HomeMy WebLinkAbout930977.tiff RESOLUTION
RE: APPROVE DONATED FOODS AGREEMENT BETWEEN THE COLORADO DEPARTMENT OF SOCIAL
SERVICES AND THE WELD COUNTY DIVISION OF HUMAN RESOURCES 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
the Commodity Supplemental Food Program between the Colorado Department of Social
Services and the Weld County Division of Human Resources, commencing October 1,
1993, and ending September 30, 1994, 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 the Commodity Supplemental
Food Program between the Colorado Department of Social Services and the Weld
County Division of Human Resources 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 22nd day of September, A.D. , 1993.
BOARD OF COUNTY COMMISSIONERS
ATTEST: WEL COUNTY, COLORADO
Weld County Clerk to the Board
Constance L. Harbert, Chairman
(y///� k),
the Bo
ard lerk to the Board W. Hy Webster, Pr -Tem���
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APPROVED AS TO FORM: ' " -'
/C��,.E. Baxter
�
il
�2SuntyAttorney Dale K l
jL
Barbara J. Kirkmey r
930977
DF-2B (Rev. 08/93
COLORADO DEPARTMENT OF SOCIAL SERVICES
1575 Sherman Street, 3rd Floor {�' tia'
Denver, CO 80203-1700 4, tit
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 Social 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 contact 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 Donated Foods
Program 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
Donated Foods 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 Donated Foods Program, 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 Donated Foods 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.
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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 reserves 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 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
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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.
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, religion 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
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9309'T)'
Department of Social 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,
1994. 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
This Agreement is binding upon the present and future elected or employed officials of
the Recipient Agency and the State of Colorado.
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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: lift c23—:& M93
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 SOCIAL SERVICES
PHONE #: (303) 356-4000 DATE -APPROVED
SIGNATURE AND TITLE OF AGENCY HEAD
OR AJJTHORIZED REPRESENTATIVE:
Constance L. Harbert, Chairman KAREN BEYE
°9/47/%3 EXECUTIVE DIRECTO
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C
H 6TATE OF COLORADO
DEPARTMENT OF SOCIAL SERVICE S$ �P oho„
1575 Sherman Street ) ����
Denver ( Ir ratio6020.4-1714 SEP 20 1993 / .)• ,, ^.o `T a
Ph< le 1 3041866-5 700 L ) < ,,, " »
IDD 140:Si 866-0294 3 - *18764
FM(1301)866-4214 ������ /// �� r '���
E `v� , c 55` y) Roy Horner
��I -1 Ca ernor
,)� ,. 1 Executive
Be ye
Director
P, �� \\, (
MEMORANDUM \ / `\j
\,,i
TO:TO: All Local Agencies and ,›, \', ivi
State Plan Recipients \
FROM: Jan Finney, Unit Chief ll
Donated Foods Unit 7L""7
DATE: September 16, 1993
SUBJECT: State Plan Update
Family Enrichment Center will terminate participation in Del Norte for the Women, Infants and
Children componet of CSFP effective October 1, 1993. Mark Garner has resigned as
administrator to seek other employment opportunities. We thank Mark for his good service and
wish him well.
Tri County Seniors, Inc. will be administering both components of CSFP; therefore we are
attaching amendments to the State Plan. Please make changes on the following pages.
Page 3 113.301.200 LOCAL AGENCY PARTICIPATION AND
APPLICATION Remove Rio Grande County: Administrator
Family Enrichment Center, P. O. Box 250, Del Norte,
CO 81132.
Page 4 13.301.300 CERFIFTCATION e.Delete Rio Grande County,
Family Enrichment Center, and insert Rio Grande County,
Changing Needs Program, 250 Spruce Street, Del Norte,
CO 81132.
Page 21 13.301.310 ELIGIBILITY REQUIREMENTS e. Rio Grande
County: Remove Family Enrichment Center address and add
following paragraph: Distribution to women, infants and
children is made by Changing Needs Program, 520 Spruce
Street, Del Norte, CO 81132 under the direction of
Administrator, Tri County Senior Citizens & Housing, Inc.,
Washington Street,Monte Vista, CO 81144.
9309x'77
113.301.200 LOCAL AGENCY PARTICIPATION AND APPLICATION
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
2200 W. Alameda Avenue
Denver, Colorado 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
13.301.210 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
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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.
13.301.300 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 338
San Luis, Colorado 81152
c. Denver Department of Social Services
Food Assistance Programs
2650 West Third Avenue
Denver, Colorado 80219
d. Mesa County Health Department
515 Patterson Road
Grand Junction, Colorado 81501
e. Rio Grande County Tri County Senior
Changing Needs Program Citizens Housing, Inc.
520 Spruce Street 311 Washington Street
Del Norte, CO 81132 Monte Vista, CO 81144
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.
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e. Rio Grande County
Distribution to women, infants, and children is made by Changing
Needs Program, 520 Spruce Street, Del Norte, CO 81132 under t h e
direction of 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 - Administrator
Tri County Senior Citizens & Housing
311 Washington
Monte Vista, CO 81144
Weekly distributions are accomplished 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.
Weld County
Distribution is accomplished by a commodity clerk under the
direction of- Executive Director
Weld County Department of Human Resources
C/0 The Weld Food Bank
P.O. Box 1805
104 11th Avenue
Greeley, Colorado 80632
Supplemental foods are arranged in grocery store fashion.The
distibution 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, sheetrock 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.
13. 301.800 PROGRAM MONITORING
The Food Assistance Division, Colorado Department of Social Services will
provide monitoring of the local project ares 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
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STATE PLAN OF OPERATION AND ADMINISTRATION
COMMODITY SUPPLEMENTAL FOOD PROGRAM
FEDERAL FISCAL YEAR 1994 (FFY94)
TABLE OF CONTENTS
GOALS AND OBJECTIVES FOR PROGRAM IMPROVEMENTS FY94 i
13.301.100 STATE AGENCY IDENTIFICATION AND AUTHORITY 1
PURPOSE OF THE PROGRAM 1
PURPOSE AND OBJECTIVE OF THE STATE PLAN 1
13.301.200 LOCAL AGENCY PARTICIPATION AND APPLICATION 3
LOCAL AGENCY APPLICATION 3
13. 310.300 CERTIFICATION 4
ELIGIBILITY REQUIREMENTS 4
PROCESSING STANDARDS 6
NOTIFICATION REQUIREMENTS 7
VERIFICATION OF CERTIFICATION 7
CERTIFICATION PERIODS 8
APPLICANT'S RIGHTS 8
DUAL PARTICIPATION 9
DISQUALIFICATION 9
13.301.400 CASELOAD MANAGEMENT 10
MAXIMUM CASELOAD ASSIGNMENT 10
IDENTIFICATION OF ELDERLY POPULATION 10
PRIORITY WAITING LIST 12
13. 301.500 OUTREACH 12
PROGRAM EXPANSION 12
PUBLIC NOTIFICATION REQUIREMENTS 13
REFERRALS TO OTHER PROGRAMS 13
13.301.600 NUTRITION EDUCATION 13
GOALS 13
METHODS 14
STAFFING AND FREQUENCY 15
EVALUATION 16
FUNDING 16
PARTICIPANT INVOLVEMENT 16
TECHNICAL ASSISTANCE 16
FOOD DEMONSTRATIONS 16
REVIEWS 17
13. 301. 700 FOOD DELIVERY SYSTEM 17
ORDERING 17
PROCEDURES 18
RECORDS 19
PROTECTION OF FOODS 19
COUNTY FOOD DISTRIBUTION POINTS 19
13.301. 800 PROGRAM MONITORING 21
13. 301.900 STATE PLANNING 22
ry;. 3.• 30977
13.301.1000 FINANCIAL MANAGEMENT 22
STATE AGENCY RESPONSIBILITY 22
LOCAL AGENCY RESPONSIBILITY 23
ADMINISTRATION COSTS 24
PROPERTY MANAGEMENT 25
ADMINISTRATIVE EXPENDITURE PLAN 25
13. 301.1100 COMPLAINTS 25
13.301.1200 AUDITS 26
STATE AGENCY AUDIT 26
LOCAL AGENCY AUDITS 26
13.301.1300 CIVIL RIGHTS 26
13.301.1400 FAIR HEARINGS 29
13 .910. 100 CSFP - CERTIFICATION FORMS 32
DF-4 SUPPLEMENTAL FOODS AUTHORIZATION 33
DF-5 CSFP SUPPLEMENTAL FOOD ID CARD 34
DF-5B CSFP VERIFICATION OF CERTIFICATION 35
DF-14 NOTICE OF ADVERSE ACTION/RIGHTS OF APPEAL 36
DF-5D CSFP SUPPLEMENTAL FOOD ID CARD DENVER COUNTY
ONLY 37
DF-5G CSFP SUPPLEMENTAL FOOD ID CARD WELD COUNTY
ONLY 38
13.910.200 CSFP DISTRIBUTION FORMS 39
DF-7 DAILY RECORD OF ISSUES 40
FNS-153 MONTHLY INVENTORY REPORT 41
CSFP ORDER FORM - DISTRIBUTOR 42
DF-13 CSFP GAIN OR LOSS REPORT 43
DF-15 CSFP EXPIRATION OF CERTIFICATION 44
CHART CSFP MAXIMUM MONTHLY DISTRIBUTION RATES 45
13.910. 300 CSFP AGREEMENT FORMS 46
CSFP STATE/LOCAL AGENCY AGREEMENT COVERING CERTIFICATION
FOR AND DISTRIBUTION OF FOOD COMMODITIES 47
CSFP PROGRAM APPLICATION FOR LOCAL AGENCIES 48
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) 49
STATE AND LOCAL DEPARTMENT/AGENCY INDIRECT COST
NEGOTIATION AGREEMENT 50
13.910.400 CSFP ADMINISTRATION INFORMATION FORMS 51
CSFP ADMINISTRATION REVIEW FORM 52
CSFP STATEMENT OF EXPENDITURE-LOCAL AGENCY 53
COLORADO DEPARTMENT OF SOCIAL SERVICES-
ORGANIZATIONAL CHART 54
CSFP STATE AND LOCAL EXPENDITURE PLAN 55
SUMMARY OF NUTRITION EDUCATION PLANS 56
LISTING OF CSFP LOCAL AGENCY EQUIPMENT 57
APPROVAL AUTHORITY 58
9309'7'7'
GOALS AND OBJECTIVES FOR PROGRAM IMPROVEMENTS FY94
I. Assessment of Current Operations
For FY94 the State will continue to work with local agencies to improve dal/or
implement automated systems. In addition, the State will begin implementing
the Entitlement Management System in preparation for USDA mandatory
implementation in FY95.
II. Goals and Objectives
A. Total automation of the Monthly Report of the Commodity Supplemental Food
Program Report (FNS-153) both at the state and local level.
B. Implement the Entitlement Management System in preparation for mandatory
implementation in FY95.
III . Urgency, Feasibility and Scope
A. Urgency
1. Automation of the state and local FNS-153 report will significantly
reduce inaccurate reporting by local agencies and reduce the amount
of gains and losses being reported to reconcile to the monthly
physical inventory.
2. USDA intends to require State agencies to implement the Entitlement
Management System in FY95. It will benefit the State to implement
on a pilot basis for FY94 to resolve any problems in advance.
B. Feasibility
Computerization of the state FNS-153 report has been partially
implemented. A computer consultant for the state has developed a Lotus
1-2-3, FNS-153 report which is being utilized by the state agency. Local
agencies have received this software. The State will continue to work
with the locals to meet this goal.
With the assistance and guidance of USDA, we will begin the development
of the Entitlement Management System to manage and account for CSFP food
dollars.
C. ' Scope
1. Computerization of the FNS-153 report will allow the state agency
to devote more time to agency training, program development and
management evaluations. Conejos, Mesa, Rio Grande (WIC) and Weld
counties still submit manual FNS-153 reports. We will work with
them to get the FNS-153 submitted on the Lotus program.
2. Implementation of the Entitlement Management System (EMS) will
provide for better management and accountability of food dollars
and caseload for CSFP. As the EMS system is developed at the state
level, we will be planning for more local agency involvement and
responsibility for food dollars and caseload.
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IV. Principle Steps To Accomplish Goals and Objectives
A. We will work with each local agency to assess their ability to automate
the FNS-153 report.
B. We will work with USDA to develop the Entitlement Management System. As
the project is developed at the state, we will analyze what functions
should be accomplished by local agencies.
93097?
DONATED FOODS PROGRAM - Commodity Supplemental Food Program
13.301.100 STATE AGENCY IDENTIFICATION AND AUTHORITY
A. Identification
1. Name of Agency: Colorado State Department of Social
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 State Services Code as amended.
13.301.110 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) .
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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.
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 13.910. 303)
f. All forms utilized for the CSF Program are identified in
Section 13.910 of the manual.
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113.301.200 LOCAL AGENCY PARTICIPATION AND APPLICATION
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
2200 W. Alameda Avenue
Denver, Colorado 80223
Mesa County Board of Commissioners
P.O. Box 897
Grand Junction, Colorado 81501
Rio Grande County:
Administrator, Family Enrichment Center
P.O. Box 250
Del Norte, Colorado 81132
and
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
13.301.210 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
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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.
13 .301.300 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 338
San Luis, Colorado 81152
c. Denver Department of Social Services
Food Assistance Programs
2650 West Third Avenue
Denver, Colorado 80219
d. Mesa County Health Department
515 Patterson Road
Grand Junction, Colorado 81501
e. Rio Grande County: Tri County Senior
Family Enrichment Center Citizens Housing, Inc.
P.O. Box 250, 520 Spruce 311 Washington
Del Norte, Colorado 8113 Monte Vista, Colorado 81144
f. Weld County Department of Human Resources
Post Office Box 1850
1500 2nd Street
Greeley, Colorado 80632
L3. 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.
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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, 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 1,075 755
2 1,454 1,022
3 1,833 1,288
4 2,212 1,555
5 2,592 1,821
6 2,971 2,088
7 3, 350 2,354
8 3, 729 2,621
For each additional household member, add $379 for women
and children (185%) and $267 for elderly (130%) .
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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 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.
13. 301.320 PROCESSING STANDARDS
a. The certification is accomplished after the eligibility
determination has been made with the use of the DF-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
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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
13.301.330 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.
13. 301. 340 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
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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.
13.301.350 CERTIFICATION PERIODS
a. Eligible pregnant women shall be certified for the
duration of their pregnancy and for six weeks
postpartum.
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.
13. 301.360 APPLICANT'S RIGHTS
The following sentences shall be read by or read to the
applicant or the applicant's parent or caretaker at the time
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.
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. ' 330977
c. If your application is approved, the local agency will
make nutrition education available to you and you are
encouraged to participate. "
13. 301.370 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.
13.301.380 DISQUALIFICATION
a. The local agency may disqualify applicants and
participants from Program participation for a period not
to exceed three (3) 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.
b. Participants may request a fair hearing as described in
13.301.1400 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
13.910.303)
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13.301.400 CASELOAD MANAGEMENT
13.301.410 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 321 306
Costilla 184 317
Denver 12,255 4,969
Mesa 1,609 0
Rio Grande 372 282
Weld 3.595 419
Total 18,336 6,293
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 during 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.
The following are caseload increases requested by local agencies:
COUNTY WOMEN, INFANTS & CHILDREN ELDERLY
Conejos 25 75
Costilla -0- 10
Denver 2,000 1,000
Mesa -0- 250
Rio Grande 53 72
Weld 100 100
2,178 1,507
IDENTIFICATIONOF 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.
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Costilla County:
Elderly population - 298 persons from current Old Age Pension rolls and
Public Health 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 County/Tri County Senior Citizens & Housing. Inc. :
Out of five (5) homes for the elderly and statistics from the nonprofit
housing authority, there are approximately four hundred (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
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9309'7!
is currently providing all other available services to the elderly in
Weld County.
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 S - 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
(1) , 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 fifteen (15) calendar days of
application (if approved) of their placement on the priority
waiting list.
13. 301. 500 OUTREACH
13 .301. 510 PROGRAM EXPANSION
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Request for program expansion will be evaluated by the State Agency with
consideration given to available caseload and administrative funds.
13.301.520 PUBLIC NOTIFICATION REQUIREMENTS
Reference Section 13.301.1300 which incorporates outreach and public
notification requirements as required by Civil Rights FNS, Instruction
113-2.
13.301.530 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 6 under the medicaid
program. Local agencies will provide this information to each pregnant,
breastfeeding 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.
13. 301.600 NUTRITION EDUCATION
13.301. 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 to up six years of age, and elderly
persons 60 years of age or older.
13
930377
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.
13.301.620 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
staffing. It would be appropriate to submit with this plan,
brochures and pamphlets, that will be used for nutrition education
of participants. This plan shall be submitted by July 1st of each
year for local agency implementation for the next fiscal year.
Nutrition education should, at a minimum, include the following:
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 on the use of the supplemental foods and on the
nutritional value of these foods;
5. Information on 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 twenty-four (24) hour diet recall, pre and post tests
of participant's knowledge of nutrition, basic nutrition
information, such as the basic four (4) , 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 on 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 for instructing participants on 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
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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.
13.301.630 STAFFING AND FREQUENCY
The local agency shall employ, or at lease 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.
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.
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9309'Ty
13.301.640 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 on 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.
13.301.650 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.
13 .301.660 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 be required annually to survey their participants
on what type of nutrition education or food handling classes or
information they would like to have presented. This information must be
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 Social
Services, to evaluate the nutrition education plans of each local agency.
The nutritionist will provide nutrition education information on an
ongoing basis to the Donated Foods Unit, Administrative Officer, 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. 301.680 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
16
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930977
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.
13.301.690 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)
13.301.700 FOOD DELIVERY SYSTEM
13. 301. 710 ORDERING
The foods donated by the United States Department of Agriculture (USDA)
for the CSFP are received by one (1) commercial distributor and four (4)
local agency warehouses. The commercial distributor is Andrews Produce,
Inc. 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 quantities to maintain an
adequate inventory at the following locations:
Location Z
Andrews Produce, Inc.
100 S. Main Street
Pueblo, CO 81002
(serves Conejos
Costilla & Rio Grande
Elderly feeding)
Location 2
Mesa Supplemental Food Program
715 4th Avenue
Grand Junction, CO 81501
(serves Mesa County)
Location 3
Denver County Supplemental Food Program
2650 West 3rd Avenue
Denver, CO 80219
(serves Denver County)
Location 4
Rio Grande County Supplemental Food Program
520 Spruce Street
Del Norte, CO 81132
(serves Rio Grande CSFP)
17
V flflr a
Location 5
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 (3) 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.
13.301.720 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.
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
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to issue either a one month 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.
13.301.730 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 close 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
P.O. Box 78
La Jara, Colorado 81140
The storage and distribution facility of approximately 500 square
feet is located in a wooden building behind the courthouse next to
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330977
the county shops. All food commodities are stored off the floor
on pallets.
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 commodity supervisor and a
staff of eight clerks under the direction of-
Denver Dept of Social Services
2650 West 3rd Avenue
Denver, CO 80219
The commodities warehouse and distribution center occupies the
majority of the large cinder block building with concrete floor.
The dry storage, distribution area and office space consists of
24.068 square feet of space. The distribution area is arranged in
grocery store fashion.
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.
20
330977
e. Rio Grande County
Distribution to women, infants, and children is accomplished
under the direction of the - Administrator,
Family Enrichment Center
520 Spruce Street
Del Norte, CO 81132
The distribution area is arranged as a self service area.
The storage and distribution facility in Del Norte is a brick
structure with concrete floors. There is a room where
certifications are accomplished. Commodities are stored in a
secure area in back of the distribution area.
Distribution to seniors is accomplished under the direction of
the - Administrator
Tri County Senior Citizens & Housing
311 Washington
Monte Vista, CO 81144
Weekly distributions are accomplished 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.
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
distibution 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, sheetrock 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.
13. 301.800 PROGRAM MONITORING
The Food Assistance Division, Colorado Department of Social Services will
provide monitoring of the local project ares 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
21
930977
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.
13.301 .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 State Agency. Input from local agencies is evaluated and utilized
in preparing future State Plans.
During FY93, the State Agency will be evaluating the feasibility of
establishing State/local Advisory Committee, with members to include
local agencies, participants, and appropriate professionals to provide
input for future State Plans and recommendations for the program.
However, this will be contingent on availability of funds and local agency
interests.
13. 301. 1000 FINANCIAL MANAGEMENT
13.301.1010 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 Social 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
22
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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 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.
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 FY94 total $1,485979.63.
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 Department of Social Services, Donated
Foods Unit, 1575 Sherman Street, 3rd Floor, Denver, Colorado 80203-
1700, by the 15th of the month following the close of the quarter.
(Reference 13.410.401) . 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.
23
930977
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.
13. 301.1030 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;
24
Q 1110v901,
(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. )
13.301.1040 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 Assistance
Programs Division.
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)
13. 301. 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.
13. 301. 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
25
930977
FNS, Regional Office for their investigation and final determination on
the validity of the complaints.
13. 301.1200 AUDITS
13.301.1210 STATE AGENCY AUDIT
a. Audits of the Department of Social 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.
13 . 301. 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 of Social 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 Auditinz 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 1994 falls.
13.301. 1300 CIVIL RIGHTS
The Colorado Department of Social Services assures the USDA Food and
Nutrition Service that in its administration of the Commodity
26
930977
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 Social 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 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.
4. Responsibility for supplying copies of the poster " . . . and
Justice for All" 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
27 .
930977
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 Social 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.
8 . 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.
28 •
9.309' I
13.301.1400 FAIR HEARINGS
Each Commodity Supplemental Food Program shall have posted in the local
office, a statement regarding the fair hearing process as established by
the Colorado Department of Social Services. The following fair hearing
procedures shall apply to all individual CSFP applicants or recipients:
a. Each potential CSFP recipient shall be informed in writing 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 submitted by an individual or
his/her parent or guardian in written form 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. The request must be signed by the individual
or his/her parent or guardian. No particular written form shall
be required. It is sufficient if the written request identifies
the individual and the decision from 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
29 •
930977
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 orll 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 forty-45
days from the date of the hearing record.
1. 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
presented 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 close 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 III.D (2) shall
• 30
930977
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.
31
930977
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 - SB 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
•
32
930977
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13.910.102
OF•5 1AEv 'dUI 1.0. NO.
IDENTIFICATION CARD-SUPPLEMENTAL FOOD
AUTHORIZING AGENCY
RECIPIENT•3 NAME RCGIPIENT•S 31G.
PROk v PROII Y•S SIG.
S+GNATURE OF CERTIFIEO AIjTHORITY
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
—34-
930977
13.910.103
•
DF-56(REV.6/90) No.
COMMODITY SUPPLEMENTAL FOOD PROGRAM
Verification of Certification
Name 008
(Pr.ep.Y.Petal.or Ca m.rt
Signature
Maroon's..Putt as Cuu..rt
Names o1 Eligible Participants: 008:
CERTIFICATION RECORD
Certification Date: Begin End
Local Agency Name:
L/A Address:
State: Phone
Local Agency Official:
Signature:
Print Name:
-35- 930977
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.
-36-
930977
DF-14 (08/93)
Page two
To schedule a conference or fair hearing, fill out this form and mail it to:
DIVISION OF ADMINISTRATIVE HEARINGS
1120 LINCOLN, SUITE 900
DENVER, CO 80203
Name of person requesting hearing:
Address: Telephone number where you can
be reached:
Your signature: Today's date:
Use this space to explain why you want a fair hearing:
I want to receive the amount of food I now receive until the hearing.
I do not want to continue receiving the amount of food I now receive until the
hearing.
-36a- 930977
13.910.105
IDENTIFICATION CARD-SUPPLEMENTAL FOOD
OF.$Q(REV.MIDI
DENVER DEPARTMENT OF SOCIAL SERVICES
AUTHORIZING AGENCY
RECIPIENPS NAME RECIPIENYS SIG.
PROXY PROEMS SIG.
SIGNATURE OF CERTIFIED AUTHORITY
7274541 7274719
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 MONTH YEAR
You may aDPeal any decision made by the local agency
regarding your denial or termination from the program
2650 WEST 3RD AVE, (3RD & BRYANT)
PLEASE DO NOT DESTROY THIS CARD
-37-
9a3C9577
13.910.106
IDENTIFICATION CARD-SUPPLEMENTAL FOOD
OF-SG(REV 791)
1.O.NO.
WELD COUNTY SUPPLEMENTAL FOODS
AUTHORIZING AGENCY
RECIPIENTS NAME RECIPIENTS SIG.
PROXY • PROXYS SIG.
SIGNATURE OF CERTIFIED AUTHORITY
GREELEY(Mon,Wed,Thor,Frt) 356-0636 857-2725
FT.LUPTON(rues) (Greeley) (FL Lupton)
THIS PROGRAM IS AVAILABLE TO ALL ELIGIBLE 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 mayappeal any decision made by the local agency
regarding your denial or termination from the program_
104 11TH AVE..GREELEY
330 PARK AVE.. FT. LUPTON
PLEASE DO NOT DESTROY THIS CARD
-38- 930977
13.910.200 CSFP DISTRIBUTION FORMS
13.910.201 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 .910.204 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
39 930977
£LLGOCG
13.910.201
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13.910.202
MONTHLY REPORT OF THE COMMODITY SUPPLEMENTAL F000 PROGRAM AND QUARTERLY ADMINISTRATIVE FINANCIAL
STATUS REPORT
1.Reportl3. Type of 1 x a x4. NUMBER OFxPARTICIPANTS:xx:aa:x as 5. RPT MEAS'MENTS
Month/Yrl Submission I
IA.-Initial IInfantslInfants 'Children IPrg/BrelPost PITotal U Part 'Total No Of ICASESI UNITS
IB.-Last Rev 10-3 Mon'(4-12) Mon' (1.6) Yr 'Feed WolWomen 14/4+84-C+D+E+F 'Elderly Part I (A)l (8)
2. StatelC.-Closeout I (A) 1 (B) I (C) 1 (D) 1 (E) I (F) I (G) 1 I
Agency Ilast Inven- I I I I I I I I I
Name 'tort' I 0 1 0 1 0 1 0 1 0 1 0 I 0 1( )I ( K )
Co Dept I
Of SocSvl STATE AND LOCAL DATA
6. 16a. 68. 7. 8. 9. 10. Ill. 112. 113. 14. 15.
I STATE & TOTAL 1COMM ISSUANCE I COMMODITY ACTIVITY I TOTAL ADJUSTMENT STATE &
COMM'TY ICODE PACK LOCAL RECEIPT TRANS INV'ORYI IACT'VTY LOCAL
NAME I SIZE BEGIN'G FERS AVAIL 'Total Issue TolTotal NI I IFoodI(12a+b+ Posi- Nega- ENDING
I INV'ORY IN (7+8+9)I 'Issued ITrnsfIFood 'Demo' c+d) tive tive INV
I I WIC IEldly I(11A+8)IOut Loss Istral ((10-13
II I I I 'tion' )+/- 14
II (A) I (B) 1 (A) I (B) I (C) I (0)1 (A) (B) a & b)
MILK EV 18081148/12 1 0 1 0 I 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 I 0 I 0
I- I I I I I I I I I I I----I I I I
MILK NF01809016/4 I 0 I 0 1 0 I 0 I 0 0 I 0 1 0 I 0 I 0 0 I 0 0 0
I. I I I I I I I I I I I----I I I I
FRM LID D165124/13 I 0 0 1 0 I 0 ' 0 1 0 1 0 l 0 0 0 0 0 0 I 0
I----I I I I I I I I I I I----I I I
FormPawd18167112/1 I 0 0 0 0 0 I 0 0 I 0 I 0 I 0 0 I 0 0 1 0
I. I I I I I I I I I I I----I I I
FormPoudIB168I6/1 I 0 1 0 1 0 I 0 0 I 0 0 0 I 0 1 0 l 0 1 0 1 0 0
I. I I I I I I I I----I I I I
Pot Deh IA180 1 1 2/16 I 0 I 0 1 0 I 0 I 0 0 1 0 1 0 I 0 I 0 0 I 0 I 0 0
I I I I I I I I I I I I.---I I I I
FARINA 18160124/14 I 0 0 I 0 1 0 I 0 I 0 1 0 I 0 I 0 I 0 0 I 0 I 0 I 0
I. -I I I I I I I I I I I-- -I I I I
Cer CornIB154112/17.51 0 I 0 I 0 I 0 I 0 0 1 0 I 0 1 0 1 0 1 0 1 0 1 0 I 0
I- -I I I I I I I I I I I----I I I
Cer RiceIB153112/17.51 0 I 0 1 0 1 0 1 0 I 0 I 0 1 0 I 0 0 0 ' 0 I 0 I 0
I- I I I I I I I I I I I----I I I I
CerWheatIB152I12/16 I 0 I 0 I 0 I 0 1 0 I 0 I 0 I 0 I 0 0 0 1 0 0 0
I- I I I I I I I I I I I----I I I I
CerlRicel8161112/8 I 0 0 1 0 1 0 I 0 0 1 0 1 0 I o I 0 I 0 0 I 0 I 0
I. I I I I I I I I I I I-
MACARONI18410124/1 I 0 l 0 1 0 0 I 0 I 0 0 0 1 0 0 I 0 I 0 I 0 I 0
I- I I I I I I I I I --- I I I
RICE 18510124/2 0 1 0 I 0 0 0 0 0 I 0 1 0 0 I 0 I 0 0 0
I I I I I I I I I I I I----I I
I I I 01 01 01 01 01 0l 01 01 0 ' 01 01 01 0l 0
I- I I I I I I I I I I I----I I I
EGG MIX 18570148/6 I 0 I 0 0 I 0 0 I 0 0 I 0 0 1 0 0 1 0 0 I 0
I1 I I I I I I I I I I I.---I 1 I I
I I I 01 0I 01 0 0 0 0 ' 01 0101 01 01 01 0
I----I I I I I I i I I----I I I
PS CRMY 18470'24/2 0 I 0 0 0 I 0 I 0 I 0 i 0 I 0 1 0 I 0 I 0 I 0 0
1""""I i I I I
Pinto 881,1914112/2 I 0 1 0 I 0 0 1 0 1 0 1 0 I 0 I 0 I I 0 1 0 I 0 I 0
me
FORM 153 - Page 1 of 4
41
9:1119'7'7
13.910.202
MONTHLY REPORT OF COMMODITY SUPPLEMENTAL I REPORTING MONTH 8 YEAR I STATE AGENCY NAME 'REPORTING MEASUREMENT
FOOD PROGRAM STATE & LOCAL INVENTORY I 'Co Dept Of Social Svcs I CASES ( ) UNITS ( X )
sass- aaaaasssaaasasssaaaaaaaasassaaasaaaaaaaasaasaaaaaaasavaasssaaasssss a
STATE AND LOCAL DATA
6. 6a. 68. 7. 8. 9. 10. I11. '12. 113. 14. 115.
STATE 8 TOTAL 'COMM ISSUANCE 1 COMMODITY ACTIVITY 1 TOTAL ADJUSTMENT 'STATE &
COMM'TY CODE PACK LOCAL RECEIPT TRANS INV'ORYI IACT'VTY 1 LOCAL ,
NAME SIZE BEGIN'G FERS AVAIL 'Total Issue TolTotal #1 I IFoodl(12a+b+ Posi• Naga- 'ENDING
INV'ORY IN (7+8+9)1 'Issued ITrnsflFood 'Deno' c+d) tive tive 'INV
WIC (EldlY ((11A+8)(Out (Loss Istral 1((10.13
I I I ( ( Iron' 1)+/- 14
' (A) I (B) I (A) I (B) I (C) I (D)I (A) (B) a 8 b)
BEEF 5TW1AS87124/15 I 0 I 0 I 0 1 0 I 0 I 0 I 0 1 0 1 0 I 0 1 0 I 0 I 0 0
I----I I I I I I I I I
BEEF ST4'AS86'24/24 I 0 1 0 1 0 I 0 I 0 1 0 I 0 I 0 I 0 0 I 0 0 1 0 I 0
BEEF 'A610'24/29 1 0 1 0 I 0 1 0 I 0 1 0 0 I 0 I 0 1 0 I 0 1 0 0 1 0
I-- I I I I I I I I I I I I I
CHICKEN IA562124/29 I 0 I 0 I 0 1 0 1 0 1 0 I a 1 0 I 0 0 1 0 I 0 ' 0 0
I I I I I I I I I I
PORK IA630'24/29 1 0 1 0 I 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0
I----1 I I I I I I I I I I I I
POULTRY IA560I24/29 I 0 I 0 I 0 1 0 I 0 I 0 0 I 0 1 0 I 0 1 0 I 0 I 0 0
1-- I I I I I I I I I I I I I
TUNA 1A701124/12.5 0 1 0 1 0 1 0 I 0 I 0 I 0 1 0 1 0 I 0 0 ' 0 i 0 0
I- I I I I I I I I I I I----I I I
I I I 0I 01 0I 01 01 01 01 01 0101 01 01 0 ' 0
I I I I I I
I I 01 01 01 DI 0I 0I 01 01 0101 01 01 01 0
I --I I I--
I I I 01 01 01 0I 01 0I 01 01 0101 01 01 01 0
I --I I I I I I I I
CARROTS (A095124/303 I 0 0 1 0 I 0 I 0 1 0 1 0 0 1 0 I 0 1 0 0 0 ' 0
I I I I I I I I I I I I----I I I I
CORN CRMIA120I24/303 0 0 0 ' 0 1 0 0 I 0 0 1 0 I 0 I 0 ' 0 1 0 I 0
I 1 I I I I I I I I I I....I I I
CORN WHK IA121124/303 I 0 I 0 I 0 I 0 I 0 I 0 I 0 1 0 I 0 1 0 I 0 I 0 I 0 I 0
I. --I I I I I I I I I----I I I
GREEN B IA060124/303 1 0 1 • 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0
l' "'I I I I I I I I I I I...•.I I I I
PEAS IA150I24/303 ' 0 1 0 1 0 0 I 0 0 I 0 I 0 0 I 0 0 0 0 1 0
I -I I I I I I I I I ----I I
20T .H0 IA169'24/303 I 0 1 0 ' 0 I 0 1 0 I 0 I 0 I 0 1 0 I 0 1 0 I 0 1 0 1 0
=;T ;.T I4221f24/303 ' 0 ' 0 ' 0 ' 0 ' 0 1 0 1 0 1 0 1 0 l 0 1 0 1 0 1 0 1 0
I . I
PUMPKIN 1A163124/303 I 0 0 I 0 1 0 0 1 0 0 0 0 1 0 I 0 0 1 0 I 0
2
rORM 153 Page 2 of 4
•
41a 930977
13.910.202
MONTHLY REPORT OF COMMODITY SUPPLEMENTAL I REPORTING MONTH 8 YEAR 1 STATE AGENCY NAME ' 'REPORTING MEASUREMENT
FOOD PROGRAM STATE 8 LOCAL INVENTORY I ICo Dept Of Social Scvs I CASES ( ) UNITS ( X )
STATE AND LOCAL DATA
6. 6a. 6B. 7. 8. N. 10. 111. 112. 113. 14. 115.
STATE 8 I TOTAL 'COMM ISSUANCE 1 COMMODITY ACTIVITY I TOTAL ADJUSTMENT 'STATE 8
COMM'TY CODE PACK LOCAL RECEIPTITRANS INV'ORYI IACT'VTY I LOCAL
NAME SIZE BEGIN'G IFERS AVAIL 'Total Issue To1Total #1 I IFoodl(12a+b+ Posi- Nega• 'ENDING
INV'ORY I IN (7+8+9)1 Ilssued 1TrnsflFood 'Demo' c+d) tive tive 'INV
' I WIC IEIdty I(11A+8)IOut Loss Istral (((10-13
I I I I I ItionI l)+/- 14
(A) I (B) I (A) I (B) I (C) I (0)1 (A) (B) a & b)
SPINACH IA166I24/303 1 0 1 0 I 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0
I-- I I I I I I I I I I I I I I I
TOMATOESIA248I24/303 10 0 I 0 I 0 ' 0 I 0 I 0 I 0 ' 0 I 0 ' 0 I 0 I 0 l 0
I-- I I I I I I I I I I I I I i
I I I DI DI DI DI DI DI DI DI DI DI DI DI GI D
I----I I I I I I I I I I I----I I I I
I I I DI 01 DI DI DI OI DI DI DID ' 0I DI DI D
I----I I I I I I I I I I I----I
APPLESAUTA355I24/303 ' 0 I 0 I 0 ' 0 I 0 I 0 I 0 I 0 ' 0 1 0 0 ' 0 I 0 I 0
I----I I I I I I I I I I I----I I I I
APRICOTSIA362I24/303 I 0 0 0 I 0 1 0 I 0 I 0 0 0 I 0 I 0 I 0 0 I 0
1----I I I I I I I I I I I----I I I I
FRUIT CKIA401124/303 I 0 I 0 I 0 I 0 ' 0 0 I 0 I 0 I 0 I 0 I 0 1 0 0 I 0
I----I I I I I I I I I I I-.--I I I I
PEACH CLIA422I24/303 1 0 0 I 0 1 0 1 0 I 0 ' 0 1 0 1 0 1 0 1 0 I 0 1 0 1 0
I.-.-1 I I I I I I I I I I----I I I I
PEARS IA439124/303 I 0 I 0 I 0 I 0 I 0 I 0 0 I 0 I 0 I 0 1 0 I 0 I 0 I 0
I----I I I I I I I I I I I----I I I I
PINAPPLEIA446I24/2 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0
1----I I I I I I I I I I I----I I I I
PLUMS IA461'24/303 1 0 1 0 1 0 1 0 1 0 ' 0 I 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0
1----1 I I I I I I I I I I----I I I I
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I "'I I I I I I I I I I I----I I I I
I I I DI 0I 0I 0I 0I 0I 0I 0I 0101 0I 0I 0I 0
1----I I I I I I I I I I I----I I I I
APPLE J IA260I12/46 I 0 I 0 0 0 l 0 I 0 I 0 I 0 1 0 I 0 1 0 I 0 I 0 I 0
I ---I I - ----I I I I
GRAPEFRJIA280112/46 I 0 0 I 0 0 0 0 0 0 0 0 0 I 0 0 0
I- — I I I I I I I I I I---I I I I
GRAPE J IA270 11 2/46 I 0 1 0 I 0 0 I 0 0 0 0 1 0 0 I 0 I 0 I 0 I 0
i -I I i I I I I I I I I----I I I I
ORANGE J1A300112/46 I 0 I 0 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 1 0 0 I 0
I---- I I I I I I I I I----I I I I
PIN'PLEJIA447I12/46 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0
FORM 153 Page 3 of 4
41b
930977
13.910.202
MONTHLY REPORT OF COMMODITY SUPPLEMENTAL I REPORTING MONTH 8 YEAR I STATE AGENCY NAME (REPORTING MEASUREMENT
FOOD PROGRAM STATE & LOCAL INVENTORY I ICO DEPT OF SOCIAL SVCS I CASES ( ) UNITS ( X )
STATE AND LOCAL DATA
6. 6a. I68. I . 8. I9. 10. '11. I12. 113. 14. 115.
I 'STATE & I TOTAL ICOMM ISSUANCE I COMMODITY ACTIVITY I TOTAL ADJUSTMENT (STATE &
COMM'TY CODE( PACK I LOCAL RECEIPTITRANS INV'ORYI IACT'VTY I LOCAL
NAME I SIZE IBEGIN'G I FERS AVAIL (Total Issue TolTotal MI I IFoodl(12a+b+ Posi- Mega- 'ENDING
IINV'ORY ( IN (7+8+9)I jlasued ITrnsflFood IDemol e+d) tive tive IINV
I I I I WIC IEldly l(11A+8)lout Loss Istral 1((10.13
I I Itionl l)+/- 14
(A) I (e) I (A) I (e) I (C) 1 (0)1 (A) (B) a & b)
0 0I 01 0I 0I 0I 0I 0I 0101 DI ai 01 0
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BUTTER (8050136/1 I 0 I 0 1 0 I 0 1 0 1 0 1 0 1 0 1 0 1 0 I 0 1 0 1 0 I 0
-•- I I I I I I I I I I I-• I I I I
CHEESE 11806016/5 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 I 0 ( 0 I 0 I 0 I 0 1 0
---I I I I I I I I I I I
CHEESE LI8062115/2 I 0 I 0 I 0 I 0 1 0 0 1 0 1 0 ( 0 1 0 1 0 I O 0 0
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F0PM 153 Page 4 of 4
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ill 'ill I 112qp,a ay 1 1 S •z f'a :j i t 1_ :¢
1•a ls1 1 1'�•� l 2 1111 3 1 I i l l c! • 1 �i
#{r 4
¢3i1 fat, l flail i t lid: i III _ li ` z 1 ili
`la li I ll=1I 1 I !Ill
. l l ! 11 •1 1 ili
lI lia,ii 1 I'•ii L a ; 11 : I i t11 • jt i; iI i- l
lei ;Il: I tii 4 1 a i I' ' , 11 I. i ,I II la : al, •
t111 1711 1 ail-; i i 024 i - 1 It ft ; 11 1$ ii . ill i
H'' 1 3f 1 all1l 1 i l3jr1f I i a al ! ii II it 1 114
g } 1
ph ' ,,�f. viii = 1 l' . a! j li 3 'g l; S
. 3 Fl it I] li 1 ' Lq $ .. 1 r ,1} _� a
i 1p 8 is=1 �Ii! _i 4 1 I . 3
41d
930977
COMMODITY SUPPLEMENTAL FOOD PROGRAM ORDER FORM
AGENCY AGENCY # CUSTOMER #
BILL TO: CITY ZIP
SHIP TO: CITY ZIP
CONTACT PERSON PHONE # DEL
DATE REQUIRED
(ORDER IN CASES ONLY)
QTY ITEM # DESCRIPTION QTY ITEM # DESCRIPTION
A282 APPLE JUICE 12/46 B161 CEREAL RICE INF. 12/8
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 B141B CORNMEAL 5/10
A355 APPLESAUCE CND 24/303 B081 MILK EVAP 48/12
A362 APRICOTS CND 24/303 13090 MILK NFD INSTANT 6/4
A401 FRUIT COCKTAIL 24/303 Ii162 FORMULA SOY DRY 6/14
A412 PEACHES CLG CND 24/303 B165 FORMULA INFANT 24/13
A439 PEARS CND 24/303 B167 FORMULA POWDER 12/1
A431 PEARS HALVES 6/10 B168 FORMULA POWDER 6/1
A446 PINEAPPLE CND 24/2 B169 FORMULA DRY SOY 6/1
A461 PLUMS CND 24/303 1305013 BUTTER 36/1
A480B PRUNES DRY BONUS 24/1 B403B HONEY PROCESS 24/24
13851 CEREAL CORN DRY 14/16 B470 PEANUT BUTTER 24/2
13852 CEREAL CORN DRY12/17.5 B060B CHEESE PROCESS 6/5
B860 CEREAL OATS DRY 24/15 B061B CHEESE PROCESS 12/2
13861 CEREAL OATS DRY 12/16 13062 CHEESE PROCESS LF 15/2
13866 CEREAL RICE DRY 12/13 B062B CHEESE PROCESS 15/2
13867 CEREAL RICE DRY12/17.5 B510 RICE MILLED 24/2
42
930977
13.910.204
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.
43
930977
13.910.205
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.
44 930977
13.910.206
FNS INSTRUCTION 835-1
REV. 1
EXHIBIT A-1
MAXIMUM MONTHLY DISTRIBUTION RATES
I nfants
Package Packages Total Maximum
Sire Per Month Amount/Month
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 Month
Inf nt Formula:
Concentrated Liquid 13-oz can 31 cans 403 ozs
or or
Powdered 1-lb can 8 cans 8 lbs
Cereal . Infant Rice 8-oz okg 4 okgs 32 ozs
Juice' 46-oz can 2 cans 92 ozs
1 Tomato Juice should not be Issued to infants.
45
930977
13.910.206 '
FNS INSTRUCTION 835-1
REV. 1
EXHIBIT A-2
MAXIMUM MONTHLY DISTRIBUTION RATES
Children (1 to 6 Years)
Package Packages Total Maximum
Size Per Month Amount/Month
Cereal , Dry Ready-to-Eatl 18-oz pkg 2 pkgs 36 ozs
or or
Fa rinal 14-oz pkg 2 okgs 28 ozs
Fag Mix. Dry 6-oz nkg 2 nkgc 12 ozs
Juice 46-oz ran 5 cans 230 ozs
Meat/Poultry 29-oz can 1 can 29 ozs
or
or
Meatball Stew 24-oz ran 1 ran 24 ozs
Milk: 396 ozs
Evaporated2 12-oz can 33 cans
Or or
Evaporated3 12-oz can 5 cans 60 ozs
Ev
and and
Instant Nonfat Dry3 25.6-oz pkg 2 pkgs 51 .2 ozs
or
4-lb pkg I pkg 4 lbs
Peanut Butter 2-lb Jar/can 1 pkg every 1 lb
or other month4
4
Peas/Beans. Dry 2-lb pkg 1 lb
Potatoes, Dehydrated 1-lb pkg 1 pkg 1 lb
or
or 2 lbs
Rice 2-lb okg i pkg
Vegetables 15/16-oz can
and/or 20-oz can 4 cans 60-116 ozs
Fruit5 27/29—oz can
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.
3 Children 3 years through 5 years of age may receive a combination of: 5 12-oz
cans of evaporated milk and 2 25.6 oz packages of instant nonfat dry milk; or 5
12-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.
45a
9313977
13.910.206
FNS INSTRUCTION 835-1
REV. 1
EXHIBIT A-3
MAXIMUM MONTHLY DISTRIBUTION RATES
Pregnant/Breast-Feeding Women
Package Packages Total Maximum
Size Per Month Amount/Month
Cereal, Dry Ready-to-Eat 1 18-oz pkg 2 pkgs 36 ozs
or or
Farina 1 14-oz nky 2 okgs 28 ozs
Fag Mix. Dry 6-oz pkg 2 pkgs 12 ozs
Juice 46-oz can 5 cans 230 ozs
Meat/Poultry 29-oz can 1 can 29 ozs
or or
Meatball Stew 24-oz can 1 can 24 ozs
Milk:
Evaporated 12—oz can 11 cans 132 ozs
and and
Instant Nonfat Dry 25.6—oz pkg 2 pkgs 51.2 ozs
or
4—lb nkg 1 pkg 4 lbs
Peanut Butter 2—lb Jar/can 1 pkg every 1 lb
or other ptonth 2
Peas/Beans. Dry 2-lb Dkg 'F 1 lb
Potatoes, Dehydrated 1-lb pkg 1 pkg 1 lb
or or
Rice 2-lb Dkfl 1 pkg 2 lbs
Vegetables 3 15/16-oz can
and/o 20-oz can 8 cans 120-232 ozs
Fruit" 27/29-oz can
•
1 Additional package sizesmay 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.
45b 930977
13.910.206
FNS INSTRUCTION 835-1
REV. 1
EXHIBIT A-4
MAXIMUM MONTHLY DISTRIBUTION RATES
•
Monbreast-Feedinn/Poctpartum Women and Elderly
Package Packages Total Maximum
Size Per Month AmountLNonth
Cereal, Dry Ready-to-Eat' 18-oz pkg 2 pkgs 36 ozs
or or
Farina' 14-oz oka 2 akas 28 ozs
Fgg Mix. Dry 6—oz nkg 2 okgs 12 ozs
Juice 46-oz okg 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 25.6-oz pkg 2 pkgs 51 .2 ozs
or
4-lb okg 1 okg 4 lbs
Peanut Butter 2-lb Jar/can 1 pkg every 1 lb
or other month
Peas/Beans. Dry 2-lb pkg n2 1 lb
Potatoes, Dehydrated 1-lb pkg 1 pkg 1 lb
or or
' Rlce 2-lb okg 1 okg 2 lbs
Vegetables3 15/16-oz can )
and/or 20-oz can 4 cans 60-116 ozs
Frult3 27/29-oz can
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.
45c . 93( -07
13.910.300 CSFP AGREEMENT FORMS
13.910.301 CSFP STATE/LOCAL AGENCY AGREEMENT COVERING CERTIFICATION FOR AND
DISTRIBUTION OF FOOD COMMODITIES
13.910.302 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)
13.910. 304 STATE AND LOCAL DEPARTMENT/AGENCY INDIRECT COST NEGOTIATION AGREEMENT.
46
930977
DF-2B (Rev. 08/93
COLORADO DEPARTMENT OF SOCIAL 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 Social 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 Donated Foods
Program 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
930977
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
Donated Foods 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 Donated Foods Program, 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 Donated Foods 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
930977
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 reserves the right to redistribute any USDA donated foods in possession of
the Recipient Agency.
3
930977
d:r
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 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.
I. 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
930977
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.
sea:
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, religion 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
5
930977
Department of Social 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,
1994. 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
This Agreement is binding upon the present and future elected or employed officials of
the Recipient Agency and the State of Colorado.
6
930977
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 SOCIAL SERVICES
PHONE #: DATE APPROVED
SIGNATURE AND TITLE OF AGENCY HEAD
OR AUTHORIZED REPRESENTATIVE:
KAREN BEYE
EXECUTIVE DIRECTOR
7
930977
13.910.302
COMMODITY SUPPLEMENTAL FOOD PROGRAM •
(CSFP)
APPLICATION FOR LOCAL AGENCIES
1. APPLICANT INFORMATION
Agency Name:
Address:
Street or PO Box City/Town Zip
Telephone:
Area Code Numbs}
Geographic Area Sewed:
Official Responsible for Program at Local Level:
Name Title
FOR PRIVATE NONPROFIT ORGANIZATIONS ONLY
IRS Tax-Exempt Certificate I
If no number,is 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 Services _ Perinatal
_ Home Health Services _ Child Health
Nutrition Education or Counseling _ EPSDT
Social Services Family Planning
Prenatal Education Immunization
Parenting Education _ WIC
Other(Specify) Other(Specify)
1 of 5 pages
•
48 930977
19.910.302 •
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 Women
- Breaatfeeding Women _ Infants Under 1 Yr.
Children 1.6 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 ens,what is the caseload?
What is this agency's anticipated caseload for CSFP?
D. Medical Records
If medical records are kept,which kinds of data are available on the groups below?
WOMEN INFANTS CHILDREN
Height
Weight
Hemoglobin
Hematocrit .
Dietary Information
Health History
•
E. Eligibility
What income guidelines are used to determine eligibility for health services?
Are clients required to live in a certain area in order to receive services?
F'. Will you be affiliated with another agency providing some of the health services? Yes No
IC yes,explain and list the name(s)and address(m)of the private physicians and/or agencies participating. Indicate
those with which your agency has a written agreement.
2
930977
13.910.302
CSFP PROGRAM
APPLICATION FOR LOCAL AGENCIES
3. NUTRITION SERVICES
The following services are to be provided as part of the WIC Program:
A. Nutrition f3creening
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 next 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 reports in a timely manner to the Colorado
Department of Social Services,Food Assistance Programs Division, Donated F«,a, Unit.
6. 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. ADDTTTONAL 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 THE 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
930977
•
13.910302
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 noncompliance with Title VI?
Yes _ No If yes,please explain.
B. Haw you ar do you deny access of any program to any person on the basis of age, sex,handicap, race, color,or
national origin?
Yes _No If yes,please explain.
C. Do you have a significant portion of the non-English speaking persons in your community?
Yes _No
If yea,do you have arias to bilingual staff If no,do you plan to bring some one on staff to perform this function?
D. Are there any discrimination complaint,pending against your agency?
Yes _No If yes,please explain.
Title VI of the Civil Rights ct provides that no person in the United States shell, on the ground of race, sex, age, color,
handicap,or national origin be excluded from participation in,be denied the benefits of,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 race,sex,color,age,handicap,or national origin in the provision of services in all programs funded. To ensure
that action will be taken to comply with Title VI requirements,the WIC Program adopts the following policies:
1. The CSFP Program will inform all sub-contractors of their responsibilities under Title VI of the Civil Rights Act.
This information can be found in the CSFP Program ManuaL
2. The CS?? Program will distribute a copy of this policy to each staff person to inform all staff of the Agencys
obligations under Title VI.
3. The CSFP Program will make no referrals to agencies that are known to engage in discriminatory practices.
4. The CSFP Program will ensure that,to the extent feasible,the public notices it publishes announcing or explaining
services furnished with USDA funds contain the words in providing thew services,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 minimum:
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 furnishing all new
and existing staff 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 shall be sent to the Colorado Department
of Social Services,Food Assistance Division, Donated Foods Unit immediately.
4
930977
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 for a CSFP Program Grant is true and accurate to the beat 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 must be completed which includes:
A. Staffing pattern to ensure provision of nutrition and health services for certification and nutrition education.
B. Administrative and clinical costs.
C. Potential caseload and plans for expansion.
5
•
9309'7"!
13.910.303
•
LETTER OF AGREEMENT
between
THE COLORADO SPECIAL SUPPLEMENTAL THE COLORADO COMMODITY SUPPLEMENTAL
FOOD 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)
erector, Date//— Director a �A
Nutrition/WIC Section Food Assistance Prog
49 930977
STATE OF COLORADO
DEPARTMENT OF SOCIAL SERVICES SCHEDULE A
Indirect Rate Proposal
For the Period July 1, 1993 to June 30, 1994
Computation of Indirect Cost Rate
F000 ASSISTANCE
Division Title, Less Exclusions DIRECT
Program Title, Total 1992 8 Costs not Indirect Salaries and Other
or Category Expenditures Allowed Costs Fringes Expenditures
EXPENDITURES 261,516,823 243,285,532 2,407,370 11,894,436 3,929,485
ROLL-FORWARD (645,802) (645,802)
TOTALS 260,871,021 243,285,532 1,761,568 11,894,436 3,929,485
INDIRECT EXPENSE 1,761,568
14.81%
DIRECT SALARIES 8 FRINGES 11,894,436
50 930977
13.910.400 CSFP ADMINISTRATION INFORMATION - FORMS
13.910.401 CSFP ADMINISTRATION REVIEW FORM
13 .910.402 CSFP STATEMENT OF EXPENDITURE - LOCAL AGENCY
13.910.403 COLORADO DEPARTMENT OF SOCIAL SERVICES - ORGANIZATIONAL CHART
13.910.404 CSFP STATE AND LOCAL AGENCY EXPENDITURE PLAN
13.910.405 SUMMARY OF NUTRITION EDUCATION PLANS
13 .910.406 LISTING OF CSFP LOCAL AGENCY EQUIPMENT
13.910.407 APPROVAL AUTHORITY
51
930977
COMMODITY
SUPPLEMENTAL
FOOD
PROGRAM
LOCAL
AGENCY
REVIEW
FORM
52
930977
1 of 8 pages
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 the 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
agency/ies 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:
52a 930977
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?
52b
930977
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, such 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?
52c
930977
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?
52d
930977
5
CSFP REVIEW FORM (4/91)
LOCAL AGENCY CIVIL RIGHTS POLICIES AND PROCEDURES (Continued)
6. Has the local agency submitted the annual FNS-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 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 concept.
8. Did the clients sign for foods received at the lime of issuance?
9. Are all foods in the warehouse stacked on pallets and away from the walls?
52e
93097'7
6
CSFP REVIEW FORM (4/91)
LOCAL AGENCY DISTRIBUTION AND WAREHOUSE PROCEDURES (Continued)
10. Is there an under or over supply of any 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 close 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?
52f
930977
7
CSFP REVIEW FORM (4/91)
LOCAL AGENCY FINANCIAL PROCEDURES (Continued)
7. Has a list of CSFP owned capital equipment been submitted to the state agency in a
timely manner, by July 1 of each year?
State Agency Recommendations:
FINAL STATE AGENCY RECOMMENDATIONS:
•
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54 930977
13.910.,402
COLORADO STATE DEPARTIE T OF SOCIAL SERVICES
SUPPLEIEN AL FOOD PROGRAM
CCUN Y ' STATEMENT OF E PENDTIURE FOR QUARTER ENDING
OBJECTIVE OF ED?ESm11UMis cutriennar issamce corm= Nuntrria4 FAIR
EDUCATION TOTAL
PEE AL SERVICES
TRAVEL ECPESLSE _
OFFICE SUPPLIES
cAnTAL =TAY
RENT-OFFICES
RENT-STORAGE OF CTlICOITIES
FREZ IMOOn1Gb
A SINO/POBLSCITY -
EOCCATICNAL SUPPLIES ._
REGIsTRnICN FEES/LU11131
CONTRACTUAL SERVICES
(SPECIFY PAYEE)TOTAL
I -
NEMER OF PARTICLPANTS CEZCOFY THAT THE ECPENDITURES REPORTED ITICN ARE AVAILABLE FOR AUDIT AT:HAVE BET: MADE AND TTLAT PAYRnr?S AND GTL�R
(SIRES' ADDRESS) (QTY)
(SIGNATURE) (DATE)
55 930977
13 . 910 . 405
MEMORANDUM
TO: Jan Finney, Unit Chief
Donated Foods Unit
FROM: Joan P. Miller, Nutritio rogram Specialist
Aging and Adult Services
DATE: August 16, 1993
SUBJECT: Nutrition Education Plans for the Commodity Supplemental
Food Program (CSFP) Federal Fiscal Year 1994 (FFY94)
CSFP Nutrition Education plans for FFY94 are approved as received
from the following counties :
Denver
Mesa
Weld
The following counties ' Nutrition Education plans are approved with
the understanding that some changes are to be made, and the revised
versions are to be submitted to this office within 60 days :
Family Enrichment
Tri County Seniors , Inc .
Rio Grande County
Costilla County
Conejos County
•
56
930977
01/09/91 22:15 7192744209 CONEJOS COUNT' NURSING Q FADE 01
r t
' `VS. V V vWTr
Y '
C l - P.O. Box 7B • 1.4 Jara, CO 8.1140 ' 719,279 4307
\\4
16 k Lou Staffer
i C. ly j Domed Foods
, -'S', L , tepartment of Social Services
%, \ ,, 3rd Floor
r\ i. ,' Denver CO 80203-1714
' Dear Ms. Stoffer,
) SS1
The following is a list of equipment that we currently have on
inventory for the Commodity Supplemental Food Program. This
equipment only has 20% ownership.
I I 1 . Compudyne Computer/Screen:
1 2. Epson LQ -850 Printer:
',,i 3. Minolta Copier EP-4210
; H 4 . Brother Fax Machine Fax-380
I i 5 . Software-Lotus
' 6 . Software-Windows
f `! If you have any questions feel free to call if you have any
questions.
!r'
Ii
eI !
1- '
r Sincer ly,
1 AT ��--�y�
! ,_1 Lod Booth, Administrator
�7 1._.f, 1� ..,1.. (� , . 9309 7
DAVID G. PACHECO (719) 672-3323
Executive Director Fax (719) 672-3317
Conejos - Costilla
COMM UNITY ACTION AGENCY
P.O. BOX 299 - SAN LUIS, COLORADO 81152
CSFP PROPERTY/EQUIPMENT PURCHASES
DESTINY 286 COMPUTER, #6536 6/6/691 $ 1,295.00
1992 FORD § TON TRUCK 1FTDFISYINPA22091 10/21/91 10,752.00
WALK-IN COOLER/FREEZER UNIT #S105MLP-1 5/92 22,400.00
57a
4309'777
JUL-26-195.3 07:47 FROM USS FOOD ASSISTANCE TO 98662704 P.0G
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-n1
1 NCR Pe onal Computer DDSS #87-65825-07
1 NCR Pe onal Computer (DGH) SN #17-17245169
1 NCR lack onal Computer (DGH) SN #17-17241282
1 Honeyw 1 Bull File Server SR-V20 DDSS #89-45601-VPo1
1 Data S r 386-SX DDSS #91-39673-VP01
1 Data S r 386-SX DDSS #91-39673-VP02
1 Data S r 386-SX DDSS #91-39673-VP03
1 Data S r 386-SX DDSS #91-39673-VP04
57b
930977
JUL-2E-199: 07:48 FFC DES FOOD ASSISTANCE TO 'zi6tit.2704
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 Compal 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-VPO1
1 Hewlet Packard Laser Printer DDSS #91-44569-VP02
1 Hewlet Packard Laser Printer DOES #91-44569-VP03
1 Hewlet Packard Laser Printer DDSS #91-44569-V904
. 930977
{
u. •v, rmuri ux, rubll Hbb1bIHoLt TO 'e,bbc704 P.04
Page 3 of 4 pages
Denver CS P Property/Equipment Purchases con't.
Page 3 of 4.
ITEM IDENTIFICATION NUMBER
Keyboards
6 NCR Xe 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 #01752051
Miscellan us
1 Mounta Filesafe Tape NA
1 JL Cha rbox DDSS #88-07430-01
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 DDBS #01-38422-VP
1 Food D onstration Table NA
930977
JUL-26-199 07:49 FROM TIES FOOD ASSISTANCE TO 96662704 F.05
Page 4 of 4 pages
Denver CS Property/Equipment Purchases can't.
Page 4 of .
ITEM IDENTIFICATION NUMBER
Warehouse nventory
1 Hyster alkie-Ryder SN #13135006684B
1 Hyster alkie-Ryder SN #13135006685B
1 Schrec Walkie-Ryder SN /15070
1 Ferroc ger SN /8300919-51-27
1 Ferroc rger SN #4800509290
1 Ferroc rger SN #181CS02792
1 Ferroc rger SN #181CS02793
1 Ferroc rger SN #8403859
1 Powerf w Charger SN #F17503
1 Powerf w Charger SN #15274-1
1 Hyster orklift SN #B108V07775B
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 #2GCEG25H0M4130705
1 Kolpak reezer and Cooler NA
930977
13.910.406
MESA COUNTY COMMODITY SUPPLEMENTAL FOOD PROGRAM
1993 INVENTORY LIST
TAG ft OUANTITY ITEM DESCRIPTION
02716 1 DESK,WOODEN GRN/BRN
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
02678 1 CABINET, METAL BLK FILE 4-DR
2 TABLES, WOODEN (36X28)
•02718 1 TYPEWRITER, ADLER ELECTRIC
06665 1 TYPEWRITER, WHEELWRITER ELEC/su 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
02713 1 CHAIR, SECRETARY
1 SHOP VAC
1 VACUUM CLEANER
1 TABLE, WAREHOUSE GRAY METAL
9 BELTS, SAFETY BLK/GRAY*
1-XXL
1-XLG
1-LG
5-MED
1-SM
1 COPIER, HARRIS 3M W/STAND/SN 918179*
02262 1 PRINTER, EPSON FX-286
06098 1 MONITOR, MAGNAVOX 80
06097 1 COMPUTER, IBM PC XT
57c
930977
NE'A COUNT ' HEALTH DEP ID30324869'2 RUG 17 ' 93 1` 11b No . 002 G2
_ 1 MONITOR, IBM PS2 COLOR
1 COMPUTER, IBM PS2 MOD 30-286
PRINTER, PANASONIC KX-P1624
2 MONITORS , SUPER VGA
2 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`
* THESE ITEMS HAVE BEEN PURCHASED WITHIN THE LAST FISCAL YEAR
930977
Family Enrichment Center
P.O. Box 250 Del Norte, CO 81132 719-657-2806
July 7, 1993
CSFP' PROPERTY/EQUIPMENT PURCHASES
1 - Forklift
1 - Pallet Jack
1 - Dolly- 2 wheel
1 - Cart 4 wheel.
1 - Cooler walk in 8 X 8
1 - Freezer walk in 8„X 6
1 - Freezer chest
2 - 28,6,Computlers
1 - 8088, Computer , ,; t
1 - Star NX 1000 Printer
1 -. Epson EPL 7000 ' Printer
1 2400. Baud,"Modem
Misc. ' software
1 - EP 300' Minolta Copier
1 - Emerson Microwave
2 - Office Chairs
3 - Office Desks,
1 - Credenza..Desk
1 Baby Scale •
1 - Adult`Sdale
3 - File Cabinets
1 - Time Clock Latham
- 1 - 'Copier Table
2 - Telephone
1 - Telephone answering machine
2 - Calculators
1 - Desk Lamp
1 - Vacuum Cleaner
1 - First Aid Kit
3 - Back support braces,
Misc. Office supplies
1 - 1980 Suburban
1 - 16 ' Flat Bed Trailer
57d
9309'7'7
•
TRI-COUNTY SENIOR CITIZENS
COMMODITIES EQUIPMENT
PERPETUAL INVENTORY
ITEM
Program:Quantity:Description, Serial No, Etc. ;Mo. ;Year ;Amount ;Mo. :Year:MANNER OF DISPOSA
, , ,
—
'COMMODi; 1 ;Dolly - Blue/Gray 4 Wheel 50'0k Rating 1 6 ;1990 1$319.00 ; :
, , , I I I
' 1 ;Hand Cart - Red 2 Wheel 600M Rating ; 6 1991 : 166.39 1 1
1 'Tarp - Blue ; 7 ;1991 120.00 ;
1 1WordProcessor - Smith Corona : 6 ;1991 , 561.22 1
1 ;Calculator - Battery.Powered/AC Adaptab; 11 ;1991 1 60.79 :___ ;
3 ;Back. belt - Black 82-IL (2 Med, 1 Large; 5 ;1992 ; 156.00 ; ; 1
,
3 ;Hard HAT-Blue HHB
; 5 ;1992 ' 17.25 ; 1 ;
, , , ,
1 Gibson Upright Rifrigerator ; 8 ;1992 ; 749.00 ; ; 1
1 :Kenmore Chest Type Freezer ; 8 11992 '. 329.00 ; 1
1
' I ;Blue 2 Wheel Dolly P400 lb Cap ; 11 11992 ; 111.13 ;—; ;
, •1 ,
1 ;Gray 4 Wheel Doily 41000 : 11 11992 ; 334.53 , 1—
57e 930977
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57f
'
r 930977
APPROVAL AUTHORITY
The State Plan of Operation and administration for the Commodity Supplemental Food
Program for Federal Fiscal Year 1994 is hereby approved.
Kare Beye G
Executive Director
Colorado State Department
of Social Services
Date of Signature
58
930977
4 MEMORAnDU
WIConstancea L. Harbert, Chairman
To Board of County Cammiccionarc Date 4ap tamhar 90, 1QQ3
U (n Q, Iy/
COLORADO From Walter J. Speckman, Executive Director, Human Resourcesj\tY]t
Subject Contract between the Colorado Department of Social Services
and the Weld County Division of Human Resources
Enclosed for Board approval is the Contract between the Colorado Department of
Social Services and the Weld County Division of Human Resources 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, 1993 through September 30, 1994.
If you have any questions, please telephone me at 353-3800.
930977
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