated milk and 1 4-lb package of nonfat dry milk.
4 One 2-lb (32 oz) jar/can/package is a 2-months' supply. Distribute peanut butter
or beans every other month. ,
5 Four cans, regardless of size, may be issued of either all fruit, all vegetables,
or a combination of both.
940991
' 13.910.206
FNS INSTRUCTION 935-1
REV. 1
/ EXHIBIT A-3
MAXIMUM MONTHLY DISTRIBUTION RATES
•
Pregnant/Breast-Feeding tfcmerl •
Package Packages Total Maximum
Size Per Month Amount/Month
Cereal, Dry Ready—to—Eats 18—oz pkg 2 pkgs 36 ozs
or
Or 1 14—oz okg 2 okas 28 ozs
Farina
Sag Mix. Dry 6—or oka 2 okas 12 ozs
Juice 46-07 can 5 cans 230 075
Meat/Poultry 29-oz can 1 can 29 ozs
or
or z4 075
jteatball Stew I 24-oz can 1 can
Milk:
Evaporated 12-oz can 11 cans 132 ozs
and •
aand
Instant Nonfat Dry 25.6-oz pkg 2 pkgs 51 .2 ozs
or
4-lb oka 1 okg 4 Ibs
Peanut Butter 2-lb Jar/can 1 pkg every 1 lb
or other onth 2
Peas/Beans. Dry 2-lb oka 1 lb
Potatoes, Dehydrated 1-lb pkg 1 pkg 1 lb
or or
Rice 2-lb okg 1 oka 2 ills
Vegetables s 15/16-oz can ]
and/o 20-oz can )l 8 cans 120-232 ozs
Fruit' 27/29-or ran
1 Additional package sizes may be available. The distribution rate for all sizes
is 2 packages per month. A combination of 1 package of dry ready-to-eat cereal
and 1 package of farina may be provided.
2 One 2-lb (32 oz) Jar/can/package is a 2-months' supply. Distribute peanut butter
or beans every other month.
3 Eight cans, regardless of size, may be issued of either all fruit, all
vegetables, or a combination of both.
940991
13.910.206
FNS INSTRUCTION 835-1
REV. 1
EXHIBIT A-4
MAXIMJM MONTHLY DISTRIBUTION RATES
Nonbreast-Feedinc/Postnartum Warren and Elderly •
Package Packages Total Maximum
Size Per Month Amount/Mo +ti
Cereal, Dry Ready-to-Eatl 18-oz pkg 2 pkgs 36 ozs
or or
Farinal 14-oz Qka 2 rakes 28 ozs
Egg Mix. Dry 6-oz nko 2 nkos 12 ozs
Juice 46-oz nko 3 cans 138 ozs
Meat/Poultry 29-oz pkg 1 can 29 ozs
or or
)Meatball Stew 24-oz can 1 can 24 ozs
Milk:
Evaporated 12-oz can 3 cans 36 ozs
and and
Instant Nonfat Dry Al. le.ier 0-44,125.6-oz pkg 2 pkgs 51 .2 ozs
/ or
4-lb pkg) 1 oka /YDM 4 lbs
Peanut Butter 2-lb Jar/can 1 pkg every 1 lb
or other month2
Peas/Beans. Dry 2-lb nkg n2 1 lb
Potatoes, Dehydrated 1-lb pkg 1 pkg 1 lb
or or
• flee 2-lb okg 1 okg 2 lbs
Vegetables] 15/16-oz can )
and/or 20-oz can 4 cans 60-116 ozs
Frult3 27/29-oz ran
1 Additional package sizes may be available. The distribution rate for all sizes
is 2 packages per month. A combination of 1 package of dry ready-to-eat cereal
and 1 package of farina may be provided.
2 One 2-lb (32 oz) Jar/can/package is a 2-months' supply. Distribute peanut butter
or beans every other month, except elderly participants may receive a 2-lb package
of peanut butter or dry beans every month.
3 Four cans, regardless of size, may be issued of either all fruit, all vegetables,
or a combination of both.
- 9-7-88
940991
13.910.300 CSFP AGREEMENT FORMS
13.910301 CSFP STATE/LOCAL AGENCY AGREEMENT COVERING CERTIFICATION FOR AND
DISTRIBUTION OF FOOD COMMODITIES
13.910302 CSFP PROGRAM APPLICATION FOR LOCAL AGENCIES
13.910.303 LETTER OF AGREEMENT FOR DETECTION AND PREVENTION OF DUAL PARTICIPATION
BETWEEN THE COLORADO COMMODITY SUPPLEMENTAL FOOD PROGRAM AND THE
COLORADO SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR WOMEN, INFANTS, AND
CHILDREN (WIC)
13.910304 STATE AND LOCAL DEPARTMENT/AGENCY INDIRECT COST NEGOTIATION AGREEMENT.
940991
DF-2B (Rev. 09/94
COLORADO DEPARTMENT OF HUMAN SERVICES
1575 Sherman Street, 3rd Floor
Denver, CO 80203-1700
•
Donated Foods Agreement
Commodity Supplemental Food Program
(Serving Low Income Women, Infants, Children and Elderly)
This agreement is made this (Enter today's date) day of 19 by
and between the Colorado Department of Human Services, 1575 Sherman Street, 3rd Floor,
Denver, CO 80203-1700 (hereinafter referred to as the "Department"), and the (Enter your
agency's name) (hereinafter referred to as the "Recipient
Agency").
Whereas, the Department is a distributing agency under a contract with the U.S.
Department of Agriculture (hereinafter referred to as "USDA"). The Contract with USDA
is subject to all federal laws and regulations. USDA controls the amount and types of
commodities available to the Department.
Whereas, the Department has the responsibility for administering the Food
Distribution Programs in Colorado in accordance with its Contract with USDA, and;
Whereas, the Recipient Agency desires to participate in the Donated Foods Program
in accordance with the terms of this Agreement; and
Whereas, as of the date of execution of the Agreement, Recipient Agency meets all
requirements for participation in this program.
NOW, THEREFORE, it is hereby agreed:
1. The Recipient Agency is operating a Commodity Supplemental Food Program which
provides supplemental foods to low income pregnant and postpartum women, infants,
children and elderly; and
Complete the following questions:
The Recipient Agency has the following types of storage facilities available:
Dry Yes No
Cooler Yes No
Frozen Yes No
1
940991
2. Recipient Agency shall participate in the Donated Foods Program in accordance with the
terms of the Agreement and applicable legal requirements described below.
3. The term "legal requirements" as it is used throughout this Agreement includes federal
and state statutes, federal and state regulations program requirements as identified in the
Food Distribution Unit Recipient Agency User's Handbook, State Plan of Operation and
Administration attached hereto and incorporated herein as Exhibit A and any amendments
thereto, which are applicable to the Food Distribution Programs, which are in effect when
this Agreement is executed. The Recipient Agency agrees to fully comply with all legal
requirements defined above, and to submit any reports requested by the Department or
USDA in a prompt and complete manner, and to enforce such legal requirements against
any sub-distributing agencies which are under contract with the Recipient Agency.
4. Recipient Agency shall receive, store and distribute donated foods. In addition, the
Recipient Agency agrees to comply with the following terms and conditions:
A. Use of Donated Foods
Donated food will be used only in connection with Recipient Agency's established
feeding operation for the sole benefit of persons served by the Recipient Agency
and will not be sold,exchanged,or otherwise disposed of by the Recipient Agency
without express written approval being obtained by the Recipient Agency from the
Department.
B. Storage Facilities
The Recipient Agency and any sub-distributing agencies under contract with the
Recipient Agency shall provide adequate facilities for the handling, storage and
distribution of donated foods. These facilities shall be such as to properly
safeguard against damage, theft, spoilage, or other loss as recommended in the
"Food Storage Guide for Schools and Institutions" in the Food Distribution Unit
User's Handbook. The Recipient Agency shall provide facilities and services that:
1. Are sanitary and free from rodent, bird, insect and other animal infestation;
2. Safeguard against theft, spoilage and other loss;
3. Maintain foods at proper storage temperatures;
4. Stock and space foods in a manner so the USDA-donated foods are readily
identified;
5. Rotate stock utilizing "First-In/First-Out" inventory practices;
6. Store donated food off the floor and away from walls in a manner to allow
for adequate ventilation;
7. Maintain accurate inventory records of product issuance; and
8. Take other protective measures as may be necessary.
The Department reserves the right to inspect the facilities, without the
benefit of prior notification, to ensure these standards are met.
2
940991
C. Responsibility for Damage. Spoilage. Theft or Other Loss
Once the donated foods have been delivered to the Recipient Agency or its carrier agent,
the Recipient Agency is responsible to the Department for said food. In the event of
damage, spoilage, theft or other loss, the Recipient Agency will promptly notify the
Department. In case of spoilage, the Recipient Agency shall furnish a certificate from the
County or the State Health Department representative confirming such spoilage..
The Recipient Agency assumes full responsibility for reimbursing the Department for the
USDA dollar value of any donated foods improperly used or disposed of or any loss or
damage to donated foods due to the failure of the Recipient Agency or its agents to
provide proper storage, care or handling. The Recipient Agency may be required by the
Department to submit documentation regarding the loss.
D. Physical Inventory
Recipient Agencies shall take an annual physical inventory of USDA commodities the last
working day of September and submit the inventory to the Department, not later than the
5th of October, in a format prescribed by the Department. Such inventory shall be
reconciled with the Recipient Agency's book inventory records and maintained on file by
the Recipient Agency.
In no event, may the inventory level of each donated food in storage exceed a six-month
supply unless sufficient justification for additional inventory has been submitted and
approved by the Department.
E. Complaints
The Recipient Agency shall immediately advise the Department in writing of any
complaints regarding the donated foods. The Recipient Agency shall provide appropriate
information regarding the product and nature of the complaint so that an investigation can
by pursued by the Department or USDA. In addition, any complaints regarding the
commercial distribution system shall be provided to the Department in writing for
appropriate action.
F. Utilization and Redistribution
Available donated foods will be requested only in such quantities as will be fully utilized
and will be receipted for by the authorized representative of the Recipient Agency. The
Department reser, the right to redistribute any USDA donated foods in possession of
the Recipient Agency.
3
A A AAAI
G. Records
The Recipient Agency will accurately maintain records of donated foods received and
such accountability records as may be prescribed by the Department. Such records shall
include, but not be limited to, accurate and complete records with respect to the receipt,
disposal, and inventory of donated foods and with respect to any,funds which arise from
the operation of the program. The Recipient Agency shall also keep accurate and
complete records showing the certification and eligibility determination of those baking
application for program participation. All records must be retained for a period of three
years from the close of the federal fiscal year to which they pertain.
H. Audits and Inspections
The Recipient Agency shall allow representatives of the Department and/or USDA to
inspect and inventory donated foods in storage, the facilities used in the handling or
storage of such donated foods inspect and audit all records, including financial records
and reports pertaining to the distribution of donated foods, and to review or audit the
procedures and methods used in carrying out the audit requirements at any reasonable
time with or without the benefit of prior notification.
All Recipient Agencies receiving more than $25,000 in federal financial assistance per
fiscal year shall have an audit made by an independent auditor, that complies with the
audit requirements established by the Office of Management and Budget Circular Number
A-128 or A- 133. The audit standards to be followed can be found in the Standards for
Audit of Governmental Organizations. Programs. Activities and Functions (1988 revision)
issued by the U.S. General Accounting Office, and the Guidelines for Audits of Federal
Awards to Nonprofit Organizations (April 1989) published by the Department of Health
and Human Services. For this purpose, the term independent auditor means a state or
local government auditor who meets the independence standards specified in generally
accepted government auditing standards; or, certified public accountant who meets such
standards.
Financial
1. Quarterly Statements of Expenditures
As required in the State Plan of Operation and Administration the Recipient Agency shall
submit to the Department by the 15th of the month following the close of the quarter, a
Quarterly Statement of Expenditure report reflecting an accurate amount of funds
expended for the quarter. The Department will reimburse the Recipient Agency their fair
share percentage of federal funds available based upon each Recipient Agency's actual
expenditures submitted for the previous quarter. The reimbursement portion of federal
funds will be disbursed to the Recipient Agency based on actual cases of"bonus"donated
foods distributed during the previous quarter. Quarterly Statements of Expenditures shall
4
44(1404
be kept current and available for audit and review purpose at the Recipient Agency.
2. Distributor Charges
The Recipient Agency shall pay the quoted price per case directly to the contracted
regional distributor as billed for the number of cases received on each shipment. The
Recipient Agency shall comply with the distributor's credit policy and payment P Y ymen t terms.
In the event a Recipient Agency falls more than 60 days in arrears in payments to the
distributor, the Department and the distributor may jointly agree to suspend issues of
donated foods and the distributor may take necessary action to pursue collection of the
account. The Recipient Agency shall request reimbursement for payments made to the
distributor on a form prescribed by the Department.
J. Civil Rights and Nondiscrimination
The Recipient Agency at all times during the execution of this agreement shall strictly
adhere to all applicable federal and state laws and implementing regulations as they
currently exist and may hereafter be amended. This includes protection of the
confidentiality of all applicant/recipient records, papers, documents, tapes and any other
materials that have been or may hereafter be established which relate to this agreement.
The Recipient Agency acknowledges that the following laws are included:
- Tide VI of the Civil Rights Act of 1964, 42 U.S.C.
Sections 2000d-I et. sea. and its implementing regulation, 45 C.F.R. Part 80 et.
sea.- and Section 504 of the Rehabilitation Act of 1973,
29 U.S.C. Section 794, and its implementing regulation, 45 C.F.R. Part 84;and
the Age Discrimination Act of 1975, 42 U.S.C. Sections
6101 et. sea. and its implementing regulation, 45 C.F.R. Part 91-and
- Title VII of the Civil Rights Act of 1964; and
the Age Discrimination in Employment Act of 1967;
and
the Equal Pay Act of 1963; and
- the Education Amendments of 1972.
- Immigration Reform and Control Act of 1986, P.L.
99-603
The Recipient Agency shall comply with all regulations applicable to these laws
prohibiting discrimination because of race, color, national origin, age, sex and handicap,
including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related conditions,
covered in Section 504 of the Rehabilitation Act of 1973, as amended, cited above. This
assurance is given in consideration of and for the purpose of obtaining any and all federal
and/or state financial assistance. Any person who feels that she/he has been discriminated
against has the right to file a complaint either with the Colorado Department of Human
5
a A nn04
The Recipient Agency shall comply with all regulations applicable to these laws
prohibiting discrimination because of race, color, national origin, age, sex and
handicap,including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related
conditions, covered in Section 504 of the Rehabilitation Act of 1973, as amended,
cited above. This assurance is given in consideration of and for the purpose of
obtaining any and all federal and/or state financial assistance. Any person who feels
that she/he has been discriminated against has the right to file a complaint•either
with the Colorado Department of Human Services or with the U.S. Department of
Agriculture, Office for Civil Rights.
The Recipient Agency is responsible for any additional Civil Rights reporting
requirements as set forth in the State Plan of Operation and Administration.
K. ' Indemnification
To the extent authorized by law, the Recipient Agency shall indemnify, save and hold
harmless the State, its employees and agents, against any and all claims, damages,
liability and court awards including costs, expenses, and attorney fees incurred as a
result of any act or omission by the Recipient Agency, or its employees, agents,
subcontractors, or assignees pursuant to the terms of this Agreement.
L. Enforcement
If the Recipient Agency fails to comply with the provisions of this Agreement, it may,
at the discretion of the Department, be disqualified from further participation in the
Program. The Recipient Agency or the Department may seek judicial relief for any
provision of this Agreement.
M. Effective Date
This Agreement will become effective on the date of approval by the Executive
Director of the Department or authorized designee, and shall remain in effect until
September 30, 1995. The Recipient Agency or the Department may terminate this
Agreement at any time by giving thirty days notice in writing. Upon such termination
by either the Recipient Agency or the Department, the Recipient Agency shall, at its
expense, return all unused donated foods in its possession to such place within the
State of Colorado as may be designated by the Department.
N. Assignment
The Recipient Agency agrees not to assign its rights or to delegate its obligations
under this Agreement without prior approval in writing from the Department.
0. Future Effect
6
940991
This Agreement is binding upon the present and future elected or employed officials
of the Recipient Agency and the State of Colorado.
P. Authorized Representative •
It shall be the duty of the Recipient Agency to promptly notify, in writing, the
Department of any change in its Agency Head or authorized representative or
change in legal address.
Q. Signatures
The individual signing this Agreement as the "Agency Head" or "Authorized
Representative" (as attested if a corporation) certifies that his/her signature legally
binds the Recipient Agency to the terms of this Agreement.
TYPE OR PRINT ALL INFORMATION BELOW:
DATE:
NAME OF RECIPIENT AGENCY:
ADDRESS:
STATE OF COLORADO
DEPARTMENT OF HUMAN
SERVICES
PHONE #: DATE APPROVED
SIGNATURE AND TITLE OF AGENCY HEAD
OR AUTHORIZED REPRESENTATIVE:
BARBARA McDONNELL
EXECUTIVE DIRECTOR
7
4/1115141
19.910802
COMMODITY SUPPLEMENTAL FOOD PROGRAM
(CSFP)
APPLICATION FOR LOCAL AGENCIES
1. APPLICANT INFORMATION •
Agency Name:
Address: e
Street or PO Box City/Town Zip
Telephone:
Area Code Numbet
Geographic Area Served:
OMde1 Responsible for Program at Local Level:
Name Title
FOR PRIVATE NONPROFIT ORGANIZATIONS ONLY
IRS Tax-Exempt Certificate/
If no number,I.application pending? YES NO .
Sponsor Agency(If different than Applicant Agency)
Name of Agency .
Address
2. HEALTH SERVICES
A. Which of the following health services or types of clinics are offered by your agency or are provided to your clients
by referral?
Service Types of Clinics
__ Physicians'Services _ Prenatal
- Nursing emcee _ Perinatal
Home Health Service Child Health
Nutrition Education or Cottrureling _ EPSDT
Social Services _ Family Planning
Prenatal Education _ Immunization
Parenting Education _ WIC
Other(Specify) Other(Specify)
1 of 5 pages
A
a a AAA.a
•
13310.302
CSFP PROGRAM
APPLICATION FOR LOCAL AGENCIES.
B. Laboratory Facilities
Which of the following available?
Facilities or equipment for measuring height and weight •
- Facilities or equipment for determining hemoglobin or hematocrit
C. Numbers served during the last 12 months(Unduplicated)
- Pregnant Teenagers — Pregnant Womee
- Breastfeeding Women — Infants Under 1 Yr.
•
Children 18 Yr. — Elderly 60 Yr.&above
If this agency currently provides WIC Program'services,what is the agency's caseload?
If WIC Program services are provided by another agency in your service area,what is the caseload?
What is this agency's anticipated carload for CSFP?
D. Medical Records
If medical records an kept,which kinds of data an available on the groups below?
WOMEN INFANTS CHILDREN
Height
Weight
Hemoglobin
Hematocit
Dietary Information
Health History
•
E. Eligibility
What income guidelines an used to determine eligibility for health services?
Are clients required to live in a certain area in order to receive services?
t'. Will you be affiliated with another agency providing some of the health services? Yes— No—
If yes,explain and list the newels)and addressees)of the private physicians and/or agencies participating. Indicate
those with which your agency has a written agreement
940991
13.910.202 •
CSFP PROGRAM
APPLICATION FOR LOCAL AGENCIES
3. NUTRITION SERVICES
The following services are to beprovided as •
part of the WIC Program:
A. Nutrition Screening
B. Nutrition Education Counseling
C. Periodic Evaluation of Client's Nutritional Status
A nutritionist/dietitian must be employed.at least on a part time basis,to provide or direct nutrition screening,education.
and followup for Program participants. For smaller agencies,it is recommended that a consulting nutritionist/dietitian be
hired.
The nutrition/dietitian must be registered with the American Dietetic Association,or a recent graduate eligible for registration
and enrolled for the nett examination.
If a nutritionist/dietitian is unavailable for employment in your area, another health specialist may be designated to be
responsible for nutrition education upon approval of the Office of Aging and Adult Services,Colorado Department of Social
Services.
Who provides or will provide the minimum nutrition services?
Registered Dietitian/Nutritionist
Other Health Specialist
4. ADMINISTRATIVE SERVICES
Who will be responsIble to provide monthly financial and administrative report, in a timely manner to the Colorado
Department of Social Services,Food Assistance Programs Division,Donated Four, Unit.
5. FOOD WAREHOUSING/DISTRIBUTION
A. Please indicate how commodity warehousing,record keeping and distribution will be organized.
—_ This agency will carry out all commodity related functions of the program.
— Commodity related functions will be subcontracted to another agency/organization.
If commodity related functions are managed by this agency,briefly describe the facility and methods.
If commodity related functions are to be subcontracted,please provide the name,address,and staff contact of the
agency/organization; and attach a signed copy of the Agreement to receive USDA commodities for distribution
through CSFP.
6. ADDITIONAL INFORMATION
A. Where will the Program participants be served? Please describe facility/facilities that will be used for both
certification and food distribution.
B. When can you ready to open a CSFP Program?
C. Indicate any additional information or comments that may facilitate review of the this application?
IT IS HEREBY AGREED THAT TICE CSFP PROGRAM BENEFITS WILL BE PROVIDED TO ELIGIBLE PARTICITPANTS
WITHOUT DISCRIMINATION ON THE BASIS OF AGE,RACE,COLOR,SEX,HANDICAP,OR NATIONAL ORIGIN.
3 of 5 pages
940991
•
13.910.302 -
CSFP PROGRAM
APPLICATION FOR LOCAL AGENCIES _
COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT OF 1964
A. Has your agency had any recent history of non—mplianos with Title VI7 •
Yes _ No If yes,please explain.
B. Have you or do you deny access of any Megrim to any person on the basis of age, sex,handicap, race,color,or
national origin?
_Yes _No If yea,please explain.
C. Do you haw a signifcant portion of the non-English speaking persons in your community?
_Yes No
If If yes,do you have access to bilingual stair If no,do you plan to bring some one on staff to perform this function?
D. An then any discrimination complaints pending against your agency?
Yes _No If yes,please explain.
Title VI of the Civil Rights et provides that no puma in the United States shall, on the ground of race, sex, age,color,
handicap,or national origin be excluded from participation in,be denied the benefits o4 or be subjected to discrimination
under any program or activity receiving federal financial assistance. The Colorado Department of Social Services, Food
Assistance Division,Donated Foods Unit is firmly committed to ensuring that no eligible person is discriminated against on
the basis of rem,sex,color,age,handicap,or national origin in the provision of services in all programs funded. To ensure
that action will he taken to comply with Title VI requirements,the WIC Program adopts the following policies
1. The CSFP Program will inform all subcontractors of their responsibilities under Title VI of the Civil Rights Act.
This information can be(mind in the CSFP Program Manual.
2. The CSFP Program will distribute a copy of this policy to each staff person to inform all staff of the Agency's
obligations under Title VL
•
3. The CSFP Program will make no referrals to agencies that an known to engage in disc iminatory practices
4. The CSFP Program will ensure that,to the extant feasible,the public notion it publishes announcing or explaining
services furnished with USDA funds contain the words in providing these servvimc,no person shall be discriminated
against on the basis of race,color,age,sex,handicap,or national origin.'
7. The State of Colorado CSFP Program has adopted and follows a written policy to assure compliance with Title VI of the Civil
Righs Act,which shall Include,at a minima=
A The CSFP Program will not discriminate and will not permit discrimination in any services or programs it funds
on the basis of race, age,color, sex,handicap,or national origin.
B. Procedures for informiing all staff and grantees of their obligations under Title VI will include furnieiling all new
and easting stall members copies of Personnel Policy and Affirmative Action Plan.
C. A written summary of investigation into complaints under Title VI of the Civil Rights Act shall be prepared and kept
on file at the local agency. Any complaint received by the local agency shell be sent to the Colorado Department
of Social Services,Food Assistance Division. Donated Foods Unit immediately.
4
940991
13.910.302
CSFP PROGRAM
APPLICATION FOR LOCAL AGENCIES
The APPLICANT assumes and assures that it will comply with CSFP program regulations if selected. The information contained in
this application fora CSFP Program Grant is true and accurate to the beet of my knowledge.
Signature of Local Official Responsible for CSFP:
NAME DATE
TITLE
The state agency shall notify the local agency of the status of its application within 30 days of receipt of the agency's application. If
the application is denied,the state agency shall advise the agency of the reasons for the denial and the right to appeal the decision.
If selected,a line-item budget application and narrative meat be completed which includes:
A. Staffing pattern to ensure provision of nutrition and health services for certification and nutrition education.
B. Administrative and clinical ants.
C. Potential caseload and plans for expansion.
•
•
• - 940991
•
.13.910.303
•
LETTER OF AGREEMENT
between
•
THE COLORADO SPECIAL SUPPLEMENTAL THE COLORADO COMMODITY SUPPLEMENTAL
F000 PROGRAM FOR WOMEN, INFANTS, FOOD PROGRAM (CSFP) •
AND CHILDREN (WIC)
effective
January 1, 1980
This letter of agreement describes the methods for detection and prevention of
dual participation between local agencies of the WIC and CSFP where both
programs co-exist in the same service area.
In an area where one of the two aforementioned food programs exists, and where
an applicant agency is applying for the other aforementioned food program,
both local agencies shall agree in writing to the following points:
1. That names of participants in both programs will be compared and screened
for potential dual participation on a quarterly basis. The participant
lists will be screened by the newest program entering the service area.
2. It is understood that the State WIC Agency will provide a computerized
alphabetical list of the WIC participants in the area being screened- on a
, quarterly basis.
3. Participants found committing dual participation shall be terminated
immediately from the aforementioned program that they have most currently
enrolled in.
4. Where intended fraud is involved, the participant may be subject to
disqualification from participation in both programs.
5. Both CSFP and WIC State-Agencies shall include a written statement which
describes and prohibits dual participation either on their intake or
other suitable form. The participant will read or have this statement
read to him/her, and will acknowledge understanding by signing his/her
name.
SPECIAL SUPPLEMENTAL FOOD PROGRAM COMMODITY SUPPLEMENTAL
FOR WOMEN, INFANTS, AND CHILDREN (WIC) FOOD PROGRAM (CSFP)
&; J4r Director /`"c a
Nutrition/WIC Section Food Assistance Prog
940991
STATE OF COLORADO
DEPARTMENT OF HUMAN SERVICES SCHEDULE A
Indirect Rate Proposal
For the Period July 1, 1994 to June 30, 1995
Computation of Indirect Cost Rate •
FOOD ASSISTANCE
Division Title, Less Exclusions DIRECT
Program Title, Total 1993 8 Costs not Indirect Salaries and Other
or Category Expenditures Allowed Costs Fringes Expenditures
EXPENDITURES 280,964,500 264,145,733 1,948,484 9,325,666 5,544,617
• TOTALS 280,964,500 264,145,733 1,948,484 9,325,666 5,544,617
INDIRECT EXPENSE 1,948,484
20.89X
DIRECT SALARIES 8 FRINGES 9,325,666
-13-
940991
COMMODITY •
SUPPLEMENTAL
FOOD
PROGRAM
LOCAL
AGENCY
REVIEW
FORM
11 ri
44/10441
1
CSFP REVIEW FORM (4/91) NAME OF LOCAL AGENCY
LOCAL AGENCY PROGRAM OVERVIEW
1. Who is responsible for what program responsibilities? List names, job titles and time
spent on CSFP.
2. Are there any current vacancies or hiring problems? •
3. Does the local agency administrator feel that present staffing is adequate?
4. Are the State Plan of Operation and Administration, information and policy letters on file?
5. Does the local agency administrator have any recommendations to improve the State Plan
or policy letters from tile state?
6. Is there a current copy of the signed CSFP agreement on file?
7. Are there any program functions which are handled by another agency. If so, name the
agencyles and functions involved.
8. Is there an agreement or memorandum of understanding on file between the local agency
and sub-agency outlining the program responsibilities of the sub-agency?
9. Does the local agency administrator anticipate any major program changes within the next
12 months?
10. What changes would the local administrator like to see implemented for CSFP either on
a local, state or national level?
11. Other local agency recommendations for program improvements:
State Agency Recommendations:
940991
2
CSFP REVIEW FORM (4/91)
LOCAL AGENCY CERTIFICATION PROCEDURES
1. Are CSFP certifications coordinated with health care services? What types of referrals are
made?
•
2. Are foods Issued to new clients within 10 days of certification?
3. What is the current caseload being served for both women and children and elderly,
where applicable?
4. Is there a waiting list? Are proper waiting list procedures being followed?
5. Are persons found ineligible at the time of certification advised in writing with a DF-14
NOTICE OF ADVERSE ACTION/RIGHTS OF APPEAL form?
6. Are persons found ineligible during the certification period advised in writing with a DF-14
NOTICE OF ADVERSE ACTION/RIGHTS OF APPEAL form?
7. Has the local agency received any requests for a fair hearing? If so, what was the
outcome?
8. Are clients notified of the illegality of dual participation?
9. Has there been any dual participation found? If so, what action was taken.
10. Are clients given nutrition education information at each certification?
11. Are clients advised of the CSFP nondiscrimination policy?
12. Are recertifications done at least every 6 months?
13. Are clients notified when their certification is about to expire? How?
940941
3
CSFP REVIEW FORM (4/91)
LOCAL AGENCY CERTIFICATION PROCEDURES (Continued) •
14. Are Verification of Certification cards issued to eligible CSFP clients who are relocating
to another CSFP or WIC service area?
15. What accomodations has the local agency made for special populations, stch as,
migrants and non-English speaking populations?
16. After a review of approximately 30 client certification files, what areas was the agency
found to be deficient? (See attached form). List findings below.
LOCAL AGENCY NUTRITION EDUCATION PROCEDURES
1. How often is nutrition.education information made available to CSFP Clients?
2. What methods are used to provide ongoing nutrition education to CSFP clients?
3. Where is the documentation being kept that nutrition education was given during each
certification or recertification?
4. Does the local agency have assistance from other nutrition programs in the area to
provide nutrition education for CSFP clients?
5. Are the nutrition education requirements of the State Plan of Operation and Administration
being met?
6. Has the nutrition education plan been submitted to the state agency for appoval on a
timely basis, by July 1 of each year?
7. Has a participant evaluation been submitted along with the nutrition education plan which
evaluates the effectiveness of the previous year's nutrition education?
8. Was the most recent nutrition education plan approved? If there were deficient areas,
have they been corrected?
940991
4
CSFP REVIEW FORM (4/91)
LOCAL AGENCY NUTRITION EDUCATION PROCEDURES (Continued)
9. Are CSFP clients advised of the following and how is this accomplished?
a. Importance of consumption of the CSFP food package by the participant for whom
it was prescribed.
b. Specific nutritional and dietary needs of the CSFP client •
c. The CSFP food package Is supplemental not a total food package.
d. How best to use the foods and their nutritional value to the CSFP client.
e. The benefits of breastfeeding.
f. The importance of ongoing health care and health care referrals.
10. Are any food demonstrations being conducted? If so, what types and how often?
11. What nutrition education materials have been developed by the local agency? Attach
sample copies.
12. Is the CSFP nondiscrimination statement printed on all nutrition education materials?
LOCAL AGENCY CIVIL RIGHTS POLICIES AND PROCEDURES
1. Is the local agency aware of the proper nondiscrimination and civil rights complaint
process? -
2. Is the nondiscrimination and civil rights complaint procedure printed on all materials given
to CSFP clients?
3. Is the local agency notifying the public at least annually of the availability of CSFP
including the nondiscrimination and civil rights complaint process? How Is this
accomplished?
4. What type of outreach has been accomplished by the local agency?
5. Is the "...And Justice for All poster displayed in all CSFP certification and distribution
areas?
940991
CSFP REVIEW FORM (12/93) 5
LOCAL AGENCY CIVIL RIGHTS POLICIES AND PROCEDURES (Continued)
6 . Has the local agency submitted the annual FN6-191 to the state
agency on a timely basis?
•
7 . Are CSFP materials available for non-English speaking CSFP
clients. Are translations available?
LOCAL AGENCY DISTRIBUTION AND WAREHOUSE PROCEDURES
1 . Are foods issued monthly or every two months?
2 . After a review of the 30 client certification files, were those
clients issued the correct food package? (See attached form) .
3 . Have the monthly inventory reports (FNS-153' s) been submitted
to the state agency on a timely basis on the 5th of the month
following the report month?
4 . Have the reports been accurate? Physically inventory and
identify 3-5 items in the warehouse .
. ) Use
the ending balance from the previous month' s FNS-153, add in
received for the month, subtract issued for the current month.
Book inventory should reconcile to the physical count .
5 . Have there been any significant damages or losses reported on
the FNS-153? If so, what was the cause and how has the problem
been resolved?
6. How is normal warehouse damage disposed of and accounted for?
7 . How are foods distributed to clients? Prepackaged or grocery
store concent.
8 . Did the clients sign for foods received at the time of
issuance?
9 . Are all foods in the warehouse stacked on pallets and away from
the walls?
940991
• 6
CSFP REVIEW FORM (4/91)
LOCAL AGENCY DISTRIBUTION AND WAREHOUSE PROCEDURES (Continued)
10. Is there an under or over supply of arty Items?
•
11. Are first in/first out procedures being followed?
12. Are pack dates current?
13. Is there a procedure for monthly pest control?
14. • Are there thermometers in all dry,cooled and frozen storage areas? Is a temperature log
being kept?
LOCAL AGENCY FINANCIAL PROCEDURES
1. Have the Quarterly Statement of Expenditure Reports been submitted to the state agency
on a timely basis, by the 15th of the month following the close of the quarter?
2. Has the federal fiscal year Actual Expenditure report been submitted to the state agency
on a timely basis, 90 days after the dose of the federal fiscal year?
3. Does the local agency have proper documentation of actual paid expenditures to support
the Quarterly Statements of Expenditures submitted to the state agency? If not. list areas
of deficiencies below. Are all reported expenditures allowable?
4. Did the local agency receive approval from the USDA and the state agency for any capital
outlay purchases over $2,500?
5. Has the local agency had a financial audit in the last two years? What findings were
there, if any? Has a copy of the financial audit been submitted to the state agency?
6. Have payments to commercial distributors been made on a timely basis?
7. Were the expenses claimed on the most recent quarterly report found to
be appropriate?
52f
940991
r
i
7
CSFP REVIEW FORM {4/91)
(Updated financial/equipment list questions added 4-94) •
LOCAL AGENCY FINANCIAL PROCEDURES (Continued)
8. Has a list of CSFP owned capital equipment been submitted to the state
agency in a timely manner, by July 1 of each year?
Please provide reviewer with current equipment list.
Has the reviewer verified the equipment?
State Agency Recommendations:
FINAL STATE AGENCY RECOMMENDATIONS:
41111441
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•
no STATE DEPARTMENT OF SCCIAL SERVICES
SUPPLEMENTAL FOOD PROGRAM
COUNTY ' STATEMENT OF twat VRE FOR =RI= IMDING
oarzcL2VE DF EJa?FSIDZT9rz =at Ifla coma= NDIRIIECN FAIR
-
__ EDOCATICNRIINGS TOTAL
PERSONAL SERVICES
TRAVEL
=musk
CAP SUPPLIES :____
CAP= OUTLAY _
RENT-SIORACE OF COITOTTIzS
�L�T"OZTLOTTTFS . .
smc/P®LIC TY
EXCI TIONAL SUPPLIES
REIZSfl ATI(TQ I?}}s/TVLTSD I CONTRACTUAL •
( Y SERVICES
PA7�J
TOTAL
NQMIDER OF PARTICTCPANTS
I AFL TRAT THE EXPENDITURES REPORTED RAVE BEEN MAT PAYROLLS
7lATICN ARE AV7flAErr FOR ACEIT AT: MADE AND ANDOTHER
(SST ADDRESS)
(QTY)
(SI ukTIIRE)
55 940991
1995
CHANGING NEEDS FOOD PROGRAM
COMMODITY SUPPLEMENTAL FOOD
NUTRITION EDUCATION PLAN
940991
i
NUTRITION EDUCATION PLAN FOR THE CHANGING NEEDS FOOD PROGRAM
Tri County Senior Citizens and Housing, Inc is the
administrative agency for the Changing Needs Food Program
who is the agency responsible for the distribution of CSFP
foods in Rio Grande County.
•
Rio Grande County is located in the San Luis Valley, a rural
area in the southwest part of Colorado. It encompasses
761 . 75 square miles and has a population of 10,225 . Of this
population, 2, 029 are sixty plus years of age and 4, 301
are women, infants and children according to the 1994 Census
This is an agricultural area dependent upon seasonal workers
who affect the fluctuation of the ethnic make-up of the
area.
The primary languages spoken in the area are English and
Spanish .
Changing Needs Food Program currently has two distribution
sites and homebound certification and delivery to the
elderly . Admen, Infants and Children use a grocery store
shopping method; the elderly have pre-packed boxes .
Transportation appears to be a concern to participants .
Since this is a rural area, public transportation is not
available .
940991
GOALS AND OBJECTIVES
In developing the 1995 Nutrition Plan for the Changing Needs
Food Program, the following goals were established:
•
GOAL #1 : Provide nutrition information and referral to the
Elderly, Women, Infants and Children in Rio
Grande County as required by the 1995 State
Nutrition Plan.
OBJECTIVE: Coordinate the goals of the 1995 State Nutrition
Plan by active distribution of CSFP.
PLAN: Provide easily accessible pick-up sites ,
transportation for the elderly to distribution
sites and delivery to home bound participants .
GOAL #2 : Provide health and nutrition information in
conformity with the 1995 State Nutrition
requirements for the Elderly, Women, Infants and
Children.
OBJECTIVE : Encourage and assist participants of all ages in
developing correct nutritional habits by
providing food demonstrations , videos , group
nutrition education classes and handouts .
PLAN: Food Demonstrations - Caregivers , breast
feeding women, postpartum women, and the elderly
will be given recipes for food samples .
Video - Caregivers will be encouraged to
immunize birth to three month old
babies .
Animated videos relative to the
importance of fruits and vegetables will
be shown to ages three to six.
Caregivers will have available
information on calcium, anemia, snack
facts with high nutrition.
940991
Pregnant and breast feeding women will
have available visual information
regarding bottle and breast feeding.
All participants including the elderly
will have available to them, visual
information on osteoporosis , cardio
vascular, respiratory conditions , and
diabetes .
Handouts - All participants will receive
handouts on current up-dated
nutritional information and other
topics relating to their health and
well being.
GOAL #3 : Refer participants to appropriate medical ,
nutritional and social services .
OBJECTIVE: Help the participants to be aware of other
community services available to them.
PLAN: The Public Health Nurse is available at designated
distribution sites . Informational posters will be
displayed . The quarterly newsletter will contain
health and nutrition information . Changing Needs
Food Program staff will be available as a resource
for information .
940991
The Changing Needs Food Program nutrition education is
supervised by nutrition expert , Rio Grande County Nursing
Service Administrator, Gwen Minks , R.N. Mrs . Minks assists
with referrals to other agencies .
•
ORGANIZATIONAL CHART
TRI COUNTY SENIOR CITIZENS & HOUSING BOARD OF DIRECTORS
ADMINISTRATOR
Registered Nurse dministrative Assistant
Certifiers
utrition Coordinator
arehouse
Staff hours : Nurse Two times a month or as needed.
Certification 8 : 30 A.M. - 4: 30 P.M.
Monday through Friday
Distribution The first three Tuesdays and
Wednesdays of each month.
In fiscal year 1995 staff nutrition training will be
supplemented by taking advantage of appropriate
workshops/seminars sponsored by the State Commodity Agency
and classes through the local CSU Area Extension office .
940991
i
In developing the 1995 Nutrition Plan an annual evaluation
was conducted . Part of the evaluation included a survey of
both—rEl-elderly and women, infants and children which
showed a close correlation between the foods refused and
recipes most frequently requested .
Target food items and recipes will be those items identified
in the survey . Also addressed will be those topics
requested most by the participants .
Also during the evaluation it was found that the quarterly
newsletter has been very beneficial to participants . It
will continue to contain up-dated nutrition information
including usage and storage hints of the commodity foods as
well as a calendar showing dates , hours of distribution and
dates nurses are available .
Changing Needs Food Program has developed a check list to
use as a tool to assure that the certifer has obtained all
the necessary information to assist participants . A copy
has been included.
QA({QQH
Listed below is the Nutritional Education Material that will
be utilized in implementing the 1995 plan. Sample material
has been included.
CHILDREN WITH PROBLEMS
•
Is Your Child Under Weight
Recipes for Nutritious Foods
You Can Help Your Over Weight Child
Tips to Help Your Over Weight Child
Feeling Good - Tips to Prevent Constipation
Conquer Anemia
Wise Tips for Avoiding Infant Allergies
But Mom - - - - I Hate Vegetables
HAND OUTS DIRECTLY TO CHILD
Coloring sheets and word games depicting the five
good groups and fitness .
TO CAREGIVERS REGARDING CHILDREN AGES ONE THROUGH FIVE
Foods Kids Like
Your Growing Child
Feeding Your Toddler
Foods for Young Children
Guide to Feeding the One to Five Year Old
INFANT FEEDING SERIES
Bottle Feeding
Baby ' s First Food
Starting Solid Foods
Teething
Adding New Foods
More Food - Eight to Twelve Months
After the First Year
Weaning
Over Weight Baby
Food for Baby ' s First Year
940991
PREGNANT WOMEN
Help Your Baby to a Healthy Start
The Time to Start Feeding a Child is Nine Months
Sooner Than People Think •
Moms To Be Make the Difference - Low Birth Weight
Can Be Prevented
Feeling Good - Tips to Control Nausea
Family Planning for You for Your Family
BREAST FEEDING WOMEN AND PREGNANT WOMEN
Breast Feeding Baby
Special Tips for Breast Feeding and Working Moms
Breast Feeding Can Make Your Family and Friends
Proud of You
Breast Feeding - Baby ' s Best Start
Breast Feeding Problems
POST PARTUM, ELDERLY, CAREGIVER
Donated Government Commodities
You Are Not Getting Enough
The Food Guide Pyramid
Guide to Good Eating
940991
COMMODITY CHECK LIST
Control# Responsible Adult
REQUIRED INFORMATION COMMENTS
Initial Certification Date
•
Certification Expiration Date
New Card or Date Change
Proxy
Responsible Adult
Date of Birth
Address - proof of residence in
Rio Grande County
Phone #
Ethnic Origin
Monthly Income
Verification of Income
Number in Household
Identification
Proof of Pregnancy
Social Security Number ( Elderly )
Birth Certificates for each child
Each qualified child weighed &
measured
Explain program is Supplemental
Immunizations Current
Refer to Public Health
Nutrition Education
Nutrition Assesment
Test of Nutritional Knowledge
Certification Administrator Date
nwnnna
\\43
SCORE SHEET FOR ANNUAL EVALUATION
1 . g� % of participants received ongoing nutrition
education material .
2 . y % of participants are satisfied with the current
nutrition education material . •
3 . Topics requested most often as needing more information, in
order of_ popularity were :
C' •$ • Iio rssu
L7 , 606
At-
4 . What percentage had received referrals to other health
services? 4/t/ %
5 Average waiting time to receive food package was C -.172 r; %
6 . Average distance traveled to commodity site was IE'S.iVC/yV /0
7 . Characteristics liked about CSFP . a. friendly staff, b. Staff
explained things well, c. Nutrition/health information, d.
Receiving foods, e . Convenience of commodity office .
OTHER:
8 . On the average, how many times a day did clients eat veggies
and fruits or drink juices?
9 . What percentage of folks knew they must pick up commodities or
be dropped from CSFP? g 9 %
10 . Which foods do we need to supply more recipes for? Top three
were : Po,-x 0i c.\we ,
\l\L h el4' S and h_Un c. A
11 . Do clients use the recipes they receive? \ICS
12 . What was the result of the snack food survey?
If -
13 . Did they like the samples prepared for them? \/ 0-
14 . Provide information learned from the cultural recipe inquiry .
N
15 . What percentage of participants want to share recipes using
commodities? 77
16 . What were the three foods most. often refused? � , ; ,, �- �/ �ty< - 47 ;i- 4�
4-3/1 M' 7/7 - ' / , and 'lw , r - cJ
94044,
STATE 01- COLORADO
COLORADO DEPARTMENT OF HUMAN SERVICES
0c.
•
1575 Denver, la�•adoS�80203-171t N` '"�'�•? ,Phone(303)866-5700 •TOD 86643294 N.• 4.,4
FAX 866-421
s �
Roy Ramer
Governor
Bartf ra McDonnell
Executive Director
September 6, 1994 Karen awe
Managing Director
Carol Refior, Administrator
520 Spruce Street
Del Note, CO 81132
Dear Ms. Refior,
You are to be commended on the 1995 Nutrition Education Plan for Commodity
Supplemental Food Program. It was very informative and I particularly like
your Organizational Chart. You mentioned transportation was a concern, you
might want to contact Bill Baker, AAA Director in Alamosa at 719-589-4511
for transportation for your elderly clients. In the spring Mr. Baker will
be doing Nutrition Screening. This is a national program and you might
ant to work with him on this project. If you would like information on
the screening let me know.
If you have any questions please call me at 303-866-5906.
• an 1 er, R. D.
dministrative Program Specialist
Building Partnerships to Improve Opportunities for Safety,Self-Sufficiency,and Dignity for the People of Colorado
•
0 A lltnna
NUTRf11ON EDUCATION PLAN CONEJOS COUNTY 1994-1995
Conejos County did complete the Nursing Service Building project started in the fall of 1993.
The Commodities Program was moved from Antonito to LaJara in May.The new building is 5000
sq.feet. 720 sq feet is used for CSFP storage and distribution. Addtional space is needed when
clients are certified and when the kitchen facility is utilized. Angelas office is 132 sq.feet The
kitchen is 135 sq.feetThe meeting room is an addtional 900 sq.feetThe meeting room will be
used when nutrition classes are offered. The Administrators office is 185 sq.feetThe
combination walk-in freezer/cooler is 60 sq. feet it is included in the storage/distribution area
footage. This unit has made the program much easier to manage. Prior to this move the agency
was having to rent cooler storage from the schools.
Administrating the CSFP program through the Conejos County Nursing Service has always
seemed like an ideal combination. Now Housing the programs under the same roof seems to
make every thing complete. Many of the clients are already involved in other agency programs
such as the HCBS,Pre and Post natal, Home Health,Well child, and HCP Programs. It is not
only easy to refer but it is also easy to do instruction because that is what Public Health is all
about
Three percent of the CSFP participants were involved in the 1994 annual evaluation of the
agency.The clients that now have to drive from Antonito certainly wish the distribution center had
remained there. Generally speaking the concensus seemed to feel that the move was a good
one. Since every one has to certify in LaJara anyway, they now can pick up commodities the
same day they certify. LaJara residents are very happy they no longer have to drive to Antonito.
Driving is always an issue in Conejos County. The Agency hours are 7A.M.-4 P.M. Some
families have hours that do not fit into this time frame.We are looking at trying later hours to see
if this will help increase the case load.
There are approximately 7400 residents in Conejos County. 67%of the county population is
Hispanic. Since Conejos County is concidered to be the most economically deprived county in
the state along with Castilla we feel very fortuneate to have the CSFP program.We know that
the new facility will enable us to do more with the clients and establish new teaching programs.
NUTRITIONAL EDUCATION
"Nutrition education shall be thoroughly integrated in the Commodity Supplemental Program
Operations", Conejos County Nursing Service outlines the following objectives for the next fiscal
year.
Objective#1 All Pregnant clients will be advised about Prenatal care options and given access
to information the agency has on nutrition during pregnancy,along with written information about
the Food Stamp program,Aid to Dependent Children, and the Child Support Enforcement
Program . We will ask moms about their childs immunization status.
Objective#2 The vestibule that clients enter when certifying will always have information
available for them on timely health issues such as cholesterol, high blood pressure, diabetes,
exercise, how to loose weightfast foods and milk allergies. In the annual evaluation these were
the topics suggested that clients wished more information on..
Objective#3 The vestibule that clients enter when picking up their commodities will have a large
bulletin board in place that changes displays monthly. Each month different topics will be
featured.There will also be a portion of the board that will feature new recipes with pictures,and
recipe exchanges. If enough interest is generated a recipe bake-off contest will be attempted.
940991
Objective#4 The Elderly clients will be asked to participate in a county wide survey and
evaluation that the Conejos Nursing Service is conducting to help determine what other needs
the elderly may have in addition to nutritional needs Example, transportation ,support groups. .
Objective#5 Continual effort will be made to increase awareness of the program to potential
clients through advertising in the weekly newspaper column,church bulletins,and radio.
Objective#6 Conejos County,collaborating with the extension office, is training an employee to •
teach nutrition classes to young mothers dealing with the problems that are issues today such
as finances,emphasis on fast foods, heavy use of fats and sugars, and total lack of
understanding about nutrition in general.This training will be completed in 1995.
NUTRfIIONAL TRAINING:
The Conejos County Nursing Service CSFP staff is as follows: Lois Booth, R.N. Administrator
Angela Mondragon,Certification
Walter Romero,Distribution
Them are an additional four full time R.N.s that work with the Elderly,Young Moms,and
children.There are many clinics sponsored by the agency, held in different communities,where
the CSFP program objectives can be pursued.
June nez was hired parttime to help develop a nutrition education program. She is using
th ucational guide,CSU extension training,CSFP information and a wealth of
bac round experience to pull this program together. Many recipes have been developed and
experimented with to give to CSFP clients. Samples(Peanut Butter snacks)have been
effectively used with the clients. A new understanding and awareness about the importance of
regular meal planning,food groupings,etc. has been observed by the staff having meals prepared
daily in the agency. Cost analysis studies will be done to check on the effectiveness of this
experiment
Since Public Health focuses on wellness and prevention, nutrition has always been heavely
emphasised.With the education program going on in the agency we are all able to put the
learned and observed to practical use in day to day encounters with clients.
NUTRITION EDUCATION ANNUAL EVALUATION
Three percent of the clients interviewed waited less than 29 minutes for their food
packages,drove less than 10 miles,thought the staff was friendly,ate veggies and fruit 2-3 times
a day,received educational materials,were referred to other health services if needed,didn t have
recipes to share,had the most trouble with powdered milk and egg mix,snacked at least every
day,and refused honey and powdered milk if they had to much .The areas they needed more
education were addressed in the objectives.
The evaluation that will be done in 1995 will ask questions about exercise and the
understanding levels about the importance of exercise. Information the Agency has will be
shared with the clients.There is a walking group and a swimming group that meets regularly in
Alamosa. The Clients that are interested will be referred to that resource.
EVALUATION
The following literature will be made available to all CSFP participants.Copies of this literature is
enclosed for perusal. The agency will determine by client response what information seems to
be of most interest.
Exercise for your Bone Health
Bone Basics for Kids
CAflanks
Calcium:lmportant at every age
Bone Basics for Men of All Ages
Bone Basics for Young Women
Using Calcium Supplements
Never Shake A Baby
You Know more about Your child than anyone else
Staying on Track
Sensible Eating During Childhood 1-6 •
Foods for young children 1-5
Is your child underweight
Check out the fat in your food
Gestational Diabetes
Diabetes Facts and Figures
Fit Facts
Fast Food
A Quick consumer guide to safe food handling
How to get enough
You can help you overweight child
Tips for reaching your Blood Pressure goal
I HEARBY CERTIFY THAT I EDUCA N PROGRAM IS SUPERVISED BY A
NUTRI1lON EXPER ,. L
`�� 7' L C/VAS
STATE OF COLORADO
COLORADO DEPARTMENT OF HUMAN SERVICES
O4'COt()
1575 Sherman Street
Denver,Colorado 80203-1714 N� .�c=.
• Phone(303)8665700 a i• G7 I
TDD(303)866-6293
FAX(303)8664214 �` e
♦ j6e
Roy Romer
Governor
• Barbara McDonnell
Executive Director
•
September 6, 1994 Karen Beye
Managing Director
Lois Booth, Public Health Administrator
Conejos County Nursing Service
19023 S. Hwy 285
La Jara CO 81140
Dear Ms. Booth, R.N.
You are to be commended on your 1995 Nutrition Education Plan for commodity
Supplemental Foods. It was very interesting and organized.
You might want to contact Bill Baker, AAA Director in Alamosa at 719-589-
4511 for transportation for your elderly clients. In the spring Mr. Baker
till be doing Nutrition Screening. This is a national program and you
ight want to work with him on this project. If you would like information
on the screening let me know.
If you have any questions please call me at 303-866-5906.
•
an Miller, R. D.
Administrative Program Specialist
•
Building Partnerships to Improve Opportunities for Safely.Sell-Sulnciency,and Dignity for the People of Colorado
•
940941
AUG 2 3 1994
i
DENVER DEPARTMENT OF SOCIAL SERVI ' ------------
INTER-DEPARTMENT CORRESPONDENCE
TO: Lu Stofer •
FROM: Anthony Quintana
SUBJECT: 1995 Denver CSFP Nutrition Education Plan
DATE; August 1, 1994
Denver Department of Social Services
Food Assistance Programs
Commodity Supplemental Food Program
1995 Nutrition Education Plan
The Denver County Commodity Supplemental Food Program (CSFP) began
distributing nutritious food packages to pregnant women, postpartum women,
and children under six years of age in September 1989.
In May of this year we hire; a new full time nutritionist to continue the
implementation of our comprehensive nutrition education program.
The continuing objectives of the nutrition education program are:
• To promote the importance of good nutrition for CSFP families.
• To create a desire in clients to use the USDA foods to supplement their
diets and to teach them how to effectively use the USDA foods to provide
nutritious meals to their families.
• To teach clients nutrition principjes in order to improve the overall health
of the household.. C
• To promote health including the referral of clients to medical services,
dental services, and child immunization clinics.
• To provide nutritional assessment and individual counseling for clients.
940991
• To provide specialized nutrition programs for at risk groups. 6Z� ,� -e
• To provide continuing training of personnel to promote he
nutrition to CSFP clients and their families.
• To provide nutrition education activities for children as to encourage
children to make healthy choices when selecting their meals or snacks.
Nutrition education program elements include:
• A bimonthly nutrition newsletter in English and Spanish for Mothers and
Children ("Commodity Corner"), and the Senior Nutrition Commodity
Corner� distribute to older adults with pre-packed boxes. A. botid
2
df
• A nutrition and hdallh video loop playing in the waiting area and soon in
the checkouts as well.
• A "point of purchase" program which provides information sheets and
recipes for the USDA foods at the bins where clients pick up their foods.
• Food demonstrations with nutrition education topics being addressed
while the demonstration is taking place. The food demonstration includes
tasting food samples that incorporate USDA foods which change monthly
according to season and foods being issued.
• Bi-lingual recipe sheets describing preparation of the demonstrated food
items to increase client acceptance of these commodities.
• A nutrition and health screening form which identifies clients at nutritional
risk and those clients needing other referrals are given to clients prior to
certification.
• Medical, dental and other referrals are provided to clients by certifiers
who have been trained to know what services and resources are available
tcfroFirteriturfanfilies in the community.
940991
• Individual nutrition counseling provided to at risk and interested clients by
the nutritionist.
• Nutrition education classes for pregnant women, breastffeeding mothers,
and for mothers of young children 0-6.
•
• Support groups for diabetes, weight control, and hypertension for those
clients that will benefit of a group setting. j%
• A "Look How I am Growing" assessment chart for infants and children
has been developed which is given to mothers after children are assessed ,
mothers are encourage to bring children to the program for monthly
nutritional assessments.
• Certifiers are trained to perform nutritional assessment in infants and
young children through the use of height and weight tables. Infants and
children that are consider to be at nutritional risk are referred to the
nutritionist. �.f(4
• A Nutrition Corner for Children has been created to assess children and
promote nutrition education, children can learn about nutrition and have
fun learning as mothers shop for their commodities.
• A "Baby Corner" has also been created. to assess babies on height, weight
and head circumference, premature babies or at risk babies are referred to
the nutritionist for counseling and follow up. The Baby Corner is also
used to provide assessment to pregnant women.
• Nutrition pamphlets which address clients' needs and concerns are
provided on an individual basis.
• Ongoing promotion of Breastfeeding for pregnant clients (certifiers discuss
feeding choice of mother, discusses advantages of Breastfeeding as
appropriate, and provide reinforcing pamphlets).
• Nutritionist conducts weekly nutrition and health inservice for staff.
940991
• The "Fun with Food" child nutrition program which targets young children
and teaches them about nutrition through games, puppets, stories, and
activities which take place in the Children's Corner.
• The Nutrition Summer Camp for young children to teach children about
good nutrition and healthy choices with hand on experience on preparation
and tasting of recipes appropriate to young children.
• A Denver CSFP cookbook which is being developed and once completed
will be distributed to clients, and all interested CSFP programs.
• Sign-up forms to the different nutrition classes are posted at the front desk
for clients to sign-up .
• Books that help children to learn about nutrition which are read to CSFP
children as part of the "Read Aloud Story Time".
• Computer software which is used to compile statistics on client responses
to provide feedback for program enhancement and development.
• Denver CSFP continues to promote and be a distribution site for the
Colorado S.H.A.R.E. Program enabling clients to acquire additional foods
such as fresh fruits and vegetables and frozen meats at reduced cost to
help provide a balanced healthy diet for the household. -
Families living in poverty often do not have enough to eat and do not know
how to use the foods issued by CSFP to stretch their food dollars and to
prepare nutritious meals for their children . In addition they face many
bathers to adequate health and medical care and often do not receive accurate
nutrition information. Our full-time nutritionist enabled Denver CSFP to plan
and implement a comprehensive nutrition education program which addresses
these issues. Denver CSFP help clients to access the medical care they and
their children need. Denver CSFP also provides clients with culturally
sensitive nutrition and health messages which generate in clients interest in
good nutrition and a knowledge of how to use the USDA foods to prepare
healthy meals for their children.
940991
STATE Or COLORADO .
COLORADO DEPARTMENT OF HUMAN SERVICES pc-cow
tiE 4�
1575ShemunStrnet M..
Denver.Colorado 800203-1714
Phone(303)8865700 TD • i� �i� %'t
O(303)866-6283 • e
FAX(303)866-4214 • •
Roy Romer
Governor
Barbara McDonnell
Executive Director
•
September 6 , 1994 itu9iN odor
Tony Quintana, Administrator
Denver Couty Food Assistance programs
80 So. Santa Fe
Denver CO 80223
Dear Mr. Quintana,
Although your objectives were very broad your Nutrition Education Plan for
1995 was conditional approved for the following reasons:
There was no executive summary of the annual evaluation for the
Commodity Supplemental Program.
What are the specialized nutrition programs for at risk groups? Does
this include the elderly?
How do you determine who is eligible for the group setting support
groups? And how often do they meet?
How does the CSFP program asses the medical needs of the clients?
What nutrition education materials are for the elderly client?
What are your plans for 1995, based on the information sent to you by
Lu Stofer?
Staff Organizational Chart for CSFP.
Please submit a plan by October 15, 1994 . If you have any questions please
call me at 866-5906 after September 12 . 1994 .
7Aan Miller, R. D.
!/Administrative Program Specialist
Sulking Partnerships to Improve Opportunities for Safely.Self-Sufficiency.and Dignity for the People of Colorado
940991
SUPP MENTAL FOODS NUTRITION PL JULY 19 4t\ - 1 \eq4
AESA COUNTY HEALTH DEPARTMENT
The supplemental food program for Mesa County is manage by the.=-M'e`sa
County Health Department . The determination of eligibilit " d
certification of clients for the women, infants and chil rens portion
of CSFP is accomplished at the MCHD. The program for the elderly is
managed at the MCHD warehouse where the CSFP commodities are o d
and dispensed _to -he clients .
t Mesa counties current caseload is 1609 for women infants and children.
The client makes an appointment and will be seen for certification
within 10 working days . As of May 1994 the actual waiting time was 4
working days . We do not have a waiting list at this time . Mesa County
CSFP warehouse is open for client pickup 9 or more days per month. The
program is managed by a supplemental food clerk ( 28 hrs/week ] under
the supervision of an RN. We provide one evening clinics per week to
serve our clients who work . The current CSFP clerk has been with the
program for several years and we do try to have her attend some
inservices on nutrition ( she attended a breast feeding conference last
year ] . We also -have a dietician at the MCHD to evaluate nutrition
literature and be available as a consultant for the CSFP clerk . The
dietician can also see clients in need of special nutritional advice
onrmited basis .
The client is assessed as to eligibility for CSFP and is given
information that the program is a supplemental rather than a total
food program. The client is also asked about special nutritional needs
for any participant and is told of the importance of the foods being
consumed by the person they are prescribed for . Attached [ #1 ] is the
documentation sheet and items 2-4 will have date entered when these
items have been discussed .
The client is given a questionnaire to complete at each visit ( see
attached #2 ] . Part of that questionnaire has a diet recall for
participants . The remainder of the questionnaire is to assess family
health and their ability to get care . The questionnaire also addresses
growth and development, substance abuse and learning problems .
The Mesa County CSFP program was fortunate to have a student in the
CU. Masters of Science in Nursing Program who did an evaluation of our
program and developed a client satisfaction tool for CSFP . Overall,
findings suggest a largely positive response and high level of
satisfaction with the CSFP . The MCHD is currently reviewing this
report and plan to incorporate most of recommendations made .
[ Satisfaction tool attached #3 ]
Some of the suggestions were:
1 : Evening hours at the warehouse
2 : More recipes at the warehouse [done ]
3 : Better map and directions to the warehouse . [ in process ]
4 : Do a survey if possible to find out reasons certified clients fail
to pick up their CSFP commodities .
5 : Nutrition education to be directed at use of egg mix and dry milk
as this what was mentioned in satisfaction tool as a need . [ in
process ]
6 : Try to address parking problems
7 : Classes at the warehouse . [planning for new kitchen ]
a4naal
NUTRITION EDUCATION
Nutrition education is provided by the CSFP clerk at the time of
certification to the responsible adult as applicable to the individual
situation. The questionnaire is reviewed including diet recall and
services the family needs . Nutrition education is of course tailored
for the person receiving the commodities . Breast feeding would be
encouraged for a pregnant client and information on dietary needs of
the pregnant woman would be given to the client . [see attached
information #4 ] Clients have an opportunity to ask questions and
recipes are given to the client to use [ It has been found from our
survey-That 26% of clients have problems using egg mix and 1C% have
problems with powdered milk ] . The nutritional value of the commodities
are discussed when time allows (calcium in milk ,Vit . C in juice etc.
#51 At this time we are not using the pyramid as our nutrition
educational materials are the WIC materials . ( basic 6, see attached
#6 ] Clients are given information on €ood stamps to increase their
ability to buy nutritious foods to round out their diet . Recipes are
available at the warehouse as well and last year we did have CSFP
foods used in dishes that the client could taste and take that recipe
home with them flTRis type of demonstration will a expanded in 1995
with the addition of a kitchen at the warehouse .CPlanning will be
started as to type and frequency of classes which will be provided/?1 7
On each recertification visit a nutrition topic that is pertinent to
the client is discussed . For example, a newborn on formula would be
given information as to how much formula that baby requires in 24 hrs
and food guide for the first year . Correct mixing of formula and
cleaning of bottles would be discussed . The postpartum mom would be
given diet information and be referred to services such as medicaid or
the Colorado Child Health Plan for the baby, immunizations and family
planning services for herself . If the mother has many concerns a
referral to a public health nurse is made . When that client returns in
6 months the questionnaire is again reviewed for concerns and at this
time discussing solids , introducing the cup and preparing baby foods
may be the topics discussed .When that client returns at 1 year of age
the questionnaire is again assessed for concerns that would be dealt
with and safety concerns and diet in the first year may be the topics
for discussion. The nutrition education is tailored to meet the needs
of the client at that particular moment in time . Literature is
available on main nutrition topics in both Spanish and English and
ethnic practices are considered in the teaching . The MCHD supplemental
food clerk is bilingual in Spanish.
As MCHD is both a WIC and a CSFP county we are careful to prevent
dual participation and have a good working relationship between
programs . Each time a client comes into the MCHD for CSFP
certification or recertification that chart is read by the PHN for
that area of the county. The nurse reviews the CSFP clerks charting
and questionnaire and follows up as needed such as assisting with
formula mixing or helping families who need more help to access a
particular service .
At the time of certification the clients are referred to other MCHD
services such as family planning, well child clinic, WIC, HCP and
immunizations . Clients are also referred to community agencies and
medical providers . EPSDT information can also be given to the client
while they are in the clinic by EPSDT personnel
CI A neut
CLIE1 SATISFACTION SURVEY •
175 clients were surveyed with the following findings :
' 1/2 of the respondents did not use "all" foods .
26% did not use egg mix
16% did not use dry milk
5% did not use canned meat
3% did not use evap. milk, farina, honey,and infant cereal
2/3 of clients would like nutrition and food preparation classes .
69% of clients felt they knew more about nutrition since being on
the CSFP program and 50% of that 69% stated they were interested
in learning more about nutrition. •
94% of clients are satisfied with pick up days .
18% had trouble finding the warehouse the first time.
62% stated parking was a problem.
75% of clients report receiving information regarding other programs
at the time of certification.
44% of the clients were contacted by a PHN after certification and 95%
of those clients felt that the contact was helpful .
FINDINGS FROM MCHD QUESTIONNAIRE
175 clients were surveyed with the following findings :
152 clients out off 154 completing this question were current on
immunizations .
142 clients reported some form of health insurance and 24 reported no
health insurance .
44 clients reported family health concerns and 131 denied health
problems .
80 clients reported dental needs and 84% denied needs .
64 clients reported smoking in the home while 104 reported no smoking.
18 people reported wanting help to quite smoking and 24 people did not
want help.
2 people reported alcohol problems in the home and 164 denied alcohol
concerns . The 2 people reporting alcohol problems did not wish help.
130 people did not feel"more" recipes are needed 24 felt recipes were
needed .
14 people expressed nutritional concerns in the family while 68 denied
concerns .
NUTRITION INFORMATION TOPICS SUGGESTED BY CLIENTS
Greatest interest expressed was information regarding 'Fat ' 'Low fat '
'Low calorie ' 'weight loss ' and on cholesterol .
Foods in Pregnancy
Good snacks, fiber,vitamins, protein
Information on the following commodities requested : powdered eggs,
powdered milk, and canned milk were listed most frequently.
NUTRITION EDUCATION PLAN FOR 1994-1995 :
Continue to provide nutrition education to clients at the initial
certification visit and at recertification as at present . Use findings
obtained from surveys to provide information that the clients
indicated would be useful to them. Keep recipes on hand for foods
indicated as problems .
The MCHD dietician will continue to review nutrition materials . The
pyramid will be incorporated when it is used in other programs in the
HD to avoid confusion.
Plan for nutrition and food preparation classes at the ware house
*thing findings of the survey to present classes of interest to the
clients .
41n4'04
NUTRITION EDUCATION PLAN - FRY 94 -
The Costilla County CSFP Program will make Nutrition Education
available to the participants of the Commodity Supplemental Food
Program (CSFP) .
This will be done primarily through the following mechanisms :
•
A. Pamphlets are distributed to participants on the Nutrition
Education component to reach the goals as identified .
1 . To ensure that CSFP foods are used properly.
2. Encourage continued selection and consumption of
nutritious food necessary to good health.
3 . Demonstrate the relationship between proper nutrition and
good health with an emphasis on pregnant , post partum,
and breastfeeding women.
B. At the time of certification, participants will be informed
that the program is only supplemental and not a total feeding
program. They are advised of seeking medical care and of the
importance of total health care for them and their families .
Many of our participants are referred to the other facilities
in Costilla County , i . e . Costilla County Nursing Services and
Costilla County WIC, Katy Baer-Nutritionist .
Participants will also be advised of the times a nutritionist
will be available in the Costilla County area for one-on-one
counseling concerning special nutritional needs and ways to
provide adequate diets or , if the participants would like ,
additional nutrition education. The certification center can
also make recommendations to the nutritionist for follow-up
on participants with special needs .
C. At the point of certification, nutrition information is
provided to the participants . The information ed
and /or developed by a nutritionist . The various tools used
are recipes for balanced meals , nutritional information,
snack ideas , and when available , information as it relates to
nutrition, Colorado Share registration /pick-up dates , etc .
The following is a more detailed description of the
information to be distributed in the packets :
940941
1 . Menus :
•
Breakfast , lunch, and supper menus of the month will be
developed and presented, with consideration to
distribution for the month when possible . This will
provide participants with ideas when they are planning
family meals .
2. Recipes : •
Recipes for each item on the menu will be provided. The
recipes will contain different ways of using the
commodities and will be written in English and Spanish.
Consideration will be given in providing recipes for
distribution of the month.
3 . Nutritional Information:
Information concerning the benefits of nutrients
contained in foods presented in the menus will be
included.
4. Snacks :
. . Ideas for snacks and foods kids like , that are
nutritionally sound , will be made available .
5 . Food Demonstrations :
. . Our agency has purchased a portable kitchen unit that will
be used to demonstrate the preparation of different recipes
that are distributed to our clients . These demonstrations
will be done on a quarterly basis in our commodity
warehouse .
6 . Other Information :
. . Information concerning breastfeeding , nutrition
pregnancy , etc . , will be provided by their doctors . The
plan will provide shopping tips , choosing foods for a
healthier family , and other information. In coordinating
with the nutritionist , the Colorado Share Program
registration/pick-up dates will also be made available .
. . All information used in the plan will be provided in both
English and Spanish when ever possible .
The plan will also provide dates when the nutritionist
will be available for one-on-one counseling .
94099i
D. Nutrition Education Classes :
Lynn Brown and Connie Gurule , CSFP Clerks , attended 16
hours of nutrition education classes sponsored by the
Colorado State University Extension Office and received
certificates for this training . They will also be
attending the Lillian Fountain Smith Conference„ also
sponsored by the Colorado State University, on July 29th
& 30th in Fort Collins , Colorado. The clerks will also be •
preparing a food demonstration for th Health Fair that
Costilla County Nursing Services will 'bing on August
5 , 1994
E. Attached is a copy of the nutrition survey we are conducting
for the current fiscal year .
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STATE Or COLORADO
COLORADO DEPARTMENT OF HUMAN SERVICES ov.co
1575 Sherman Street
Denver,
S 3C0oherred° 80203-1714
Pho Cam)886-8d2583 0 *At!):
�r
FAX(303)866-4214
s 6s
Roy Rarer
Governor
Banta McDonnell
Executive Director
September 6, 1994 Karen°eye
Managing Director
David Pacheco, Director
Conejos/Costilla Community Action Agency
P O Box 299
San Luis, Cp 81152
Dear Mr. Pacheo,
Thank you for sending in your 1995 nutrition education plan. On the last
page of the plan you stated there was a copy of the Nutrition Survey
(evaluation) this was not attached would •you please send me a copy no later
than October 15, 1994.
Your agency is to be commended for sending two of your staff to the
Nutrition and the Preschool Child: A training course. Dr. Pat Kendall
;poke very highly of your attendees, and I was able to meet them at the
conference they attended at Colorado State University.
If you have any questions please call me at 303-866-5906 after September
12, 1994.
oa 1 e ,
Administrative Program Specialist
•
Bulking Partnerships to Improve Opportunities for Safely,Self-Sufficiency,and Dignity for the People of Colorado
940991
SEP- 2-94 FRI 15 18 WELD CC HRD FAX NO. 3033563975 P. 03
Weld County Division of
Human Resources
Nutrition Education Plan
The Weld County Division of Human Resources will make Nutrition Education
available to participants of the Commodity Supplemental Food Program (CSFP4.
This will he done primarily thrnagh the following mechanisms:
1. A nutritionist on a part-time basis will direct the Nutrition Education
component to reach the goals as identified:
a. To ensure that CSFP foods are used properly.
b. Encourage continued selection and consumption of nutritious food
necessary to good health.
c. Demonstrate the relationship between proper nutrition and good health
with an emphasis on pregnant. post partum, and breastfeeding women.
d. To effect a positive change in eating habits through maximum use of
supplemental foods within the context of ethnic. cultural, and
geographical preferences.
2. At the time of certification, participants will be informed that the program
is only supplemental and not a total feeding program. They are advised of
seeking medical care and of the importance of total health care for item and
their families. Many of our participants are referred for certification
from the other two (2) clinics in Weld County, Sunrise Health Center and
Plan de Salud del Valle.
Participants will also be advised of the times a nutritionist will be
available at the Division of Human Resources for one-on-one rnunieling
concerning special nutritional needs and ways to provide adequate diets, or,
if the participants would like, additional nutrition education. If
neceaaaty, the nutritionist will make these services available in the home.
The certification center can also make reconmondationa to the nutritionist
for follow-up on participants with special needs.
3. At the point of certification, nutrition information is provided to the
participants. The infocmalioa is approved and/or developed by a
nutritionist. The various tools used are recipes for balanced meals,
nutritional information. snack ideas, and when available, information as it
relates to nutrition, shopping trips, etc. The following is a more detailed
description of the information to be distributed in the packets:
a. Menus:
3eeakfast, lunch, and Supper menus of the month, which include all four
C ‘c(4LJlements of a balanced diet, will be developed and presented. When
-- the menu is developed, consideialiuu will be given to Distribution for
the month, if possible. This will provide participants with ideas when
they are planning family meals.
940991
SEP- 2-94 FRI 15: 19 WELD 00 HRD FAX NO. 3033563975 P. 04
Nutrition Education Plan
Page Two
b. Recipes:
Recipes for each item on the menu will be provided. The recipes will
contain different ways of using the commodities and will be written in
English and Spanish. Consideration will be given in providing recipes
from the ethnic background of participants.
c. Nutritional Information:
Information concerning the benefits of nutrients contained in foods
presented in the menus will be included. They will be given an
explanation of the areas of the body the nutrients are helping and what
foods are providing these vitamins.
d. Snacks:
Ideas for snacks to give the children between meals will be made
available. These snacks will be nutritionally sound and not the "Junk
food" usually provided as snacks.
e. Other Information:
InfolmaLi,m cunceniiug breastfeeding, nutrition during pregnancy, etc.,
will be provided by their doctors. Shopping tips and other information
will be provided in the plan.
All information used in the packet will be provided in both English and
• Spanish whenever possible.
The packet will also re-identify when the nutritionist is available fnr
one-on-one counseling.
4. Nutrition Education Classes:
Nutrition education classes will be offered at various times throughout the
year. The major topic will be the use of the commodities.
•
940991
SEP- 2-94 FRI 15: 19 WELD CO HR) FAX NO. 3033553975 P. 05
4 mEMORAnDum
dillk To o,r,__August 25, 1994
COLORADO From Joyce_E.. Johnson. weld county Nutrition Consultant
sub;,,p,'utrition Education Plan for Supplemtntal Food Program
•
The following dates have been scheduled for nutrition counseling and
demonstrations at the Supplemental Foods receiving building. Menus-of-the Month
will be available for all clients. Recipes using current commodities and samples
of recipes will he available for children and parents.
October 1994 "Halloween Surprise"
(Pumpkin Bars)
November 1994 "Basic Mix for Thanksgiving"
(Cheese and Biscuit Mix)
Deceubet 1994 "Holiday Cheer"
(Peanut Butter Balls)
January 1995 "Farina Recipes"
(Chicken with Stutting)
February 1995 "Valentine Time"
(Peanut Butter Cake)
March 1995 "Menu of the Month"
(Tuna Checsics)
April 1995 "Delicious Mixes Using Dry Milk"
(Milkshakes, Creamy Sauces and Gravies)
May 1995 "Lily Feeds Her Baby" Video
Western Dairy Council
June 1995 "Fruit Juice for Good Health"
(Orange Juice Gelatin)
July 1995 "Sunmertime Salads"
(Tuna Salad on Tiny Biscuits)
August 1995 "Encouraging Good Eating Habits for Your Child"
(Healthy Finger Food)
September 1995 "First Foods" Video
Western Dairy Council
(Creamy Potato Soup)
940ggi
SEP- 2-94 FRI 15:20 WELD CO HRD FAX NO. 3033562975 P. 06
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LOW COST - HIGH NUTRITION MENU A
e.
• a CREAM OF CORN SOUP +ap
TUNA CHEESIES let
Si PEANUT BUTTER COOKIE - CHILLED APPI.EJUICE ,i
a III
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+e 1 cup canned chicken or perk 1 tablespoon chopped onion a •
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1/4 cup cgg mix (or 1 -teaspoon onion powder) ten`
•e 1/3_4go nonfat dry milk 1 teaspoon celery seed Ng
1. can (16 oz.j Cream Style Corn (or 2 tablespoons chopped 1'a
a
• 0 I-l/Z cuo water or enough for fresh celery) ,■p
' desired consistency Season to taste •tip,
Ka
de' `Combine egg mix. dry milk and seasoning in saucepan. ,n a
a Add Cream Style Corn, celery, onion, water and stir over low heat until '■'
• a mixture begins to simmer. Add chicken, cover and sinner over low heat ,Aar
a a
for five minutes. fet
Y■
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de
yy±' For Vegetarian Corn Chowder, omit meat. a
ti. Serve with Coleslaw. Hakeo Apple and Cheese Wafers. +a
zGAzz de4. %
E%sr Makes 3-4 servings. .,■
NU `'a
Na,
•f TUNA WE EMS Out
' 6 Sandwiches ``
s a
s a
'a re}
Ya 1 can(6 1/2 oz) Tuna.drained VS tsp.Pepper ,■e
•e ' t c.Celery,choopea 1,4 c.Mayonnaise or salad dressing 'a'
1/2 c.Process Amercntheese diced 6 Hamburger buns. spit ,e
1 T.Instant mmCec onion Fa=or Margarre.softened let
O•
P • Mix tuna.celery,cheese.onion.salt.,pepper,and mayonnaise. Spreaa buns with ■
fa margarine. Fib buns with tuna mixture. Place each on peace of aluminum foil and tdd '■ti
r!■ edges securely;pace on ungreased cookie sheet. Cock in 350'F.oven until hot,about 20 s'
+a minutes. - yew
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SEP- 2-94 FRI 15:20 WELD CO HRD FAX NO, 3033561975 P, 07
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�■i 1/2 c.Milk 2 tsp.Yarlia s •
'" 1/4Ib.Baer or margarine 1/2 C.Peanut timer '/e`
.in Cook sugar,mdk,margameandco=for11/2minutes. Startcotatingamenmirnvenn wa
iii. reached a full boil. Remove from beat add cats.mas.and vartila and peanut butter. Ent ‘5r
••�
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9x13 pan :■U
3/4 t.Dry egg mix 1 e.Rao J■`
VI +314 e.water or 3 eggs Add. 314 tsp.Baking �:
a powder Stir in
1 1!3 c.Broom sugar,pained 1/4 tsp.Baking soca , #■`
a"; 1/3 c.Melted butter or margarine - 1/2 c.Caco:un(obbratt ] Add a a
+• 1 tap.Vanilla Add J•`
Ns•
1/2 c.Peanut Amer `•
•
di` Bake 25-30 minutes at 350'F. des.
it.lts �■
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IF■wi
' +PEANUT SUITES COOKIES �•t
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i 21/2c.flcr JS4
1 c Peanut Butter
i r� 1/2tsp.Salt(optinat8 1 c.Sugar �No
■►
1/2 tsp.Bating soda 1 c.Brown
t•; 1 c.Fat(margarine.butter.or shortening) 2 sugar.Paced Alit
en
flax, a•i,• salt,and hating soda. Set aside. Mix fat and Pia mutter. Add both kinds of w•
�,. sugar. b5x well. Add eggs and beat wee. Stu kwmixture into peanut ester mixture. tell
wg■ Drop downfrom a=won on baiting pan. Flatten with a fork Bake at 375 F.
• F (moderate oven)10-15 minutes untillightly frowned. ''r
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• ■ - iii
SEP- 2-94 FRI 15:21 AELD CO HRD FAX NO. 3033563975 P. 08
414:2=2aZ:2
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MENU OF THE MONTH
reS) . .
XI Tiny Tuna Cakes
Red Cherry Fruit Jello Garden Greens Peas
Bread and Butter Milk
Tiny Tuna Cakes
1 91/4 oz. tuna (drained and flaked)
11 cup leftover or instant mashed potatoesilletV
2/3 cup evaporated milk
2 teaspoons parsleyNIX rralVe 1 teaspoon salt
1/8 teaspoon pepper `i riiivut 1 cup fine dry bread crumbs or crushed cereal [ r
ellriV
Mix together tuna, potatoes, 1/3 cup evaporated milk,
Ifiparsley, salt and pepper. Shape into 12 patties. RollridIM
in bread crumbs. Dip in remaining 1/3 cup evaporated milk. ill
ry Roll again in crumbs. Brown well in hot greased skillet.
Serve with any vegetable and fruit. Also whole wheat V
Xbread 1s a good choice for children.
`V Mix your dry milk with water the day before use. Children
��/�Jy like it best if it is well-chilled.
�{c Tune is an excellent choice of protein. Well-drained ofreatV
isr all oil it is excellent for the young pregnant or lactating
mother. PPM
Enjoy Tuna Fish in Salads too! And the young child will IX enjoy a cold tuna fish sandwich with a cup of hot tomato
soup.
V 21-92-1015
40491
SEP- 2-94 FRI 15.21 WELD CO HRD FAX NO. 3033563975 P. 09
13.910.107
COLORADO DEPARTMENT OF SOCIAL SERVICES
DONATED FOODS UNIT
1575 SHERMAN STREET, 3td FLOOR
DDNVDR, CO 00203-1700
(303) 866-5100
•
DONATED FOODS USED FOR CSFP FOOD DEMONSTRATIONS
FOOD ITEM QUANTITY
n/`�qpi .. :csue.r. -5 Cc.,..y
ZThef"-;5' t114
L
PURPOSE' 1I OF DEMONSTRATION: p
1 t 64 to co er.z 1 t PLwW\'{i�=w ��r_^�^ �t/�: v�� eit� ce5 5
\����"f""��� Ida3 milA . 411p (K \u.tiCe. '�t— Lott-Les eaS� ,
ATTACH EXTRA PAGES IF NEEDED
DEMONSTRATION SITE USED FOR CSFP FOOD DEMONSTRATIONS
Agency Name: _,-Weld County Supplemental Fowles Program
Name of Demonstrator: Joyce E. Johnson MA mate _D - - G
Malting Address: 1551 North 17th Ave . P.U. Box 1805
Telephone: j$O3) 353-3816 pA.Y (35(j 3975
Ex. 3326
IMPORTANT? Any product transferred to any other agency fur demonstration purposes must ban prior
written approval from the S. Agency, 1575 Sherman Street,3rd Floor,Dearer,CO 80203-1700.
• • • • • • • • • • • • • •
APPROVED BY STATE CSPP OFFICE:
If commodities were used for demonstrations a cony of this form most accept any the monthly 153 Report:
940991
SEP- 2-94 :RI 15:22 WELD CO HRD Pry NO. 3033563975 P. 10
13.910.107
COLORADO DEPARTMENT OF SOCIAL SERVICES
DONATED WOODS UNIT
1575 SHERMAN STREET, 3rd FLOOR
DENVER, co 80203-1700
(303) 8g6-3100
•
DONATED FOODS USED FOR CSFP FOOD DEMONSTRATIONS
FOOD ITEM OUANTIfl'
'Pr r,Cr _ A r1„,- _
JI k ri
PURPOSE or DEMONSTRATION:
st M iK g r- L ,
CCU 4-
161SCa.a4 rth X) 1ft-�{t4.Uu.c bt Cut.:C VvLZX
.�r. ll..s'Lfl r, btata re b_ A.t`n ea; IL. .
ATTACH EXTRA PAGES IF NEEDED
DEMONSTRATION SITE USED FOR CSFP FOOD DEMONSTRATIONS
Agency Name Weld County Supplemental Foods Program
Name of Demoustratir: Joyce F. ,(nhnsnn VA /Date 1 !— ( —c± •
•
Mailing Address: 1551 North 17th Ave. P.O. Box 1805
Telephone: (303) 353-3816 FAX ( 35Q 3075
Ea. 3328
IMPORTANT! Any product transferred to any other agency for demonstration purposes must have prior
written approval from the Agency, 1573 Sherman Street, 3rd Fluor, Denver,CO 80203-1700.
APPROVED BY STATE CSFP OFFICE:
If commodities were used for demonstrations a copy of this form must accompany the monthly 153 Report.
940991
SEP- 2-94 FRI 15:22 rlELD CO HRD FAX NO. 303356 975 P. 11
13.910.107
COLORADO DEPARTMENT OF SOCIAL SERVICES
DONATED FOOn5 : nrT
1575 SHERMAN STREET, 3rd FLOOR
DENVER, CO 80203-1700 •
(303) 866-5100
e
DONATED FOODS USED FOR CSFP FOOD DEMONSTRATIONS
Ff.XID ITEM OUANTITY
Pee.uuj lalkite t" CA:Le-a
f-3 YVl: t1t i he,,t
One-3c C.e►-e ( tl boXc
PURPOSE OP DEMONSTRATION:
(t Caol,d,,, C.Lc ; kkow to p rout`a 42,..na L0( o crI na
U.SDf1 Cent.eme&flin T�g, Yea j. bi..jle r.. 6mU5 --f 4_
aLe; ty\jc *....rAr a 'R
ecipe cipcs 's- 1`( fef•tlt0A CAc..cctil•ON
ATTACH EXTRA PAGES IF NEEDED
DEMONSTRATION SITE USED FOR CSFP FOOD DEMONSTRATIONS
Agency Name: weld County Supplemental Foods Program
Name of Demonstrator; - Joyce E. Johnson MA mate ,1,-i- q c..a
Mailing Address: 1551 North 17th Ave. P.O. Box 1805
Telephone (3O3) 353-3816 PAX (358 3975
Ex. 3326 .
IMPORTANT! Any product transferred to any other agency for demonstration purposed must have prior
written approval from the ti. ... Agency, 157S Sherman Street,3rd Floor,Denver, CO 80203.1700.
APPROVED BY STATE CSFP OFFICE:
If commodities were used for demonstrations a cony of this form must accompany the montjL153 Report
4an4o,
SEP- 2-94 FRI 15:23 WELD CO HRD FAX Na 30335A397H P. 12
13.910.107
COLORADO UEFARTMENT OF SOCIAL SERVICES
DONATED Forms UWST
1575 SEERMAN STREET, 3rd FLOOR
DENVER, CO 80203-1700
(303) 866-5100
•
DONATED FOODS USED FOR CSFP FOOD DEMONSTRATIONS
FOOD ITEM OUAN7TTY
^T en #n.4
w:l c. c,_ c a.ti.b
PURPOSE OF DEMONSTRATION:
4 la
€)„t p.,,Ie \ } L.
to. r.VKgr" tje te..Co NeI <0.� 2 ttx
a �'( �1G%.•4ke Ca�cr re? L. .A+stw�, 1 CoYKI." ocj.L �+C cxw.�. `.a e'F, Ct
Co n.`.v�oQt 4«.-) a t\c . . �.�3v tic a�4C F`r�,.:E`� ly �i�..� `
F e.ti..t L .:..lx vas.,.ri 4:1 •
ATTACH EXTRA PAGES IF NEEDED
DEMONSTRATION SITE USED FOR CSFP FOOD DEMONSTRATIONS
Agency Name: Weld County Supplemental Foods Program
•
Name of Demonstrator: _Joyce E. Johnson MA (Date 1-gag__
Mailing Address: 1551 North 17th Ave. P.O. Box 1805
Telephone! 1303) 353-3816 FAX (35g 3975
Ex. 3326
IMPORTANT Any product trausferred to any other agency for demonstration pttrpoms most Dan prior
written approval from the ti...,, Agency, 1575 Sherman Street, 3rd Floor, Denver,CO 80203-1700.
APPROVED BY STATE CSPP OFFICE:
If commodities were used for demonstrations a cony of this form must accompany the monthly 153 Report.
940991
O
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G p -0-04-"7-1 o Q
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O C j
e X10 1 -�- - �-j,,E13 .l
P.O. Box 78 * ,La Jara,CO 81140 •
i il719$74 1307
Iv A� _�� ^._ cam_ �L.Qr�� .-�- ..CIL_ _.
1994-95 CSFP EQUIPMENT LIST
Conejas County Nursing Service
August 22, 1994
The following is a list of equipment used for the Commodity Supplemental Food
Program.
Compudyne Computer/Screen
Epson LQ - 850 Printer
Minolta Copier EP-4210
Brother Fax Machine Fax - 380
Software-Lotus
Software-Windows
Walk-in Cooler/Freezer
Refrigerator/Freezer
386 Epson Wingate computer
UFO
Lo Booth, Public Health Administrator
1` S cloves C'Jo good
940441
•
DAVID G. PACHECO (719) 672-3323
Executive Director Fax (719) 672-3317
Conejos- Castilla
COMMUNITY ACTION AGENCY
P.O. BOX 299 - SAN LUIS, COLORADO 81152
CSFP PROPERTY/EQUIPMENT PURCHASES
DESTINY 286 COMPUTER, #6536 6/6/91 $ 1,295.00
1992 FORD § TON TRUCK 1 FIMS15YINPA22091 10/21/91 10,752.00
WALK-IN COLLER FREEZER UNIT #A105MLP-1 5/92 22,400.00
PORTABLE KITCHEN UNIT 3/94 1,355.64
HYSTER FORKLIFT /E8OB 1991 8098V015778 6/94 TRANSFERED PROM
WELD COUNTY
g4nQo,
JUL-26-1993 07:47 FROM DSS FOOD ASSISTANCE TO 98662704 F.02
Page 1 of 4 pages
DENVER DEPARTMENT OF SOCIAL SERVICES
FOOD ASSISTANCE PROGRAMS
TO: u Stofer
FROM: ony Quintana
•
SUBJECT: temized List of CSFP Property/Equipment Purchases
DATE: my 22, 1993
Page 1 of 4.
Following is the current Itemized List of CSFP Property/Equipment
Purchases
ITEM IDENTIFICATION NUMBER
Computers
1 NCR Pe onal Computer SN #15-1853-7704
1 NCR Pe onal Computer SN #15-185365518
1 NCR Pe onal Computer DDSS #87-65875-01
1 NCR Pe onal Computer DDSS #87-65825-07
1 NCR P onal Computer (DGH) SN #17-17245169
1 NCR Pe onal Computer (DOH) SN #17-17241282
1 Honeyw 1 Bull File Server SR-V20 DDSS #89-45601-VP01
1 Data S r 386-SX DDSS #91-39673-VP01
1 Data S r 386-SX DDSS 191-39673-VP02
1 Data S r 386-SX DDSS #91-39673-VP03
1 Data S r 386-SX DDSS #91-39673-VP04
57b
940004
JUL-26-199 07:48 FPrTh1 DSS FOOD ASSISTANCE
TO 98662704 P,03
Page 2 of 4 pages
Denver CS Property/Equipment Purchases con't.
Page 2 of
ITEM IDENTIFICATION NUMBER
•
Monitors
1 Imtec for Monitor DDSS #90-12117-VP03
1 compel olor Monitor SN #2A001846
1 IBM Co r Monitor DDSS #85-32665-VP40
1 NCR Co r Monitor DDSS #87-65825-06
1 NCR Mo chrome Monitor DDSS #87-65824-03
1 Magnav VGA DDSS #91-39673-VP02
1 Magnav VGA DDSS #91-39673-VP03
1 Magnav VGA DDSS #AF-11042
1 Magnav VGA DDSS #AF-11403
Printers
1 NCR Do Matrix Printer DDSS #87-65824-09
1 Hewlet Packard Laser Printer DDSS #91-44569-VP01
1 Hewlet Packard Laser Printer DDSS #91-44569-VP02
1 Hewlet Packard Laser Printer DDSS #91-44569-VP03
1 Hewlet Packard Laser Printer DDSS #91-44569-VP04
91 0441
,,,.,� �., i�� vim, • ., rRui'I Uoa rUuLj Hiblo!HNLE TO J3O627J4 F,34
Page 3 of 4 pages
Denver CS P Property/Equipment Purchases con't.
Page 3 of 4.
ITEM IDENTIFIC4TION NUMBER
•
Keyboards
6 NCR Ke ards (2 DGH) LR63292
1 Data S r Keyboard SN /00882051
1 Data S r Keyboard SN #00212051
1 Data S r Keyboard SN #14481121
1 Data S r Keyboard SN 101752051
Miscellan us
1 Mounta Filesafe Tape NA
1 JL Cha rbox DDSS X88-07430-01
1 Everex odem DDSS #88-3371-01
1 Everex odem DDSS #88-3371-03
1 Everex odem DDSS #88-3371-04
1 Microc Modem SN #1413045184
1 Microc Modem DDSS /AF1154
1 Panaso c Fascimile Machine DDCC #01-32422-VP
1 Food D onstration Table NA
940991
JUL-26-1993 07:49 FROM DSS FOOD ASSISTANCE TO 98662704 F.05
Page 4 of 4 pages
Denver CS Property/Equipment Purchases con't.
Page 4 of .
ITEM IDENTIFICATION NUMBER
•
Warehouse nventory
1 Hyster alkie-Ryder SN #13135006684B
1 Hyster alkie-Ryder SN #13135006685B
1 Schre Walkie-Ryder SN #15070
1 Ferroc ger SN 08300919-51-27
1 Ferro rger SN #4800509290
1 Ferroc rger SN #1810502792
1 Ferro rger SN #181CS02792
1 Ferroc rger SN #8403859
1 Powerf w Charger SN #F17503
1 Powerf w Charger SN #15274-1
1 Hyster orklift SN #B108V077758
1 Multit Forklift SN #50027238
1 Kamats Forklift SN #20168A
1 Slipsh t Forklift Attachment SN #666628-P-1
1 Ford T Ck F-800 VID #1FDPF82K7GVA09670
1 Chevro t Cargo Van VID #2GCEG25HOM4130705
1 Kolpak reezer and Cooler NA
940991
MESA COUNTY COMMODITY SUPPLEMENTAL
FOOD PROGRAM
1994 INVENTORY LIST •
940991
TAG# QUANTITY ITEM DESCRIPTION
02716 1 DESK,W000EN GRNIBRN
1 DESK, METAL GRAY
1 DESK, WOODEN BRN
2 CHAIRS, COMPUTER •
4 CABINET, METAL TAN FILE 4-DR •
02711 1 CABINET,METAL GRAY DBL DR SUPP
02673 1 CABINET,METAL BLK FILE 4-DR
2 TABLES, WOODEN(36X28)
02;18 1 TYPEWRITER, ADLER ELECTRIC
06665 1 TYPEWRITER, WHEELWRITER ELECISN 1120099
06661 1 FORKLIFT, ELEC
06662 1 PALLET JACK, ELEC/SN 339359
1 TYPING TABLE, GRAY
1 TYPING TABLE, BRN
06664 1 TABLE, FOLDING 6FT
06251 1 COPIER STAND
1 CALCULATOR, SHARP COMPET VX-1652
05498 1 CALCULATOR, SHARP COMPET VX-1652
1 PHONE, CORDLESS AT&T
2 COMPUTER HUTCHES/PARTICLE BOARD
2 PRINTER STANDS/PARTICLE BOARD
3 TABLES, FOLDING 8FT BRN
2 TABLES, FOLDING 6FT BRN
8 CHAIRS, STACKABLE MAUVE
8 CHAIRS, STACKABLE BLUE
8 CHAIRS, STACKABLE BRN
05386 1 PALLET JACK GRAY
2 PALLET JACKS YELLOW
2 HAND TRUCKS GRN
1 HAND TRUCKS BLUE
2 • CHEST FREEZERS
05154 1 UPRIGHT FREEZER
03638 1 REFRIGERATOR (BREAK ROOM)
05156 1 REFRIGERATOR (FRONT)
1 COFFEE MAKER (40QT)
2 CHAIRS, SECRETARY
02113 1 CHAIR, SECRETARY
1 SHOP VAC
1 VACUUM CLEANER
1 TABLE, WAREHOUSE GRAY METAL
9 BELTS, SAFETY aLK/GRAY
1-XXL
1-XLG
940991
r nne_-rr .n rti ice.n �u11J tl.lnn-i ur ?II
ti
1-LO
1 5-MED
02262 1 1-SM
06098 1 COPIER, HARRIS 3M W/STAND/SN 918179
06097 1 PRINTER, EPSON FX-286
1 MONITOR, MAGNAVOX 80 •
1 COMPUTER, IBM PC XT
1 MONITOR, IBM PS2 COLOR
2 COMPUTER, IBM PS2 MOD 30-286
2 PRINTER, PANASONIC KX-P1624
1 MONITORS, SUPER VGA
1 COMPUTERS, MATRIX 386-33
1 PRINTER, PANASONIC KX-P1180
1 PRINTER, FX-850
1 BUFFER, FLOOR
1 WALK-IN FREEZER
1 MICROWAVE OVEN
1 CORDLESS PHONE
2 MULTI-LINE PHONES*
1 PORTABLE KITCHEN*
* THESE ITEMS HAVE BEEN PURCHASED WITHIN THE LAST FISCAL YEAR
940991
•
CHANGING NEEDS FOOD PROGRAM `.•''?
COMMODITIES EQUIPMENT •
PERPETUAL INVENTORY
•
I i ITEM 1
I I I I
IProgram(QuantitylDescription, Serial No, Etc. IMo. (Year I
! I I ! I I
ICOMMODII 1 (Dolly - Blue/Gray 4 Wheel 500# Rating 1 6 11990 I
I I 1 (Hand Cart - Red 2 Wheel 600# Rating 16 11991 I
I I I I I I
i I 1 (Tarp - Blue 17 11991 I
I I I I I !
I I 1 IWordProcessor - Smith Corona 16 11991 I
I I I I I I
I I 1 (Gibson Upright Rifrigerator 18 11992 I
I I I I I I
1 I 1 (Kenmore Chest Type Freezer 18 11992 I
I I I I I I
! I 1 (Blue 2 Wheel Dolly #400 lb Cap 111 11992 I
I 1 1 I ! I
I I 1 (Gray 4 Wheel Dolly #1000 111 11992 I
I I I I I I
I i 1 (Citizen Printer 16 ( 1992 I
I I I I I I
I I I I I I
I I I I I I
I ( IDel Norte Site I I I
I I 1 I I I
I I 1 (Star Printer NX-1000 I I I
I I I 1 I I
I I 1 !Samsung_ Monitor mdl# MA 2565 I I I
I i I I t I
I ! 1 IPC Power Center 80-Data
I I I I I I
I I 1 (Computer SN# 51828 I I I
i I i I 1 I
I I 1 (Modem 80-Data 2400 SN# 71108770 I I I
I I I I I i
l i 1 !Computer table 1 2 ( 1991 I
I I I I I I
I I 2 !Keyboards I I I
( ! 1
I I 1 !Office Desk - grey 4 drawer ! 2 11991 I
! I I I I 1
I I 1 I Emerson Microwave MT 3055 SN#00207803 I 11991 I
I I I I I
I I 1 !Copier Table Folding_ 4' ! 2 11991 I
I I I I I I
1 I 1 (Minolta Copier EP300 I I I
I I 1 (File Cabinet Tan 4 drawer
I I I I 1 i
1 ! 1 !Sharp Calculator EL-2192C I I I 940991
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I I 1 (Computer Credenza Desk Oak look
I I I I I� I
! I 1 IComputer 80-Data SN#32877 ID FCCIDFPF4YI I I
! I I I I I •
I I 1 IRelisys Monitor RE5154E Color I I I
I I I I f I
I I 1 'Epson Printer Laser EPL-7000 I 2 1 1992 I
I I I I I I
I I 1 ILabelwriter II Plus COStar I I I
I I I I I I
! I 1 IPC Wand PW-100 I I I
I I I I I I
I I 1 18088 Computer with monitor I I I
I I ! I I I
•
•
•
940491
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•
•
APPROVAL AUTHORITY
The amended State Plan of Operation and administration for the Commodity Supplemental
Food Program with the Colorado Department of Human Services for Federal Fiscal Year
1995 is hereby approved.
S ander
Barbara McDonnell
Executive Director
Colorado State Department
of Human Service
,ofetk mit
Date of Sigaiature
940991
mEmoRAnDum
I W. H. Webster, Chairman
Wi`P To Board of County Commissioners Date October 4, 1994
COLORADO From Walter J. Speckman, Executive Director, Human Services
Contract between the Colorado Department of Social Services
Subject:
and the Weld County Division of Human Services
Enclosed for Board approval is the Contract between the Colorado Department of
Social Services and the Weld County Division of Human Services for the
administration and operation of the Commodity Supplemental Food Program.
This is a continuing Contract which defines the responsibilities and requirements
governing the Commodity Supplemental Food Program.
The period of this Contract is October 1, 1994 through September 30, 1994.
If you have any questions, please telephone me at 353-3800.
940991
Hello