HomeMy WebLinkAbout951999.tiffRESOLUTION
RE: APPROVE DONATED FOODS AGREEMENT BETWEEN HUMAN SERVICES AND
COLORADO DEPARTMENT OF HUMAN SERVICES AND AUTHORIZE CHAIRMAN TO
SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Donated Foods Agreement for the
Commodity Supplemental Food Program between the County of Weld, State of Colorado, by and
through the Board of County Commissioners of Weld County, on behalf of the Weld County
Division of Human Services, and the Colorado Department of Human Services, commencing
October 1, 1995, and ending September 30, 1996, 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 County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Weld County Division of Human Services, and
the Colorado Department of Human Services be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chairman be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 25th day of September, A.D., 1995.
BOARD OF COUNTY COMMISSIONERS
tiaqty Clerk to the Board
eputy Clerthe Board
COUNTY, COLOR DO
Dale K. Hall, Chairman
arbt J. Kirkmeyer,
W. H. ebster
i/6-; .spar
/George . Baxter
951999
H R0066
DF-2B (Rev. 09/94
COLORADO DEPARTMENT OF HUMAN SERVICES
1575 Sherman Street, 3rd Floor
Denver, CO 80203-1700
Donated Foods Agreement
Commodity Supplemental Food Program
(Serving Low Income Women, Infants, Children and Elderly)
This agreement is made this (Enter today's date) day of 19 by
and between the Colorado Department of Human Services, 1575 Sherman Street, 3rd Floor,
Denver, CO 80203-1700 (hereinafter referred to as the "Department"), and the (Enter your
agency's name) (hereinafter referred to as the "Recipient
Agency").
Whereas, the Department is a distributing agency under a contract with the U.S.
Department of Agriculture (hereinafter referred to as "USDA"). The Contract with USDA
is subject to all federal laws and regulations. USDA controls the amount and types of
commodities available to the Department.
Whereas, the Department has the responsibility for administering the Food
Distribution Programs in Colorado in accordance with its Contract with USDA, and;
Whereas, the Recipient Agency desires to participate in the Donated Foods Program
in accordance with the terms of this Agreement; and
Whereas, as of the date of execution of the Agreement, Recipient Agency meets all
requirements for participation in this program.
NOW, THEREFORE, it is hereby agreed:
1. The Recipient Agency is operating a Commodity Supplemental Food Program which
provides supplemental foods to low income pregnant and postpartum women, infants,
children and elderly; and
Complete the following questions:
The Recipient Agency has the following types of storage facilities available:
Dry Yes x No
Cooler Yes x No
Frozen Yes x No
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2. Recipient Agency shall participate in the Donated Foods Program in accordance with the
terms of the Agreement and applicable legal requirements described below.
3. The term "legal requirements" as it is used throughout this Agreement includes federal
and state statutes, federal and state regulations program requirements as identified in the
Food Distribution Unit Recipient Agency User's Handbook, State Plan of Operation and
Administration attached hereto and incorporated herein as Exhibit A and any amendments
thereto, which are applicable to the Food Distribution Programs, which are in effect when
this Agreement is executed. The Recipient Agency agrees to fully comply with all legal
requirements defined above, and to submit any reports requested by the Department or
USDA in a prompt and complete manner, and to enforce such legal requirements against
any sub -distributing agencies which are under contract with the Recipient Agency.
4. Recipient Agency shall receive, store and distribute donated foods. In addition, the
Recipient Agency agrees to comply with the following terms and conditions:
A. Use of Donated Foods
Donated food will be used only in connection with Recipient Agency's established
feeding operation for the sole benefit of persons served by the Recipient Agency
and will not be sold, exchanged, or otherwise disposed of by the Recipient Agency
without express written approval being obtained by the Recipient Agency from the
Department.
B. Storage Facilities
The Recipient Agency and any sub -distributing agencies under contract with the
Recipient Agency shall provide adequate facilities for the handling, storage and
distribution of donated foods. These facilities shall be such as to properly
safeguard against damage, theft, spoilage, or other loss as recommended in the
"Food Storage Guide for Schools and Institutions" in the Food Distribution Unit
User's Handbook. The Recipient Agency shall provide facilities and services that:
1. Are sanitary and free from rodent, 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 rese, 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.
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 be kept current and available
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for audit and reviewpurpose at the Recipient Agency.
2. Distributor Charges
The Recipient Agency shall pay the quoted price per case directly to the contracted
Tegional 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 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.
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Any person who feels that she/he has been discriminated against has the right to file
a complaint either with the Colorado Department of Human Services or with the
U.S. Department of Agriculture, Office for Civil Rights.
The Recipient Agency is responsible for any additional Civil Rights reporting
requirements as set forth in the State Plan of Operation and Administration.
K. Indemnification
To the extent authorized by law, the Recipient Agency shall indemnify, save and hold
harmless the State, its employees and agents, against any and all claims, damages,
liability and court awards including costs, expenses, and attorney fees incurred as a
result of any act or omission by the Recipient Agency, ur 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 furtherparticipation 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, 1996. The Recipient Agency or the Department may terminate this
Agreement at any time by giving 30 days notice in writing. Upon such termination
by either the Recipient Agency or the Department, the Recipient Agency shall, at its
expense, return all unused donated foods in its possession to such place within the
State of Colorado as may be designated by the Department.
N. Assignment
The Recipient Agency agrees not to assign its rights or to delegate its obligations
under this Agreement without prior approval in writing from the Department.
0. Future Effect
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This Agreement is binding upon the present and future elected or employed officials
of the Recipient Agency and the State of Colorado.
P. Authorized Representative
It shall be the duty of the Recipient Agency to promptly notify, in writing, the
Department of any change in its Agency Head or authorized representative or
change in legal address.
O. 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: 09/25/95
NAME OF RECIPIENT AGENCY:
WELD COUNTY BOARD OF COMMISSIONERS
ADDRESS:
915 10th Street
P.O. Box 758
Greeley, CO 80632
PHONE #: e970) 356-4000
STATE OF COLORADO
DEPARTMENT OF _HUMAN
SERVICES
SIGNATURE AND 1'I'1LE OF AGENCY HEAD
OR AUTHORIZED REPRESENTATIVE:
;,SHall, Chairman
'TNTY BOARD OF COMMISSIONERS EXECUTIVE DIRECTOR
,,t
�,.
r'
7
BARBARA McDONNELL
STATE PLAN OF OPERATION AND ADMINISTRATION
COMMODITY SUPPLEMENTAL FOOD PROGRAM
FEDERAL FISCAL YEAR 1996 (FFY96)
TABLE OF CONTENTS
GOALS AND OBJECTIVES FOR PROGRAM IMPROVEMENTS FY96
13301.100 STATE AGENCY IDENTIFICATION AND AUTHORITY 1
PURPOSE OF THE PROGRAM 1
PURPOSE AND OBJECTIVE OF THE STATE PROGRAM 1
13.301.200 LOCAL AGENCY PARTICIPATION AND APPLICATION 2
LOCAL AGENCY APPLICATION
13.310.300 CERTIFICATION 3
ELIGIBILITY REQUIREMENTS 4
PROCESSING STANDARDS -5
NOTIFICATION REQUIREMENTS 6
VERIFICATION OF CERTIFICATION 6
CERTIFICATION PERIODS........7
APPLICANT'S RIGHTS »7
DUAL PARTICIPATION ..7
DISQUALIFICATION 8
13.301.400 CASELOAD MANAGEMENT ..._......... 8
MAXIMUM CASELOAD ASSIGNMENT 9
IDENTIFICATION OF ELDERLY POPULATION 9
PRIORITY WAITING LIST ..11
13.301.500 OUTREACH „..„ 11
PROGRAM EXPANSION ..»11
PUBLIC NOTIFICATION REQUIREMENTS 11
REFERRALS TO OTHER PROGRAMS 12
13.301.600 NUTRITION EDUCATION ...12
GOALS ....12
-METHODS »»12
STAFFING AND FREQUENCY...13
EVALUATION 14
-FUNDING 14
PARTICIPANT INVOLVEMENT 14
TECHNICAL ASSISTANCE..._._.14
-FOOD DEMONSTRATIONS........15
-REVIEWS ...15
13.301.700 FOOD DELIVERY SYSTEM „„ „ 15
ORDERING ..15
PROCEDURES 16
RECORDS »....17
PROTECTION OF FOODS....... 17
COUNTY FOOD DISTRIBUTION POINTS 17
13.301.800 PROGRAM MONITORING .20
13.301.900 STATE PLANNING »»» 20
13.301.1000 FINANCIAL MANAGEMENT ..20
STATE AGENCY RESPONSIBILITY 20
LOCAL AGENCY RESPONSIBILITY 21
-ADMINISTRATIVE COSTS ..22
PROPERTY MANAGEMENT „ 23
ADMINISTRATIVE EXPENDITURE PLAN 23
13.301.1100 COMPLAINTS ... 23
851999
13.301.1200 AUDITS _. .. »» 23
STATE AGENCY AUDIT .. » .. 23
LOCAL AGENCY AUDITS » .. .. 23
13.301.1300 CIVIL RIGHTS 24
13.301.1400 FAIR HEARINGS ..._ 26
13.910.100 CSFP- CERTIFICATION FORMS SECTION
13.910.101 DF-4 No longer used - accomplished by computer
13.910.102 DF-5 CSFP SUPPLEMENTAL FOOD ID CARD
13.910.103 DF-5B CSFP VERIFICATION OF CERTIFICATION
13.910.104 DF-14 NOTICE OF ADVERSE ACTION/RIGHTS OF APPEAL
13.910.105 DF-5D CSFP SUPPLEMENTAL FOOD ID CARD DENVER COUNTY ONLY
13.910.106 DF-5G CSFP SUPPLEMENTAL FOOD ID CARD WELD COUNT ONLY
13.910.107 DONATED FOODS USED FOR CSFP FOOD DEMONSTRATIONS
13.910.200 CSFP DISTRIBUTION FORMS
13.901.201 FNS -153 MONTHLY INVENTORY/DISTRIBUTION REPORT -5 PAGES
13.901.202 FNS -153 REORTING INSTRUCTIONS
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 MONTHLY DISTRIBUTION RATES - 4 PAGES
13.910.300 CSFP AGREEMENT FORMS
13.910.301 CSFP STATE/LOCAL AGENCY AGREEMENT COVERING CERTIFICATION
FOR AND DISTRIBUTION OF FOOD COMMODITIES - 7 PAGES
13.910.302 CSFP PROGRAM APPLICATION FOR LOCAL AGENCIES
13.910.303 LETTER OF AGREEMENT FOR DETECTION AND PREVENTION
FOR DUAL PARTICIPATION -BETWEEN THE COLORADO
COMMODITY SUPPLEMENTAL FOOD PROGRAM FOR WOMEN,
INFANTS, AND CHILDREN (WIC)
13.910.304 STATE AND LOCAL DEPARTMENT/AGENCY INDIRECT COST
NEGOTIATION AGREEMENT
13.910.400 CSFP ADMINISTRATION INFORMATION FORMS
13.910.401 CSFP ADMINISTRATION REVIEW FORM - 5 PAGES
13.910.402 CSFP LOCAL AGENCY CERTIFICATION FILE REVIEW FORM
13.910.403 CSFP LOCAL AGENCY ACTUAL EXPENDITURES FORM
13.910.404 CSFP STATE AND LOCAL EXPENDITURES FORM
13.910.405 COUNTY QUARTERLY STATEMENT OF EXPENDITURES
13.910.406 COLO. DEPT. OF HUMAN SERVICES ORGANIZATIONAL CHART
SUMMARY OF NUTRITION EDUCATION PLANS
LISTING OF CSFP LOCAL AGENCY EQUIPMENT
APPROVAL AUTHORITY
951999
SUPPLEMENTAL FOOD PROGRAM
ADDRESS & TELEPHONE LIST
SEPTEMBER, 1995
CONEJOS COUNTY
Certification
Lois Booth, Public Health Admnstr
Angela Garcia Mondragon
Conejos County Nursing Service
P.O. Box 78
(UPS:19023 S.Hiway 285)
La Jara, CO 81140
(719)274-4307' `FAX 274-4309
Distribution
Walter Romero, Commodity Clerk
(719)274-5308
Distribution Mon-Thurs 8-4:30
COSTILLA
Certification & Distribution
Vivian Gallegos, Director 672-3332
Costilla County Nursing Service
P.O. Box 99 • FAX 719-672-3856
San Luis, CO 81152
(719)672-3323"Connie(Ans machine)
TAX 1-719-672-0728
DENVER COUNTY
Tony Quintana, Administrator
Denver County Food Assistance Programs
80 So. Santa Fe Drive
Denver, CO 80223 FAX 436-2824
(303)436-2800 -Public Information
436-2805'Tony Quintana,Program Admin
436-2808'Carrie Schroeder, Nutritionist
436-2806'Pam Ladewig, Asst' Admin
436-2810'Marcus Skeens, Warehouse
436-2811*Front Desk Clerk
436-2807 'June Cleveland,Volunteers
Bandy Martinez, Associate Manager
Maria Valdes, Division Director -727-2938
Denver Dept. of Social Services
2200 W. Alameda Ave, Denver,CO 80223
MESA COUNTY
_Larry Chynoweth, Special Projects Coord
Mesa County Health Dept.
515 Patterson Road
Grand Junction, CO 81506
(970)248-6971 "FAX 1-970-248-6972
Kathy-(303)248-6945'Health Nurse
Warehouse & Certification
715 4th Ave. Gr Jcf, CO 81501
Mary Ann Garcia,Coordinator 241-3651
Cherry Sprott, WIC Cert 970-243-8417
Jim Winpigler, Wrhse FAX 970-245-9575
-Rene Archuletta, Elderly Certs'241-0388
RIO GRANDE COUNTY
Certification & Distribution
Changing Needs Food Program
Carol Refior, Administrator
311 Washington Street
Monte Vista, CO 81144
(719)852-5778 FAX 1-719-852-2912
Warehouse*"Dale Trujillo
320 Spruce St.(Shipping address)
Del Norte, CO 81132
1-719-657-2806
WELD COUNTY
Administration
Walt Speckman, Executive Director
Marilyn Carlino, Fiscal Officer
Weld County Dept. of Human Resources
P.O. Box 1805
Greeley, CO 80632
(303)353-3815/3816
FAX 1356-3975
Certification & Distribution
Leona Martens, Director 303-356-2199
Weld County Food Bank
104 11th Avenue
Greeley, CO 80631
Ray Lopez, CSFP Mgr.(303)356-0636
Ft. Lupton on Tues.(303)857-2725
Ft. Collins on Thurs. (303)493-4477
FAX (303)356-2297
GOALS AND OBJECTIVES FOR PROGRAM IMPROVEMENTS FY96
L Assessment of Current Operations
A. Status of automation of FNS -153 Report
1. State Agency provided diskette copies of the Lotus 1-2-3 software for the automation of the 153
-report and held a training session with each Local Agency.
2. Two Locals are still unable to transmit modem to modem. Costilla County moved to a building that
needs additional electrical outlets so more than one modem can be run at a time. This need is being
addressed. Weld County also needs another modem so report can be transmitted even though
distribution is being held and other modems are being used.
3. Rio Grande County now takes direct shipment from Andrews for Costilla County and Conejos
County and delivers to Costilla and Conejos upon their request.
II. Program Expansion
1. In addition to expanding into Larimer County in January, 1994, and adding a tailgate distribution
in New Raymer, Weld County has expanded into Ft. Collins and Loveland.
2. Rio Grande County has expanded into Mineral County and Saquache County. In addition, they
distribute prepacked boxes to seniors in Creed, Colorado every third Wednesday.
IL Goals & Objectives
A. Promote more nutrition education.
1. Provide specific information for nutrition education , such as recipes low in fat, high in calcium.
1. Work with Jane Frobose, nutritionist with CSU Denver Extension, to develop recipes that
stretch commodities, and recipes using commodities that could be made in the microwave.
3. Provide information and hand-outs to promote knowledge about the Food Guide Pyramid and
ensure that participants know what foods should make up their daily diet.
B. Encourage and promote increased participation.
1. Work closely with Local Agencies to expand service areas and maximize opportunities for
increased participation.
C. Design form for Nutrition Education Plan.
11. Divide report into sections with headings asking for components necessary for the plan to be
Approved.
1. Encourage uniformity in Nutrition Education plan, while still allowing for individual input.
'951999
DONATED FOODS PROGRAM - Commodity Supplemental Food Program
13301700 STATE AGENCY IDENTIFICATION AND AUTHORITY
A. Identification
1. Name of Agency: Colorado State Department of$uman
Services (hereinafter called the State Agency)
2. Mailing Address: 1575 Sherman 3rdFloor
Denver, CO 80203-1700
B. Authority
The Commodity Supplemental Food Program, herein known as CSFP, is
administered by this agency on the basis of section 26-1-109, of the Colorado
Revised Statutes (CRS) as amended.
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 monitorState and local
agency performance to assure Program goals are reached. State and local agencies
shall enter into written agreements, copies of which shall be kept on file at all
agencies. The agreement shall provide assurance that the local agencies will
comply with the Federal Regulations (7 CFR Part 247), the State Plan of Operation
and Administration, and requirements of Title VI of the Civil Rights Act of 1964
(FNS - Instruction 113-2).
d. If the local agency cannot comply with any part of the requirements of the above
regulations, they shall enter into agreements with another appropriate
agency/agencies in order to meet the requirements. The written agreement shall:
(1) identify the Program responsibilities; (2) be approved by the State Agency; and
(3) provide for copy to be maintained on file at both the State and local agency.
951999
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.
113.301.200 LOCAL AGENCY -PARTICIPATION AND APPLICATION
The following counties have currently signed agreements with the State Agency to
operate the commodity Supplemental Foodirogram:
Conejos Countylioard of Commissioners
County Courthouse
Conejos, Colorado 81129
Costilla County Board of Commissioners
Costilla County Courthouse
San Luis, Colorado 81152
Manager, Denver Department of Social Services
80 South Santa Fe.
Denver, CO 80223
Mesa County Board of Commissioners
P.O. Box 897
Grand Junction, COlorad0$1501
Administrator, Tri County Senior Citizens and Housing, Inc.
311 Washington
MonteVista, Colorado 81144
Weld County Board of Commissioners
Post Office -Box 758
Greeley, Colorado 80631
2
951399
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 theapplication 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 initiationorexpansion shall be -notified
within 30 days. If there are no administrative funds available for their
program, the State Agency shall notify the approved agency when funds
become available.
d. When the local agency has been approved for CSFP Program in an area
served by the Special Supplemental -Food -Program (WIC), the State
Agency shall maintain documentation justifying the need for two -programs
in -the
same service area.
e. Local agencies requesting program expansion shall follow the above
procedures and be given approved/disapproved-status by the State Agency.
13301.300 CERTIFICATION
Names and locations of the local agencies which will be responsible for She
certification ofpersons is as follows:
a. Conejos County Nursing Agency
Post Office Box -78
La Jara, Colorado 81140
b. Costilla County Nursing Service
Post Office Box 99
San Luis, Colorado 81152
c. Denver Department of Social Services
Food Assistance -Programs
80SouthSanta Fe
Denver, Colorado 80223
d. Warehouse and Certification
715 4th Avenue
Grand Junction, Colorado 81501
e. Rio Grande County
Changing Needs Food Program
520 Spruce Street
Del Norte, CO:1132
(This address is for shipping only)
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Tri County Senior
Citizens Housing, Inc.
311 Washington Street
Monte Vista, CO 81144
f. Weld County Department of Human Resources
Post Dffice Box 1850
1500 2nd Street
Greeley, Color -ado -80632
13.301.310 ELIGDHLITYRREQUIREMENTS
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 lo 6 years), pregnant,
postpartum or breastfeedingwomen, or elderly person 60 years ofage-or
older.
At certification, the local agency shall check the identification of each
participant. For a child -participant, an immunization record, birth
certificate or other records that the local agency personnel consider
adequate identification shall tie acceptable. When issuing supplemental
foods, the distribution agency shall check the identification of the parent,
or caretaker through -the viewing oT 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
NeedylDisabled (AND), Supplemental Security Income MI), or a general
assistance program. A woman, infant, or child -not participating in any
such program will meet income eligibility requirements for CSFP
participation if the income of the -household does not exceed the current
income standard for whichever program for low income persons the local
agency -has established for determining financial eligibility. A prospective
elderly participant's household income must meet the income criteria of
130 percent of the poverty level or below. Certification agency personnel
shall document on the (DF-4) Authorization form (Reference 13.910.101) or
other State Agency approved -form in the space provided, which of the
above criteria was used to determine eligibility and what source was used
to verify the applicant's/caretaker's income, such as viewing paycheck
stubs, (count gross pay), letter from employer, eligibility documents or
telephone verification from an appropriate official of participation in
Federal, State or local -food, health or other program for low income
persons.
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951999
The maximum income guidelines are indicated below and are updated eachJuly 1.
Household Size Women & Children - 185%
1 1,152
2 1,547
3 1,941
4 1,336
5 2,731
6 3,125
7 3,520
8 3,915
For each additional family
member add $395
Elderly - 130%
of _poverty
810
1,087
1,364
1,642
1,919
2,196
2,474
2,751
For each -additional
-family member add
$278
c. The prospective participant must reside in the area served by the local
CSFP Agency to which the request for certification is made. However, no
citizenship or durational residence requirements are to be imposed as a
condition of eligibility.
d. No nutritional risk requirement shall be imposed on the prospective
woman, infant, or child participant as a condition of eligibility, but may be
used for a prospective elderly participant at the discretion of the local
agency with prior approval by the State Agency.
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.
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951999
"This certification form is being made in connection with the receipt of
Federal assistance. Program officials may verify information of this form.
I am aware that deliberate misrepresentation may subject me to
prosecution under applicable State and Federal statutes. I have been
advised of my rights and obligations under the program. I certify that the
information I have provided for my eligibility determination is correct to
the best of my knowledge.
I, the undersigned, certify that I have not applied for or received benefits
from any other Commodity Supplemental Food Program (CSFP) or the
Special Supplemental Food Program (WIC) in the month of application;
nor will I apply for and receive CSFP or WIC benefits in subsequent
_months at the same time asI am receiving benefits under this application if
1 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 Tor 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 oT 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 Certification forms from participants who have been participating
in the CSFP or the Special Supplemental Food Program (WIC) and complete
certification for the Commodity Supplemental Food Program.
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951999
b. The Verification of Certification is valid until the certification periodsspires.and
shall be accepted as proof of eligibility for -Program benefits.
c. The Verification of Certification (DF3B) shall include the following information:
(Reference 13.910.103)
1. -Name of participant.
2. The -date the certification was_performed.
3. The date the eertification 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 to age six and
elderly persons b0 years of age or older shall be _certified at the time of -their
entrance into the program and at intervals not to exceed stx months in length.
However, for those elderly participants who receive monthly Social Security
income and experience difficulty maintaining their eligibility throughout -the year,
certification may be for an additional six months without reviewing the case
record or collecting new eligibility providing there are no women, infants or
children waiting to be served. It is recommended -elderly clients with this
eligibility problem be certified through the end of November, then in December
do certification through the end of May. This should provide continued eligibility
through the income transition -time.
c. Benefits should bexontinued through the end of the last month of eligibility.
13301.360 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 asignificant proportion of the population
served by a local agency is composed of nonEnglish or limited English speaking persons
who -speak the same language, the sentences shall be stated to such persons in a language
they understand:
a. "Standards for participation in the Program are the same for everyone
regardless of race, color, national origin, sex, age, or handicap.
b. You may appeal any decision made by the local agency regarding your written
denial or termination from the program.
c. If your application is approved, the local agency will make -nutrition education
available to you and you are encouraged to participate."
13.301.370 DUAL -PARTICIPATION
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951922
a. As part iof 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,svhich 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 ofthe 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 months if it is established that the
applicant, participant, parent or caretaker, fraudulentlyapplied 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 hearingasdescribed in 13.3011400 to co . t the
disqu 'tication.
c. For purposes i eterminingtiisqualification, the definiti.. of -fraud is:
Anyone knowingly, wi Ily, and -deceitfully
to which theyareaot entitl . y:
the intent of obtaining benefits
1. Making false statem s ora i r in writing.
2. Concealing info p ation.
3. Altering p ;:ram documents for the ose of receiving increased
benef , I r transferring benefits to an unauth > d individual.
4. S -. g or transferring commodities.
Committing dual_participation. (Reference 13.910303)
13.301.400 CASELOAD- MANAGEMENT
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951999
b. Participants may requester fair hearing as described in 13301.1400 to contest
the disqualification.
c. For purposes of determining disqualification, the definition of fraud is:
Anyone knowingly, willfully, and deceitfully -with the intent of obtaining
benefits to which -they are -not entitledby:
1. Making false statements orally or in writing.
2. Concealing information.
3. Altering program documents forthe purpose of receiving increased
benefits or transferring benefits to an unauthorized individual.
4. Committing dual participation. (Reference 13,910303)
13301.400 CASELOAD MANAGEMENT
13301.410 MAXIMUM CASELOAD ASSIGNMENT
The maximum number of participants that may receive benefits at each Project Area are as follows:
MAXIMUM CASELOAD
PROJECT WOMEN, INFANTS, & CHILDREN ELDERLY
Conejos 225 300
Costilla 130 280
Denver 9,301 4,985
Mesa 2,100 700
Rio Grande 300 400
Weld 3 73 1.050
Total 15,429 7,715
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 -mailman' caseload limit is basedionthe
average yeaMo late monthly participation. As long as Inc local agency cumulative _total
participation is not acceded during the fiscal Dear 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 theState Agency biannually andadjustedaccordingly.
IDENTIFICATION OFFLDERLYYOPULATION
Conejos County:
Elderly population - 482 persons from current Old Age Pension rolls. Approximately 386 are eligible
for CSFP. Homebound -elderly are identified through the County'' Home & Community Based
Services (HCBS) program. Currently there are 65 clients being served through HCBS.
Transportation and deliveries are accomplished through proxies or commodity stalL When food
packages are issued, the back of the certification -form is to be signed and dated by the recipient
under the appropriate month and initialled by the person making the delivery.
Mesa County:
The elderly population in Mesa County increased by30% between 1990and 1993, justifying the -need
for an elderly program -which was started inFebruary, 1994. Participants are served Tuesdaythrough
8
13.301.410 MAXIMUM CASELOAD ASSIGNMENT
Themaximumaumber of participants that may receive benefits at each Project Area areas follows:
PROJECT
Conejos
Costilla
_Denver
Mesa
Rio Grande
Weld
Total
MAXIMUM CASELOAD
WOMEN, INFANTS, & CHILDREN ELDERLY
195 330
120 325
8 ,717 5,528
1,900 850
250 -500
2904 1 25
14,086 9,058
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 Torm. 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 Tound out -o -f -compliance. USDA, FNS will impose a claim on the state as the
maximum caseload is exceeded, and this claim will then te 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 theState Agency biannually and adjusted accordingly.
IDENTIFICATION OF ELDERLY POPULATION
Coneios County:
Elderly population - 482 persons from current Old Age Pension rolls. Approximately 386 are eligiblefor
CSFP. Homebound elderly are identified through the County's Home & Community Based Services (HCBS)
program. Currently there are 65 clients being served through HCBS. Transportation and deliveries are
accomplished through proxies or commodity staff. When food packages are issued, the back of the
certification form is to be signed and dated by the recipient under the appropriate month and initialled by the
person making the delivery.
Mesa County:
The elderly population in -Mesa County increased by 50% between 1990 and 1993, justifying the need for an
elderly program which was started in February, 1994. Participants -are served Tuesday through Friday, with
Thursday being set aside -for elderly only. Distribution site is 715 South 4th Avenue in Grand Junction, and
homebound delivery is accomplished by the staff. When food packages are issued, the back of the certification
form is to be signed -and dated by the recipient under the appropriate month and initialled by the person
making the delivery.
Costilla County:
Elderly population— 298 persons fromsurrent 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.
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951299
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 Tor the number of elderly at 125 percent of the poverty level was
14,977. (Provided by Reed Reynolds, State Demographer (303)866-3120. Denver Department of Social
Services has approximately 8,000 persons currently receiving Old Age Pensions. Homebound elderly are
defined as those persons who have no relatives or friends and are unable to pick up their food supplements on
a monthly basis by themselves. They are referred by the Departments of Social Services with all referrals
being followed by telephone and home visits. Training of volunteers will be in the following areas:
1) Ability to explain programs, eligibility requirements,
2) Review of eligibility -and certifications at even numbered periods 247:7(g)(1)(iii) for
homebound elderly.
3) Knowledge of nutritional needs of seniors.
Certification is accomplished in the same manner as currently used for women, infants, -and children at the
current certification site and low income senior high rises through -out the county.
Rio Grande Countv/Tri County Senior Citizens & Housing, Inc:
Out of eight apartment complexes for the elderly, and statistics from the nonprofit housing authority, there
areapproximately 735 eligible recipients for this program. Certification is accomplished at the distribution
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 Tor the elderly population in Weld County is accomplished through
the Area Agencies Older Americans Act programs, Weld County Rural Senior Aide Coordinator program,
and Weld County Long Term Care Coordinator Committee agencies. Certification is accomplished at the
current CSFP site, and agreements are set up with designated home health-care agencies and home delivered
meals programs for referrals and certification procedures. Food distribution occurs at the current Greeley
site on Monday, Wednesday, Thursday and Friday. Every Tuesday food is distributed at 104 11th Avenue, Ft.
Lupton, Colorado. Volunteers and agency representatives are designated to pick up and deliver to certified
homebound. The Weld County Area Agency on Aging (AAA) is integrated with the current Supplemental
Food Program to provide information, outreach, certification, and food distribution. AAA is currently
providing all other available services to the elderly in Weld County.
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951299 •
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 participantsaccording to their category:
Priority 1 - Pregnant, breastfeeding women -and infants through llatonths of age
Priority 2 - Children ages one through three years
Priority 3 - Children ages four through five years
Priority -4 - Postpartum women
Priority -5 - Elderly
b. When vacancies occur, the following action will be taken to determine which individual will become
an active participant:
1. Determine the highest priority _group -for which a name appears (i.e. if priority 1 has no
names listed, go -to priority 2, etc.)
2. Within the priority_group from which names are tolte chosen, -select the individual -who has
been on the list longest (he. 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 infantsliave-reached age one,stc.) (a)
If -they are stillxligible 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 usinglheariginal date -assigned to the priority list.
Lacalagencies 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 (andFNS)to use income and/or
nutritional riskscreening as a subcategory for the priority list.
Applicants shall be notified within 15 calendar days of application (if approved) of their placement on
the priority waiting list'
13.301.300 OUTREACH
13.301.510 PROGRAM EXPANSION
Request for program expansion will be evaluated by theState Agency with consideration given to available
caseload and administrative funds.
13.301.520 PUBLIC NOTIFICATION REQUIREMENTS
Through advertisement in the newspapers, the State Agency will notify the generaLpublic on an annual basis
of a 30 day opportunity to comment on the development of the State -Plan.
Reference Section 13.301.1300 which incorporates outreach and public notification requirements as required
by Civil -Rights FNS, Instruction 113-2.
11
9519-99
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 withimaterials showing the maximum income limitsaccording
to -family size,applicable to.pregnant women, infants, andshildren up -to agesix underthe Medicaid program.
Localagencieswill 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 thelVIedicaid program.
The State Agency will -ensure that written information concerning food stamps, SSI andinedical
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
This space intentionally left for additions
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 nutritiionxducation 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 ioperations and shall
have the dual purpose of -ensuring the CSFP foods are used properly and of Providing knowledge that
encourages -continued selection and consumption of nutritious foods necessary to good health.
Additional goals of the nutrition education shall be:
1. To demonstrate the relationship between proper nutrition and good health, with emphasis on
pregnant, postpartum and breastfeeding women, infants, and children up to six years of age, and
elderly persons 60 years of age or older.
2. To effect a:ositive 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
12
951999
used for nutrition education of participants. This planshall 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 about the use of the supplemental foods and about the nutritional value of these
foods;
5. Information about the benefits of breastfeeding; and
6. An explanation of the importanceiof health care.
b. The methods used to providenutrition-educationat the local agency may include a 24 hour diet recall,
pre and post tests of participant's knowledge of nutrition, basic nutrition information, such as
illustrated in the Food Guide Pyramid, and how the pregnant woman, mother, oricaretaker can use
this knowledge in meeting -her nutritional requirements and those of _her children. Handout
materials are used in -English -and Spanish -for additional instruction about nutrition and food
handling. These materials can be obtained from -the Colorado Dairy Council and other companies,
such as Del Monte. Recipes provided by agencies, such as the Dairy Council and CSU Extension
Service -are also utilized as handout materials to instruct participants about how to use -supplemental
foods for nutritious meals andsnacks.
c. The minimum nutrition -education may be provided on an individual interview basis or instructed
nutrition education classes. -Most participants are involved in a nutritional assessment at -the initial
visit. The frequency of formal nutrition education classes depends upon the agency's financial ability
to provide this service. Whichever method is used, nutrition education is to be provided nn an
ongoing basis. The professional expertise to provide nutrition -education may include a -Registered
Dietitian, -Public Health Nutritionist, -Registered Nurse, Physician or 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 ofstaff providing nutrition -education.
13.301.630 STAFFING AND FREQUENCY
The local agency shall employ, or at least have the service of, a part-time nutritionist to coordinate the
nutrition -education program and to train paraprofessionals for implementation of the plan.
a. Nutrition Education shall be provided at certification 9r distribution sites or in homes of participants
as needed.
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951999
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.
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 about basic nutrition and
the use of supplemental foods. Homebound elderly should also be included in the evaluation process.
Information provided by the completed _questionnaires or other evaluation _methods shall be considered in
formulating future plans for nutrition education. Atopy 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 about what type of nutrition
education or food handling classes or information they would like to have presented. This information must be
included inthelocal agency nutrition education plan.
13.301.670 TECHNICAL ASSISTANCE
The State Agency shall utilize the services -of the Nutritionist in the Division of Services for the Aging,
Colorado Department of Human Services, to evaluate the nutrition educationplansMf each local agency. The
nutritionist will provide nutrition -education information on an ongoing basis to the Food Distribution
Program, Social Services Specialist II who will in turn, provide information to the local agencies. The CSU,
UNC, Adams State, and Mesa Colleges will be contacted to determine if students would be interested in
developing, implementing, and presenting nutrition education Classes or materials at the local certification
and/or distribution agencies. Local agencies will continue to utilize local resources and any nutrition
education materials provided by the State from USDA totnhance their nutrition education.
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951999
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, orany other such purpose. Supplemental foods may not be provided to any
other community agency or facility for any purpose, unless such agency has entered into a signed written
agreement -with the State or local agency to provide nutrition education services under the program or unless
authorized by the State Agency. Approval for demonstrations using USDA food commodities -must be given
prior to demonstration. The local agency shall submit -request form 13.910.107 to document food items used,
the agency site, and the purpose for the demonstration. When approval has been granted by the State -and the
demonstration has been completed, form 13.910.107 must be submitted with -and documented on theYNS-153
report for the applicable month of the demonstration.
13.301.690 REVIEWS
The State Agency shall conduct an annual administrative review of the CSFP projects, includingaspects-of
nutrition education. The findings from the review will be evaluated by the nutritionist at -the State level to
assure -the local agency is incompliance with the plan for nutritional education. (Reference 13.910.406)
13.301.700 FOOD DELIVERYSYSTEM
13.301.710 ORDERING
The foods donated by the United StatesDepartment of Agriculture (USDA) for the CSFP are received by one
commercial distributor and four local agency warehouses. The commercial distributor is Andrews Produce,
Inc. and Vanask Warehouse Company. The localagency warehouses are -the Denver County Supplemental
Food Program, Mesa County Supplemental Food Program, Rio GrandeSupplemental 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:
Vanask Warehouse Company
6201 East 42ndAvenue
Denver, CO 80216
Subcontractor
Andrews Produce, Inc.
100 S. Main Street
Pueblo, CO 81002
(serves Conejos
Costilla & Rio Grande
Elderly feeding)
Mesa Supplemental Food Program
715 4th Avenue
Grand Junction, CO 81501
(serves Mesa County)
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951999
Denver County Supplemental Food Program
80South Santa Fe
Denver, CO 80223
(serves Denver County)
Changing Needs Food_Program
311 Washington Street
Monte Vista, C011144
(serves Rio Grande CSFP)
Weld County Supplemental Food Program
CIO The Weld Food Bank
104 11th Avenue
Greeley, CO 80631
(serves Greeley C-SFP)
Commodities are ordered by the State Agency -from USDA on form FNS -52 Food Requisition and form FNS -S3
Multi -Food -Requisition. Food orders are -submitted based on computations of Quarterly -Estimates. _Food
requirements are -estimated based on most recent average -three month participation multiplied by the
maximum rate of issue-tosletermineinonthly 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 theagencyfor 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 forpick up or delivery. This is adjusted month depending on fuel
prices. Pricessnay be adjusted up or down on an annual basis effective October 1st each year, based on the
Consumer Price Index (CPI -1J).
The distributor charges to local agencies -are paid by the localagencyand reimbursed by the State Agency out
of Federal administrative -funds. Once a local agency notifies the distributor as to how foods are to the
distributed for the State -fiscal year (July - June), the decision cannot be reversed unless mutually agreed upon
by theagency and the distributor. In situations of -extenuating circumstances, the State Agency shall act as
arbitrator to makefinal decisions.
The local agency may receive foodsas often as every other week provided there is a minimum 10 rase order.
Local agencies must notify the distributors oY 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 inaccordancewith their pickup schedules.
13.301320 PROCEDURES
Deliveries may be monthly or less often at the request of the locaLagency. _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..
16
951999
Participants shall be issued prescriptions for supplemental foods, based on "Maximum Monthly Distribution
Rates" (Reference 13.910.207) by personnel designated by the local agency. The local agency may choose to
issue either a one month supply of foods each month or a two month supply every othermonth. However, local
agencies -which choose to issue a two month supply every other month, shallinform participantsthatthey 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- number, recipient's name, recipient's signature,Troxy, proxy's -signature, s'gnature of authority,
effective date and -expiration date. (Reference 13.910.102). Homebound elderly will be issued a proxy, ifatall
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 -8c Loss Report. Adjustments to physical inventory shall be made in the positive and negative columns
of -the FNS -153. All reports shall be retained fora period of three years, subsequent to the close of the
Federal fiscal year to which they pertain. {References 13.910.202,103,-205,104)
13.301.740 PROTECTION OF FOODS
The local agency is required to provide reasonable protection of the donated foods against theft, spoilage,
infestation, lire and other loss. Such -reasonable protection shall include, but not be limited to, the
responsibilitynf (1) -keeping doors and windows of the facility locked at all times when an employee is not in
attendance, (2) Rotating the inventory on afiirst-in/first-out basis, (3) Using an effective means of Test control
on 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. Coneios County
Distribution is accomplished by commodityxlerk under the direction of-
Conejos County -Public Health Department
Lois -Booth, Administrator
P.O.Dox 78
La Jara, Colorado 81140
The Conejos County CSFP distributioneenter is-resently located in the new Conejos County Nursing
Service Building, 19023 Highway 185 South, LaJara, CO. 81140. -The building is a 100 s 50 sq ft
Butler metal building with brick trim. 500sq ft are allocated for commoditywarehousing. All foods
arestored on pallets in an enclosed room with secured entrances. The food needing cold storage is
stored in the 80 sq It cooler/freezer. Recordsare kept in a locked filing cabinet in the warehouse.
Theeomputor that is utilized for record keeping is located in the commodity clerk's office -which is
100 sq-ft. Food is boxed and distributed from behind a counter. The lobby waiting area consists of
120 sq ft.
The certification area lobby is located in -the CCNS section of the building and is150agft.
17
95199E
b. Costilla County
Distribution is accomplished by a commodity clerk under the direction of -
Administrator, Costilla County Nursing Service
P. O. Box 99
San Luis, CO 81152
The Distribution site is located at 112 Main Street, San Luis, CO 81152. The building is a 55 x 41
square foot adobe building. 465 square feet are allocated for commodity warehousing of SIC and
Elderly monthly distribution. 273 square feet is used for TE-FAP storage. 371 square feet is used for
office space and280 square feet is used foractual distribution and lobby waiting area. All foods are
stored on pallets in the warehouse room. Records are kept in cabinets in the office rooms. The
computer that is utilized for record keeping is located in the commodity clerk's office. Food is boxed
and distributed at -a counter behind the distribution desk. The certification is accomplished in the
commodity clerk's office to allow privacy. Security conventional -doors, windows, and locks are in
place.
c. _Denver.County
The distribution is accomplished- by a lead worker and a staff of eight warehousemen, 7 certifiers, a
nutritionist, a safety specialist, a volunteer coordinator, a secretary and an administrative assistant
under the direction of -
Anthony R. Quintana, Progr-am Administrator
Denver Department of Social Services
Food Assistance Program
80 South Santa Fe Drive
Denver, CO 80223
Phone 436- 800, -Fax 436-2824
Commodities are distributed in a 42,000 sq foot centrally located warehouse and distribution site. All
commodities are received by direct shipment from USDA with _cheese and butter stored in a drive-in
freezer and refrigerator. Commodities are distributed on site in a grocery store fashion as well As
delivery to over 3,000 clients. Clients have direct access to nutrition counseling by a registered
dietitian as well as a book ownership library, stories read to the children, educational videos and a car
seat loaner program.
d. Mesa county
Distribution is accomplished by a CommodityClerk under the direction of -
Special Projects Coordinator
Mesa County Health Department
515-PattersonRoad
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.
18
e. Rio Grande, Saguache and Mineral Counties
These three counties are served by the Changing Needs Food Program,
Carol Refior, Administrator
Tri County Senior Citizens & Housing, Inc.
311 Washington Street
Monte Vista, CO 81144
Rio Grande County
Distributions are made once -per week for the first 3 weeks of the month in Monte Vista, twice per
week for the first 3 weeks of the month iniDel Norte. Commodities are stored in a locked storage c
losetat theMHonte Vista site. Seniors receive prepac-ked boxes.
Sa2uache County
Distributions are the first two Thursdays of the month. Distribution sites are as follows: The first
Thursday is in Saguache at the Public Health Office and Moffat at the school. The second Thursday
is in Center, CO at the Catholic Church. Seniors receive prepacked boxes.
Mineral County
Distribution site is in Creed, at the Mineral County Health Center on the third Wednesday of the
month. Seniors receive prepacked boxes.
Weld County
Distribution is accomplished by Weld Food Bank under the direction of -
Leona Martens, Director
WeldiFood Bank
104 11th Avenue
Greeley, Colorado 80632
Supplemental foods are arranged in grocery store fashion.The distribution center in Greeley is
approximately 32 feet by 27 feet with a tile floor. Security is provided by the Greeley Police
Department, who check the building on a regular route.
The distribution center in Fort Lupton is approximately 397 square feet with cement floors, -sheet rock
interior walls, brick exterior walls. The distribution site has 1 window with bars and 3 locked doors.
Address is330 Park Avenue, Fort Lupton, Colorado 80621. Weld county has expanded into several
moreareas, including Mineral County. The FL Collins Food Bank located at 1301 Blue Spruce, #1. is
the distribution site for C-SFP on every Thursday from 9 A.M. To 3 P.M.. In Loveland, adistribution
is held every 4th Friday of the month except during the holiday -season. Instead of every 4th Friday in
November and December, distribution is on the 3rd Friday. The location is the Presbyterian church,
2500 North Garfield. The time is 12:30 to 2:00 P.M. and is in conjunction with the Brown Bag
program.
19
In January, 1994 Weld County began a tailgatre distribution in New Raymer, 63 miles from Greeley.
Certification is accomplished by direct modem located in Greeley facility. Distribution is every 3rd
Wednesday from 10:00 to 12:00 in the fire hall.
13.30L800 PROGRAM MONITORING
The Food Distribution Programs, Colorado Department of Human Services, will provide monitoring of the
local agencies byitaving staff members make an annual on -site visit. During this visit, program operations
will be reviewed to determine compliance with the provisions of the State Plan of Operation and
Administration, the agreement between the State Agency and the local agency and any instructions provided
by the Food and Nutrition Service, USDA and/or the State Agency.
a. A review check list which has been approved by the Food and Nutrition Service (FNS) will beatilized.
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 thatiplanned 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 Agency. Input from local agencies is evaluated and
utilized in preparing future State Plans.
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 Human Services and forwarded to the Regional Office, USDA within thirty days after
the end of each quarter.
c. The procedures related to the Letter of Credit drawdowns and disbursements are: Upon notification
of the Quarterly Letter of Credit authorized, the State Agency shall deduct the authorized amount for
the State retention. In addition, anamount 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 Statements of Expenditures submitted for the previous
quarter. The State doesmot 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
20
951999
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 July 1st of each calendar year, an annual budget for
the upcoming Federal fiscal year (October 1 - September 30). This will be compared against reports
of expenditures for the previous fiscal year. Obvious areas of discrepancy will be negotiated to resolve
and reach agreement on budgets proposed. Local agency anticipated budgets for FY95 total
$1,571,340.00.
b. Local agencies will maintain accurate and complete records to reflect all administrative expense funds
received from the State Agency and the authorized expenditures to cover Program costs. The local
agency shall maintain complete and accurate records with respect to the receipt, distribution, and
inventory of supplemental foods.
c. Financial reports (Statement of Expenditures)as required by the State Agency and the Food and
Nutrition Service, USDA will be completed and submitted to Colorado Department of Human
Services, Food Distribution Programs, 1575 Sherman Street, 3rd Floor, Denver, Colorado 80203-
1700, by the 15th of the month -following the close of the quarter. (Reference 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.
d. All program and financial records at the local agencies shall be retained for a period of three years
subsequent tothe _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.
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951999
13.301.1030 ADMINISTRATIVE COSTS
MI 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 forsuch 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 $2500.00 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 proeeeds, 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 leaseaptiion to
purchase agreements;
(5) Management studies performed by agencies or departments other than the State or local
agency or those performed by outside consultants under contract with the State or local
agency.
3. Unallowable Costs - the following are unallowable costs for CSFP, in addition to unallowable costs
identified in OMB Circular A-87. (Previous Edition FMC 74-7).
(1) Costs incurred for rearrangement and alteration of facilities not required specifically of the
Program;
(2) Actual losses which could have been covered by permissible insurance (through anapproved
self-insurance programer otherwise.)
22
951999
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 Distribution
Programs.
Local Agency
Local agencies shall provide to the State Agency by each July 1 an itemized list of any
property/equipment purchased with CSFP administrative funds. The State Agency shall maintain
records for property/equipment at each agency. The local agency shall notify the State Agency prior
to disposition of any property/equipment acquired with CSFP administrative funds. Local agencies
shall maintain records of inventories or property/equipment. (Reference 13.910.402)
13.301.1050 ADMINISTRATIVEEXPENDITURE PLAN
State and local agency expenditures for the Federal fiscal year shall be submitted annually to USDA,
FNS as an amendment to the State Plan. The actual expenditures must be submitted to USDA within
ninety (90) days after the close of the Federal fiscal year. The expenditure plan will be submitted in
the format provided by USDA. (Reference 13.910.405) This format will be utilized to identify all
costs for the operation of all aspects of the CSF Program for the previous Federal fiscal year. Local
agencies shall submit their annual administrative expenditure plan to the State Agency not later than
October 31st of each year after the close of the Federal Fiscal Year. The report shall be submitted in
the format as prescribed by the State Agency.
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 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 Human Services are made annually by the State Auditor's Office using
the requirements for financial and compliance audits as established by the U.S. Office of Management
and Budget Circular Number A-128. This Circular is issued pursuant to the Single Audit Act of 1984,
P.L. 98-502 which mandated an organization wide audit. It establishes audit requirements for state
and local governments that receive federal funds and defines the federal and states' responsibility for
implementing and monitoring those requirements.
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
23
951999
and compliance audits. This permits the Department of Human Services to provide assurance to the
federal government that federal funds "passed through" the state to subrecipients were expended in
accordance with federal and state laws and regulations. The local agency will retain an independent
auditor to perform such audits. For this purpose, the term independent auditor means a state or local
government auditor who meets the independence standards specified in the "Yellow Book",
Government Auditing Standards (1988); or a certified public accountant who meets such standards.
b. Audit reports as required by this section will reflect audit findings and questioned costs in the format
specified in the "Yellow Book", Government Auditing Standards (1988). This manner of presentation
will permit the State Agency to take corrective action to resolve the questioned costs within six months
of receipt of the audit report. Audit reports that do not comply with this format will be returned to
the independent auditor for modification. The State Agency will take appropriate follow up action. A
complete copy of the audit of each subrecipient will be on file at the State Agency for review by
USDA.
c. The six participating CSFP projects will be required to have an audit at the end of their fiscal year in
which the close of the Federal Fiscal year 1995 falls.
13.301.1300 CIVIL RIGHTS
The Colorado Department of Human Services assures the USDA Food and Nutrition Service that in its
administration of the Commodity Supplemental Food Program in the State of Colorado, it will comply
with all requirements of (Title VI of the Civil Rights Act of 1964 and USDA Regulations 7 CFR Part
15), including requirements of racial and ethnic participation data collection, public notification of the
nondiscrimination policy, and annual reviews of each local agency to assure compliance with such
policy, to the end that no person shall, on the grounds of race, color, national origin, age, sex, or
handicap be excluded from participation in, be denied benefits of, or be otherwise subject to
discrimination under the CSF Program. The Colorado Department of -Human Services further
assures USDA, FNS that:
a. Program information and publications will be provided in the appropriate language for minority
group areas. The local agency shall ensure that there are bilingual staff members or interpreters
available to serve limited or non-lnglish 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 insureassigned 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, tr
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
24
951999
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 of the following
code letters in the lower left hand column of the participant's CSFP authorization form:
CODE
A
B
c
D
E
RACIAL GROUP
BLACK
HISPANIC
ASIAN OR PACIFIC ISLANDER
AMERICAN INDIAN OR ALASKAN NATIVE
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 raciaUethnic group data for the reporting months (to be specified by USDA, FNS) are to
be tabulated and submitted on a report form FNS -191 to be supplied by USDA FNS through
the State Agency.
The data reported will be analyzed by the State Agency to compare minority participation
within individual counties to the total minority population and to evaluate minority
participation in relation to minority and/or bilingual staffing at local agencies.
6. An annual civil rights compliance review will be conducted by the State Department of
Human Services so as to assure that these delegated responsibilities with respect to
nondiscrimination are being performed. During these reviews, specific areas regarding civil
rights are discussed and technical assistance is provided to local agencies at the time.
(Reference 13.910.406)
7. All complaints received by the State or local agencies which allege discrimination based on
race, color, or national origin shall be referred to the Secretary of Agriculture or the
Director, Office of Advocacy and Enterprise, USDA, Washington, D.C. 20250.
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.
25
13.301.1400 FAIR HEARINGS
The following fair hearing procedures shall apply to all individual CSFP applicants or recipients:
a. Each potential CSFP recipient shall be informed in writing (by use of DF-14) at the time of
application and at the time of denial or termination, of his or her right to appeal and of the fair
hearing procedures.
b. Any CSFP applicant or his/her parent or guardian may appeal from a decision made by a local
agency, with respect to the eligibility of such person to receive the supplemental foods.
c. A request for a hearing shall be made by an individual or his/her parent or guardian to the local
agency within 60 days from the date the agency mails or gives the -applicant or participant the notice
of adverse action to deny or terminate benefits. No particular written form shall be required;
however if the recipient choses to appeal in writing it is sufficient if the written request identifies the
individual and the decision from (DF-14) which the appeal is being made.
d. The individual may be assisted or represented by an attorney or other person at the hearing.
e. MI 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.
i. 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.
ii. The individual shall have an opportunity to question or refute any testimony or other evidence and to
confront and cross examine any adverse witnesses.
The hearing shall be conducted and the decision shall be made by a hearing official who did not
participate in making the decision under appeal or in any previous conferences thereof. Such hearing
official shall be appointed by the head of the local agency and the appointment shall be made in
writing.
j. The decision of the hearing officer shall be based on the oral and documentary evidence presented at
the hearing and such decision shall be made part of the hearing record.
k. The individual and any designated representative shall be notified in writing of the decision of the
hearing official within 45 days from the date of the hearing record.
A written record shall be prepared with respect to the hearing, which record shall include the
decision under appeal, any documentary evidence submitted, and the summary of any testimony
preasented at the hearing, the decision of the hearing official, including the reason therefrom and a
copy of the notification to the family concerned of the decision of the hearing official.
26
-951999
ten. 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 Colorado Department of Human Resources, Food Distribution -3rd Floor, 1575
Sherman Street, 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.
q•
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.
Participants who appeal the termination of benefits within the 15 day advance adverse notice period
provided by _IID (2) shall continue to receive Program benefits until the hearing official reaches a
decision. Applicants who are denied benefits at initial certification or at subsequent certifications
may -appeal the denial but shall not receive benefits while awaiting the hearing.
27
13.910.100 CSFP - CERTIFICATIONTORMS
13.910.102 DF --5 CSFP SUPPLEMENTAL FOOD IDENTIFICATION CARD
13.910.103 DF -SB CSFP V£RIFIICATION OF CERTIFICATION
13.910.104 DF - 14 NOTICE OF ADVERSE ACTION/RIG-HTS OF APPEAL
13.910.105 CSFP SUPPLEMENTAL FOOD IDENTIFICATION CARD - DENVER COUNTYDNLY
13.910.106 CSFP SUPPLEMENTAL FOODIDENTIFICATION CARD - WELD COUNTY DNLY
13.910.107 CSFP DONATED -FOODS USEDFOR FOOD DEMONSTRATIONS
951999
13.910.102
DF-5 (REV 7/80( 1.0. NO.
IDENTIFICATION CATRD-SUPPLEMENTAL FOOD -
AUTHORIZING •GENCY
RECIPIENT'S NAME
PROXY
RECIPIENTS SIG.
PROX Y'S SIG.
SIGNATURE OF CERTIFIED AUTHORITY
You may appeal any decision made by the Local Agency
regarding your denial or termination from the Program.
YOUR AUTHORIZATIGN#OR SUPPLEMENTAL
FOODS IS GOOD THROUGH:
MONTH YEAR
MONTH
Y E API
PLEASE DO NOT DEST-ROYTHIS CARD
951999
11.910.103
OF3(REV. 6/801 No.
COMMODITY SUPPLEMENTAL FOOD PROGRAM
Verification of Certification
Name DOB
leanicipant. Parent. or Caretaaerl
Signature
(Participant. Parent. wLarelaaarl
Names of Eligible Participants: DOB:
CERTIFICATION -RECORD
CertificationDate: Begin _
Local Agency Name: —
L/A Address:
State: Phone
Local Agency Official:
Signature:
Print -Name:
End
951999
13.910.104
DF-14 (11/95)
COLORADO DEPARTMENT OF HUMAN SERVICES
COMMODITY SUPPLEMENTAL FOOD PROGRAM
NOTICE OF ADVERSE ACTION/RIGHT-S 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 hasteen 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 theiutcome of theconference, or if you do not want to have a conference, you
mayrequesta local level hearing at:
NAME AND ADDRESS OF LOCAL LEVEL HEARING AUTHORITY:
If you wish, you may request a -state level hearing at:
CDLORADOREPARTMENT OF HUMAN SERVICES
FOOD DISTRIBUTION UNIT -3RD FLOOR
1575 Sherman Street
DENVER, CO 80203
To request a conference and/or hearing, call your certification office or filliout and return the form on the following
page 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, yourxertification 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.
DF-14 (11/95)
Page two
To schedule a conference or fair hearing, fill out this form and mail it to:
COLORADO DEPARTMENT OF HUMAN SERVICES
FOOD DISTRIBUTION UNIT -3RD FLOOR
1575 SHERMAN STREET
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 wanta 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 ofloodl now receive until the hearing.
All programs of the U.S. Department of Agriculture are available to everyone without -regard to race, color, national
origin, age, sex, or handicap. If anyone believes they have been discriminated against, they should write immediately
to the Secretary of Agriculture, Washington, D.C. 20250.
13.910.105
IDENTIFICATION CARD. -SUPPLEMENTAL FOOD
OF -50 MEV. SAO
I.D. NO.
DENVER DEPARTMENT OF SOCIAL SERVICES
AUTHORIZING -GENCY
REClPIENrs NAME
RECIPIENTS SIG
PROXY PROaYS31G
SIGNATURE OF CERTIFIED AUTHORITY
727.2541 727.2719
•
OPEN WEEK DAYS (ENGLISH) (SPANISH)
THIS PROGRAM IS AVAILABLE TO ALL ELIGIBLE PER-
SONS REGARDLESS OF RACE. -COLOR, NATIONAL
ORIGIN. RELIGION, POLITICAL ISELIEF, SEX. AGE. OR
HANDICAP.
YOUR AUTHORIZATION FOR SUPPLEMENTAL FOODS
IS GOOD THROUGH:
MONTH
YEAR I MONTH
YEAR
You may aopsal any decision mace by the local agency
regarding your4enial or termination from the program
2650 WEST 3RD AVE..13RD dIEIRYANT)
PLEASE 00 NOT DESTROY -THIS -CARO
951999
13.910.106
IDENTIFICATION CARD -SUPPLEMENTAL FOOD
DF.G MREV TNtn
I.D. NO.
WELD COUNTY SUPPLEMENTAL FOODS
AUTHORIZING AGENCY
RECIPIENTS NAME RECIPIENTS SG.
PROXY PROXY'S SG-
SIGNATUREtF CERTIFIED AUTHORITY
GREELEY (Mon, Wed, Thur, Ed) 1560636 857-2725
FT. LUPTON (Tues) (Greeley) (FL Lupton)
THIS PROGRAM IS AVAILABLE TO AU. EUGIBLE PERSONS
REGARDLESS OF RACE, COLOR. NATIONAL ORIGIN.
RELIGION. POLITICAL BELIEF. SEX AGE, OR HANDICAP.
YOUR AUTHORIZATIONFOR SUPPLEMENTAL FOODS IS
G000 THROUGH:
MONTH YEAR
MONTH YEAR
You may appeal any decision made by the local agency
Iegatdmg your denial or temenation from the program.
106 11TH AVE.. GREECE?
330 PARK AVE.. FT. LUPTON
PLEASE DO NOT DESTROY THIS CARD
951999
13.910.107
COLORADO DEPARTMENT OF _SOCIAL SERVICES
DONATED FOODS UNIT
1575 SHERMAN STREET, 3rd FLOOR
DENVER, CO 80203-1700
(303) 866-5100
DONATED FOODS USED FOR CSFP FOOD DEMONSTRATIONS
FOOD ITEM QUANTITY
PURPOSE OF DEMONSTRATION:
ATTACH EXTRA PAGES IF NEEDED
DEMONSTRATION SITE USED FOR CSFP FOOD DEMONSTRATIONS
Agency Name:
Name of Demonstrator:
Mailing Address:
Telephone:
/Date
( ) FAX( )
* * * * * * * * * * * * * * * * * * ► * * * * * * * * * * * * * * * * * * * * * ■ * * * * * * * * * * * * * * *
IMPORTANT! Any product transferred to any other agency for demonstration purposes must have prior
written approval from the Si::u' Agency, 1575 Sherman Street, 3rd Floor, Denver, CO 80203-1700.
* * *-* -*a * • . 4 -*-* * * * * * * * * * * * * * * * * * * *-* * *
APPROVED BY STATE CSFP OFFICE:
If commodities were used for demonstrations a copy of this form must accompany the monthly 153 Report.
951999
13.910.200 CSFP DISTRIBUTION FORMS
13.910.201 FNS - 153 CSFP MONTHLY FOOD INVENTORY AND DISTRIBUTION REPORT - 5 PAGES
13.910.202 FNS - 153 -REPORTING INSTRUCTIONS
13.910.203 CSFP ORDER FORM - DISTRIBUTOR
13.910.204 DF -13 CSFP GAIN OR LOSS REPORT
13.910.205 DF -13 CSFP EXPIRATI0NOF CERTIFICATION
13.910.206 C-HAiRT CSFP MAXIMUM MONTHLY DISTRIBUTION RATES --4 PAGES
951999
13.910.201
MONTHLY REPORT OF COMMODITY SUPPLEMENTAL FWD PROGRAM AND QUARTERLY ADMINISTRATIVE FINANCIAL
STATUS REPORT
port 3. Type of
....AB/Yr Submission
A. -Initial
----- B. -Last Rev
2. State C. -Closeout
Agcy Noe last Inven-
Dept Of tory
Hunan
Services
4. NUMBER OF PARTICIPANTS 5. RPT NEAS'NENTS
Infants
0-3 Mon
(A)
6.
COMN'TY
NAME
MILK EV
MILK NED
FRM POWD
PRIMO
FRM SOY
FRM SOY
POT DER
RICE
MACARONI
SPAGHETT
SPAGHETT
6a.
CODE
5081
8090
B167
B168
B162
8169
A196
8510
B425
B835
8839
6B.
PACK
SIZE
48/12
6/4
6/1
Infants
(4-12) Non
(B)
7.
STATE &
LOCAL
BEGIR'G
INV'ORY
8.
RECEIPT
Children
(1-6) Yr
(C)
Prg/Bre
Feed No
(D)
Post P
Women
(E)
STATE AND LOCAL DATA
9. 10.
TOTAL
REDON INV'ORY
ATIONS AVAIL
IN (7+8+9)
11.
COMM ISSUANCE
Total Issue To
WIC Eldly
(A) (B)
12/16
24/2
24/1
12/2
24/1
Total i Part
4A+B+C+D+E+F
(F)
Total No Of
Elderly Part
(G)
12.
COMMODITY ACTIVITY
Total / REDON
Issued ATION
(11A+B) Out
(A) (B)
Food
Loss
(C)
Food
Deco
stra
tion
(D)
13.
TOTAL
ACT'VTY
(12a+b+
c+d)
CASES
(A)
( )PR
UNITS -
(B)
(Y I
14.
ADJUSTMENT
Posi-
tive
(A)
Nega-
tive
(B)
15.
STATE 4
LOCAL
ENDING
INV
((10-13
)+/- 14
a & b)
FORE 153 06/94 Page 1 of 5
951999
MONTHLY REPORT OF COMMODITY SUPPLEMENTAL
FOOD PROGRAM STATE & LOCAL INVENTORY
REPORTING MONTH & YEAR
STATE AGENCY NAME
Co Dept Of Husan Services
REPORTING MEASUREMENT
CASES ( ) UNITS ( X )
STATE AND LOCAL DATA
6.
COUM'TY
NAME
6a.
CODE
68.
PACK
SIZE
FARINA
CER CORN
CER CORN
B160
B851
8852
24/14
14/16
12/17.5
7.
STATE &
LOCAL
BEGIN'G
INV'ORY
8.
RECEIPT
9. 10.
TOTAL
RECON INV'ORY
ATIONS AVAIL
IN (7+8+9)
11.
COMM ISSUANCE
12.
COMMODITY ACTIVITY
Total Issue To
WIC Eldly
(A) (8)
CER CORN 8850 24/18
CER OATS B860 24/15
CER OATS 8861 12/16
CER RICE 8867 12/17.5
R RICE B864 24/13
CER RICE B866 12/13
CERWHEAT 8871 12/16
CERWHEAT B870 24/18
Total I REDON Food
Issued ATIONS Food Deao
(11A+B) Out Loss stra
tion
(A) (B) (C) (D)
13. 14. 15.
TOTAL ADJUSTMENT STATE i
ACT'VTY ------ ------ LOCAL
(12a+b+ Posi- Nega- ENDING
c+d) tive tive INV
((10-13
)+/- 14
(A) (B) a & b)
CERIRICE
8161
12/8
EGG MIX
A570
48/6
PB CRMY
B470
24/2
PINTO BD
ITILS
A914
A135
12/2
12/2
FORM 153 06/94 Page 2 of 5
951999
MONTHLY REPORT OF CCWRODITY SUPPLEMENTAL
FOOD PROGRAM STATE & LOCAL INVENTORY
REPORTING MONTH & YEAR I STATE AGENCY NAME
Co Dept Of Human Services
REPORTING MEASUREMENT
CASES ( ) UNITS ( I )
6.
CONN'TY
NAME
6a.
CODE
6B.
PACK
SIZE
7.
STATE &
LOCAL
BEGIN'G
INV'ORY
8.
RECEIPT
STATE AND LOCAL DATA
9. 10.
TOTAL
REDON INV'ORY
ATIONS AVAIL
IN (7+8+9)
11. 12.
COMM ISSUANCE COMMODITY ACTIVITY
Total Issue To Total i REWN
Issued ATIONS Food
WIC Eldly (11A+B) Out Loss
(A) (B) (A) (B) (C)
Food
Demo
stra
tion
(D)
13.
TOTAL
ACT'VTY
(12a+b+
c+d)
14.
ADJUSTMENT
Posi- Nega-
tive tive
(A)
(B)
15.
STATE &
LOCAL
ENDING
INV
((10-13
)+/- 14
a & b)
BEEF STW
BEEF STW
BEEP NJ
CHICKEN
PORK NJ
POULTRY
LUNCH MT
"CH MT
CARROTS
CORN CRH
A587
1589
1610
A562
1630
1560
A617
A619
1095
A120
24/24
24/15
24/29
24/29
24/29
24/29
24/30
24/30
24/303
24/303
CORN WHK A121 24/303
GREEN B 1060 24/303
-BEAN VEG A090 24/300
-PEAS A145 24/303
POT WHO 1169 24/303
POT SWT
SPINACH
1221
24/303
A166
24/303
TOMATOES
?KIN
A248
A163
24/303
24/303
FORM 153 06/94 Page 3 of 5
951999
MONTHLY REPORT OF COMMODITY SUPPLEMENTAL I REPORTING MONTH AND YEAR
FOOD PROGRAM STATE & LOCAL INVENTORY
STATE AGENCY NAME
Co Dept Of Human Services
REPORTING MEASUREMENT
CASES ( ) UNITS ( Y )
6.
CONM'TY
NAME
6a.
CODE
6B.
PACK
SIZE
STATE AND LOCAL DATA
7.
STATE &
LOCAL
BEGIN'G
INV'ORY
8.
RECEIPT
9.
REDON
ATIONS
IN
10.
TOTAL
INV'ORY
AVAIL
(7+8+9)
11.
COMM ISSUANCE
12.
COMMODITY ACTIVITY
Total Issue To
WIC Eldly
(A)
(B)
Total i REDON Food
Issued ATIONS Food Demo
(11A+B) Out Loss stra
tion
(A) (B) (C) (D)
13.
TOTAL
ACT'VTY
(12a+b+
c+d)
14.
ADJUSTMENT
Posi- Nega-
tive tive
(A)
TUNA A740
24/12.5
TUNA
A741
24/1225
APPLESAU
APRICOTS
FRUIT CK
CL
PEARS
PINAPPLE
A355
A362
A401
A412
A439
A446
PLUMS
A461
24/303
24/303
24/303
24/303
24/303
24/2
24/303
(B)
15.
STATE &
LOCAL
ENDING
INV
((10-13
)+/- 14
a & b)
APPLE J A282 12/46
GRAPEFRJ
GRAPE J
A280
A285
12/46
12/46
ORANGE J
A300
-TOMATO J
PIN'PLEJ
A290
A286
12/46
12/46
12/46
TORN 153 06/94 Page 4 of 5
B51999
MONTHLY REPORT OF COMMODITY SUPPLEMENTAL I REPORTING MONTH & YEAR
FOOD PROGRAM STATE & LOCAL INVENTORY
STATE AGENCY NAME
Co Dept Of Human Services
REPORTING MEASUREMENT
CASES ( ) UNITS ( I )
6.
COMIC!?
NAME
-BUTTER
CHEESE L
-CHEESE L
CHEESE L
CORNMEAL
HONEY,CN
6a.
CODE
B050
8060
B061
B062
6B. 7.
STATE &
PACK LOCAL
SIZE BEGIN'G
INV'ORY
36/1
6/5
12/2
15/2
B137
8403
10/5
24/24
8.
RECEIPT
STATE AND LOCAL DATA
9.
REDON
ATIONS
IN
10.
TOTAL
INV'ORY
AVAIL
(7+8+9)
11.
COMM ISSUANCE
Total Issue To
WIC
(A)
Eldly
(B)
12.
COMMODITY ACTIVITY
Total
Issued
(11A+B)
(A)
REDON
ATIONS
Out
(B)
Food
Food Demo
Loss stra
tion
(C) (D)
13. 14. 15..
TOTAL ADJUSTMENT STATE 6
ACf'VTY ---- LOCAL
(12a+b+ Posi- Mega- ENDING
c+d) tive tive INV
((10-13
+/- 14
(A) (B) a 6 b)
16. REMARKS Provide Explanation as Requested by Instructions.) (Attach Additional Sheets as Deemed Necessary.)
17. SIGNATURE
18. TITLE
19.
DATE
20.
CSFP
ADMINISTRATION
OUTLAYS
(A)
UNLIQ.
OBLIG. (B)
TOTAL
(C)
UNLIQ BAL OF
ADVANCES (D)
FORM 153 06/94 Page 5 of 5
1951999
13.910.202
A�1 •1 1 Ii! f f
ii 111 f ! 1 11 III
'
t2•ii .51 t I ' ljj ' + '
I
1 It ii, t ' f I 1; Jib : I i
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lit 11111 ' f ,
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JIII,hif1l1.;1 .,�, ,s t t r.1 ' fJI aa_:1j g 7 f
10
• , jq,i lids ! slat '' .4 a -
J 'ii �"Ii'.i I;I!t'11l'�i�111, 14111$3iii
Winn; a pI li ' j a1311111$138a1
i 1i1iJ1 •j!3} , =7' { i•
afd"11 a j5di,aIari 3f! #'{,33 ie,i
lb Ii, laid 1 a ( 1aaaIt
a
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e
E lei ,t 1 t;i1 I ,
j'21 411
t
t I1! iii t 1111 i. F I i i iii! I I
JP pi 1 l;;: ` '1 i 1, =F
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,x 1
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1 1 i a ! ! li i ta 1
ail
• 1t 1
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I•i.i(}„, F2121 Jilin] fI' 1is r'
3 ,,1 ,ta,ztFiiii ,, ill141 14
'i 'II ill '
;� at=1 It iah a $ 1 fin 1 11 z 11; ,l 'i ] ' 7
Pill i,ziij 1•'j,=f;1i= Xii'' situ
1.if]!i!j'fill 1ii.li1fif i=}'i :Iii4 4111
lilt1ili 1 =;i�ffi11, �i%ii=dri;1I;lI ii;I
ai i 1 � li i 1'''' f it lji 1s i-, 1
ii ii .al �i !sill ' 'I fil . $ :: Si1 1 -I .I .l =1 ;It (,
F!
•
•
951999
13.010.203
COMMODITY SUPPLEMENTAL FOOD PROGRAM ORDER FORM
AGENCY AGENCY # CUSTOMER #
BILL TO: CITY ZIP
SHIP TO: CITY ZIP
CONTACT PERSON PHONE #
DATE REQUIRED
(ORDER IN CASES ONLY)
DEL
@TY
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
A300
ORANGE JUICE 12/46
A570
EGGMI% 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
M LK EVAP 48/12
A362
APRICOTS CND 24/303
B090
MILK NFD INSTANT 6/4
A401
FRUIT COCKTAIL 24/303
B162
FORMULA SOY DRY 6/14
A412
PEACHES CLG CND 24/303
B165
FORMULA INFANT 24/13
A4S9
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
B050B
BUTTER 36/1
A48011
PRUNES DRY BONUS 24/1
B40311
HONEY PROCESS 24/24
13851
CEREAL CORN DRY 14/16
13470
PEANUT BUTTER 24/2
B852
CEREAL CORN DRY12/17.5
B060B
CHEESE PROCESS 6/5
B860
CEREAL OATS DRY 24/15
B061B
CHEESE PROCESS 12/2
11861
CEREAL OATS DRY 12/16
B062
CHEESE PROCESS LF 15/2
13866
CEREAL RICE DRY 12/13
B062B
CHEESE PROCESS 15/2
B867
CEREAL RICE DRY12/17.5
B510
RICE MILLED 24/2
951999
13.910.204
DF-13 08/93)
GAIN OR LOSS REPORT - FOOD DISTRIBUTION
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 49
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 DonatedFood.
Attach one copy to the monthly Foods Inventory and Distribution Report DF-12.
Retain the other copy in file.
951999
13.910205
DF15 (8/93)
COMMODITY SUPPLEMENTAL FORD 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.
96399
13110.-206
FNS INSTRUCTION 835-1
REV. 1
EXHIBIT -A-1
MAXIMJM MONTHLY DISTRIBUTION RATES
Infants
Package Packages Total Maximum
She Per Month Amount/Month
INFANTS: 0-3 Months
Infant Formula:
Concentrated Liquid
or
Powdered
INFANTS: 4-1? Months
Inf nt-Formula:
Concentrated Liquid
or
Powdered
Cereal. Irfnnt Rive
Juices
13 -oz can
1 -lb can
13-ez tan
1-lh ran
8 -oz nka 4 nknc
31 cans
or
$ cans
31 cans
or
8 rens
46-az cen 7 r-nns
1 Tomato juice should not be Issued to Infants.
403 ozs
8 lbs
403 ozs
8 -Ihs
3? ozs
9? nzs
951999
13.910.206 '
FRS INSTRUCTION 835-1
REV. 1
EXHIBIT K-2
MAXI?4JM MONTHLY DISTRIBUTION RATES
Cereal, Dry Ready-to-Eatl
or
Farina'
Fag Mix. nu
Julte
lte
Meat/Poultry
or
Meatball Stew
Milk:
Evaporated2
or
Evaporated3
and
Instant Nonfat Dry3
Peanut Butter
or
peas/Beans. Dry
Potatoes, Dehydrated
or
Rice
Vegetables?
and/or
Fruit5
Children (1 to 6
Package
Size
Years)
i-a
Packag
Per Mnnth
Total -Maximum
Amount/Month
18 -oz pkg 2 pkgs 36 ozs
14-nz nkn
or
7
nkns
28 ozs
6-nz nkn 7 nligs 12 ozs
46-nz ran 5 rans 230 ozs
29 -oz tan
74-nz ran
12toz tan
12 -oz can
25.6 -oz
4-lh nkn
2 -lb jar/can 1 pkg every,
other month"
7 -lb okn
1 -lb pkg 1 pkg
pkg
1 can
Or
ran
29 ozs
24 ars
33 cans ' 396 ozs
0
cans 60 ozs
and
2 pkgs 51.2 ozs
or
1 nka 4 Its
7-lh nka
15/16 -oz can
20-az can )7
27/79-nz ran
or
1 dig
1 lb
1 I
1 Ib
2 Ihs
4 cans 60-116 ozs
1 Additional package sizes may fie 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
mil -k; or a combination of 5 12 -oz cans of evaporated mil -k and 225.6 -oz packages
of Instant nonfat dry milk; or a ccmbination 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-mlik and 2 25.6 oz -packages of instant nonfat dry milk; or 5
12 -oz cans of evaporated milk and 1 4-tb package of nonfat dry milk.
1 -months' supply. Distribute peanut butter
4 One 2 -lb (32 oz) jar/can/package is a
or beans every other month.
5 Four cans, regardless of size, may be
or a combination of both.
issued -of either all fruit, all vegetables,
9519S9
13.910.206
FNS INSTRUCTION 835-1
REV. 1
EXHIBIT A-3
MAXIMl1M MONTHLY DISTRIBUTION RATES
Cerea I , -Dry Ready —to —Eat
or
Farina 1
Egg Mix. Try
Juice
-teat/Poultry
or
jleatball Stew
Milk:
Evaporated
and
Instant Nonfat Dry
Peanut butter
Or -
feac/Renn5. try
Potatoes. Dehydrated
or
Bice
Vegetables
and/
Fruit
25.E -oz pkg
Pregnant/Breast-Feeding tlanen
Package Packages Total Maximum
S17e Per Month Amount/Month
1 1B-cz pkg 2 pkgs 36 ozs
14 -*07 nkn
fi-nz nkn
46-n, ran
2 -9 -oz can
24-n7 ran
or
2 nkgs
7 -akgs
5 cans
1 can
or
i ran 74 m3
28 ors
12 ozs
230 075
29 ozs
12 -oz can 11 cans 132 ozs
and
2 pkgs 51.2 azs
or
4 -lb nka 1 ekg 4 Ibs
2 -lb Jar/can 1 pkg every
othersonth 2
7-lh nkn
1 -lb pkg
2- I I`pkn
1 -5/16 -oz can
20 -oz can
77/79-nz ran
1 lb
1 lb
1 pkg 1 lb
or
1 pkn 2 Ibs
B cans 120-232 ozs
1 Additional package sizes -nay be available. The distribution rate for all sizes
is 2 packages per month. A combination of 1 package of dry ready -treat cereal
and 1 package of-fan-na 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 canbinatton of both.
951-999
12.910.206
FNS INSTRUCTION 835-1
REV. 1
EXHIBIT A-4
MAXIMUM MONTHLY DISTRIBUTION RATES
I{gnbreast-Feed i ng/Postpartum Women and -FI der I v
Cerea l , Dry Ready -to -Eat 1
or
Farina l
Fgg Mix Dry
Juice
Meat/Pou I try
or
Meatball Stew
Milk:
Evaporated
and
I nstant tiontat Dry
Peanut Butter
or
Peas/Beans. Dry
Potatoes, Dehydrated
or
Rice
Vegetables
and/or
Frult3
Package
Sire
1b -oz pkg 2 pkgs
or
14-nr okg 2 okas
JMZ nkn 2 nkgs 12 ozs
46 mr nkg 3 cans 138 075
29 -oz pkg
24-07 tan
Packages
Per Month Amount/Month
Total Maximum
12 -oz can
36 ozs
28 Ors
1 can 29 ozs
or
1 ran 2-4 ozs
3 cans
1 and
No 10039f dr4r S 2 .pkgs
a 4-Ih Oka) of -nkg /YDM
2 -lb Jar/can
7 -lb nkn
1 -lb pkg
2 -lb nk
f5/1b-oz
20 -oz
27/79-07
can
can
ran
1 pkg every,h other mont
n2
1 pkg
or
1 nkg
36 ozs
51.2 nzs
4 lbs
1 lb
1 lb
1 lb
2 lbs
4 cans -60-116 ozs
1 Additional package sizes may be available. The distrlburtion rate for all sizes
is 2 packages per month. A caubinatiion of 1 package of dry ready -to -eat cereal
and 1 package of farina nay be provided.
2 The 2 -it (32 oz) Jar/can/package Is a 2 -months' supply. Distrtbute peanut butter
or beans every -other month, except elderly participants may receive a 2 -It pack -age
of peanut butter ar dry beans every month.
3 Four cans, regardless of size, -may be (issued of either all fruit, all vegetables,
or a combination of both.
9-7-88
951999
13.910.300 CSFP AGREEMENT -FORMS
13.910301 C-SFP STATE/LOCAL AGENCY AGREEMENT COVERING CERTIFICATION FOR AND
DISTRIBUTION OF -FOOD COMMODITIES TDF-2B) - 7PAGES
13.910.302 C-SFP PROGRAM APPLICATION FOR LOCAL AGENCIES - STAGES
13.910.303 LETTER OF AGREEMENT FOR DETECTION AND PREVENTION OF DEAL
PARTICIPATION BETWEEN THE COLORADO COMMODITY SUPPLEMENTAL FOOD
PROGRAM AND THE COLORADO SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR
WOMEN, INFANTS, AND CHILDREN (WIC)
13.910304 STATE AND LOCAL DEPARTMENT/AGENCY INDIRECT COST NEGOTIATION
AGREEMENT.
951999
13.910.301
DF-2B (Rev. 09/94
COLORADO DEPARTMENT OF HUMAN SERVICES
1575 Sherman Street, 3rd Floor
Denver, CO 80203-1700
Donated Foods Agreement
Commodity Supplemental Food Program
(Serving Low Income Women, Infants, Children and Elderly)
This agreement is made this (Enter today's date) day of 19 by
and between the ColoradoDepartment of Human Services, 1575 Sherman Street, 3rd -floor,
Denver, CO 80203-1700 (hereinafter referred to as the "Department"), andthe (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 ofAgriculture (hereinafter referredrtoas "USDA"). The Contract with -USDA
is subject to all federal laws and regulations. USDA controls the amount and types of
commodities available to the Department.
Whereas, the Department has the responsibility for administering the Food
Distribution Programs in Colorado in accordance with its Contract with USDA, and;
Whereas, theRecipient Agency desires to participate in theDonated Foods Program
in accordance with the terms of this Agreement; and
Whereas, as of the date of execution of theAgreement, RecipientAgency meets all
requirements for participation in this program.
NOW, THEREFORE, it is hereby agreed:
1. TheRecipient Agencyis operating -a Commodity Supplemental Food Program which
provides supplemental foods tolow income pregnant and postpartum women, infants,
childrenand 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
951299
2. Recipient Agency shall participate in the -Donated Foods Program in accordance with the -
terms of the Agreement and applicable legal requirements described below.
3. The term "legal requirements" as it is used throughout this Agreement includes federal.
and state statutes, federal and state regulations program requirements as identified in the
Food Distribution UnitRecipient Agency User's Handbook, State Plan of Operation and
Administration attached hereto and incorporated herein as Exhibit A and any amendments
thereto, which are applicable to the Food Distribution Programs, which are in effect when
this Agreement is executed. The Recipient Agency agrees to fully comply with all legal
requirements defined above, and to submit any reports requested by the Department or
USDA in a prompt and complete manner, and to enforce such legal requirements against
any sub -distributing agencies which are under contract with the Recipient Agency.
4. Recipient Agency shall receive, store and distribute donated foods. In addition, the
Recipient Agency agrees to comply with the following terms and conditions:
A. Use of Donated Foods
Donated food will be used only in connection with Recipient Agency's established
feeding operation for the sole benefit of persons served by the Recipient Agency
and will not be sold, exchanged, or otherwise disposed of by the Recipient Agency
without express written approval being obtainedby the Recipient Agency fi.ui 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 lather loss as recommended in die
"Food Storage Guide for Schools and Institutions" in the Food Distribution Unit
User's Handbook. The Recipient Agency shall provide facilities and services that:
1. Are sanitaryandfree from rodent, bird, insect and other animal infestation;
2. Safeguard against -theft, spoilage and other loss;
3. Maintain foods at proper storage temperatures;
4. Stoc-kand space foods in a manner so the USDA -donated foods are readily
identified;
5. Rotate stock utilizing "First-In7First-Out" inventory practices;
6. Store donated food off the floor -and away from walls in a manner to allow
foradequateventilation;
7. Maintain accurate inventory records ofproduct 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.
951999
C. Responsibility -for Damage. Spoilage. -Theft or Otherloss
Once the donated foods have been delivered to the Recipient Agency or its carrieragent,
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 Recpient 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 thelast
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 inventorylevel 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. TheRecipient Agency shallprovide 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 reset the right to redistribute any USDA donated foods in possession of
the Recipient Agency.
3
951999
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 aperiod of three
years from the close of the federal fiscal year to which they pertain.
IL Audits and Inspections
Me Recipient Agency shall allow representatives of the Department and/or USDA to
inspect and inventory donated foods in storage, the facilities used in the handing 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 she close of the quarter, a
Quarterly Statement of Expenditure report reflecting an accurate amount of funds
expended for she quarter. The Department willzeimburse theRecipient 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 theRecipient Agency based on actual cases of 'bonus"donated
foods distributed during the previous quarter. Quarterly Statements of Expenditures shall
4
951999
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 iof 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:
Tide 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 E0 et.
sea.;, and
Section 504 of the Rehabilitation Act of 1973,
29 U.B.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
Tide VII of the Civil Rights Act -of 1964; and
the Age Discrimination in Employment Act of 1967;
and
the Equal Tay 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 ofrace, color, national arigin, age, sex and handicap,
including Acquired Immune Deficiency Syndrome (AIDS) nr AIDS related conditions,
covered in Section 304 of the Rehabilitation Act of 1973, as amended, cited above. This
assurance is given in consideration of and for -the purpose of obtaining any and all federal
and/or state financial assistance. Any person who -feels that she/he has been discriminated
against has the right to file a complaint either with the Colorado Department of Human
5
951999
The Recipient Agency shall comply with all regulations applicable to these laws
prohibiting discrimination because of race, color, national origin, age, sex and
handicap, including Acquired Immune_Deficiency Syndrome (AIDS) or AIDS related
conditions, covered in Section 504 of the Rehabilitation Act of 1973, as amended,
cited above. This assurance is given in consideration of and for the purpose of
obtainingany and all federal and/oristate financial assistance. Any person who feels
that she/he has been discriminated against .has the right to file a complaint -either
with the Colorado Department of Human Services or with the -U.S. Department of
Agriculture, Office for Civil Rights.
The Recipient Agency is responsible for any additional Civil Rights reporting
requirements as set forth in the State -Plan of Operation and Administration.
K. ' Indemnification
To the extent authorized by law, the RecipientAgency shall indemnify, save and hold
harmless the Mate, its employees mid 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 R-ecipient Agency fails -to comply withthe provisions of this Agreement, it may,
at discretion of theDepartment, be disqualified from further _participation in the
Program. The Recipient Agency or the Department may seek judicial relieffor 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 30,13995. The Recipient Agency or the Department may terminate this
Agreement at any time by giving -thirty days -notice in writing. Upon such termination
by either the -Recipient Agency or the Department, the Recipient Agency_shall, at its
expense, return all unused donated foods in its possession to such place within -the
State of Colorado as may be designated by the Department.
N. Assignment
The Recipient Agency agrees not to assign its rights or to delegate its obligations
under this Agreement without prior approval in writing from the Department.
0. Future Effect
6
951999
This Agreement is binding upon the present and future elected or employed _officials
of the Recipient Agency and the State of Colorado.
P. Authorized Representative
It shall be the duty of the Recipient Agency _to promptly notify, in writing, the
Department _of any change in its Agency Head or authorized representative or
change in legal address.
Q. Si ng atures
The individual signing _this Agreement as the "Agency Head" or "Authorized
R-epresentative" (as attested if a corporation) certifies that his/her signature legally
binds the Recipient Agency to the terms of this Agreement.
TYPE OR PRINT ALLINFORMATION BELOW:
DATE:
NAME OF RECIPIENT AGENCY:
ADDRESS:
STATE OF COLORADO
DEPARTMENT OF HUMAN
SERVICES
PHONE*:
DATE APPROVED
SIGNATURE AND TITLE OF AGENCY HEAD
OR AUTHORIZED REPRESENTATIVE:
7
BARBARA McDONNELL
EXECUTIVE DIRECTOR
951999
13.910.902
COMMODITYSDPPLEMENTAL FOODPROGRAM
(CSFP)
APPLICATION -Fa LOCAL AGENCIES
1. APPLICANT INFORMATION
Agency Name:
Address:
Telephone:
Street or P9 Box
City/Town Zip
Area Code Numbet
Geographic Area Served:
Official Responsible for Program -at Loallevel:
Name Title
FOR PRIVATE NONPROFIT ORGANIZATIONS ONLY
IRS Tar -Exempt -Certificate.
If no number. is application pending? YES - NO .
SPmuwr-Agency (If different than Applicant -Agency)
Name of Agency
Address
2. HEALTH SERVICES
A. Which a7 the following health services -or types of clinics an offered by your agency -0r an provided to your clients
by referral?
Service Types of Clinics
Phys(dand-Services _ Prenatal
Nursing -Services _ Perinatal
hors Health Services _ Child -Health
Nutrition Education or Counseling _ EPSDT
_Social Services , Family Planning
Prenatal Education _ Immunization
Parenting$ducation _ WIC
Other (Specify) _ Other (Specify)
1 of 5 pages
951999
13410.302
CSFPPROGRAM
APPLICATION FOR LOCAL AGENCIES
B. Laboratory Facilities
Whichzo( the following available?
- Facilities or equipment for meaning height and weight
_ Facilities or egdpmentfor determining hemoglobin or-hamatocrit
C. Number served during the last 12unonths (Unduplicated)
- Pregnant Teenagers _ Pregnant Women
- Breastfseding Women
Children 14 Yr.
Infanta Under 1 Yr.
Elderly 60 Yr.dr_above
If this agency earrently provides WIC Fragrant asrvins, what is the agency's uaabad7
If WIC Programrrvices are provided by another agsneysn your service area, -what is the caseload?
What S thisspncyn anticipated curbed for CSFPr
D. Medical -Records
Uned(eal rends an kept, which kinds of data annullable en the groups below?
WOMEN
INFANTS
CHILDREN
Height
Weight
Hemoglobin
Hematac it
Dietary Information
Health History
E.
Eligibility
What income guidelines an used to determine eligibility for healthaervina?
Are clients required to live in a certain area in order to receive services?
F. Will you be affiliated -with another gency providing some of the health services? Yes _ No
If yes, explain and list the newels) and addressee) of theprivatephysiciaa and/or agencies participating. Indicate
thosenth which your agency hank written agreemem.
2
951-999
13.910.302
CSFP PROGRAM
APPLICATION FOR LOCAL AGENCIES
3. NUTRITION SERVICES
The -following -services are tobe provided as -part of the WIC Program:
A. Nutrition -Screwing
B. Nutrition -Education Counseling
C. Periodic Evalastion of Client's Nutritional Status
A nutritionist/dietitian must -be employed. at least on a pert lime basis. toirvvide or direct nuttitionacreening, 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, on recent graduate eligible for registration
and enrolled for the newt examination.
If amutritionist/dietltlan is -unavailable for employment in yourarea, another health apeciaBatmay be designated to be
reepombLlor nutrition education spin approval of the Office of Agingyndatlt:ervioes, Colorado Department of Social
Services.
Who provides or will -provide fheminimnmsutrition services? •
- Registered Distitian/Nutritionist
- Other Health Specialist
4. ADMINISTRATIVE -SERVICES
Who will be responsible to provide monthly financial and administrative reports in timelymanner to the Colorado
Department of Social Services, Food Assistance Programs Division. Donated Foot, Unit.
5. FOOD WAREHOUSING/DISTRIBUTION
A. Pleaseandieatathow_commodity warehousing, record keeping and_distribution will be organized.
- This ajenty-will earry out all commodity related functions of the program.
Commodity related -functions will be subcontracted to another agency/organization.
Itcommodity related functions are managed by this agency, briefly describe -the facility and methods.
If commodity related function. are to be subcontracted, please provide the name, address, and staff contact of the
agency/organization: sndattachm signed -copy of the Agreement to receive USDA commodities for distribution
through CSFP.
6. ADDMONALJNFORMATION
A. Where will the Program participants be -served? Please describe facility/facilities that will be used for both
certificationand food distribution.
B. When -can you ready to open a CSFP Programs
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 DISCRDUNATIONON THE BASIS OF AGE. RACE, COLOR, SEZ,BANDICAP, OR NATIONAL ORIGIN.
3 of 5 pages
J •
951999
13.910.302
(SF4-PROGRAM
APPLICATION FOR LOCAL AGENCIES
COMPLIANCE WITH TITI£-VI OF 'THE CIVIL RIGHTS ACT OF 1964
A. -Has your agency hadmy recent hiaory of nmsompliance-with Title VI?
Yea _ No If yaw -please explain.
B. Have you or do -you deny acme of any program tom pence on the basis of age,-eex, handicap, -race, color, or
national origin?
Yes _ No If -yes, please explain.
C. Do you.have skignilloant-thrtionof the m& Engiish speaking -persona in your community?
_Yee ,No
If M do you banns to bilingualmaul? If no, do -you plan to bringaome one on staff to-performlhie function?
D. Are then any disc®inatiae mmplaiats-pendiog against your-genc7?
Yes _-No If y3., plassemplaia.
Title VI of the Civil Rights et;amides _that no panache she United States shall, -on-the ground of race, sax, age, color,
handicap, or national origin be excluded from participation in, be denied the benefits oil or be aubjectsdso discrimination
under anyprogram or activity receiving federal financial assistance The Colorado tepertmentxf Social —Services. Food
Assistance Division, Donated Foods unit is ftrmlyaommitted to ensuring that no eligible person is discriminated against on
the basis of now sex,color, age, handicap, or national origin4n the provision of services instil -programs funded. -To-ensure
that action will be taken to amply -with Title VI requirements, the WIC Program adopts -he following policies:
1. The CSFP Program -will inform -snails -contractors ofsheir-responsibilitiaxnder Title VI of the Civil Rights Act.
This_tnformation can be found in the_ SFP-Program Manual.
2. The CSFP Program will distribute-, copy of -this policy toeach-ata f person to inform all stall of the Agency's
obligations under Title VI.
3. The-CSFP-Program willmake m referrals to -agencies that are known -to engage -in discriminatorypnctices.
4- The CSFP Prognm.nU ensure that, to the extent tensible, the -public notices it publisher announcing or explaining
services furnished -with USDA funds contain the words in minding these services, no person shall be discriminated
against -on- ho basis of-raa,miar, age, sex, handicap, or national origin.'
7. ThaStats ofSolorado CSFP Program hasadopted-and foilom written policy to asap compliant with This VlatsheCivii
Rlghs Act, which shall include, at a minimum
A. The CSFP Program -will not discriminate and will -not -permit discrimination than services or -programs it funds
on the basis of race, age. color,aex, handicap, or national -origin.
9. Procedures for informiing all staff -and grantees of -their obligations under Title VI -will include furnishing all new
and existing stslfinemben copies of i arsonnel Policy and-Alfrmative Action Plan.
C. A -written summary of investigation into complaints under Title VI of the Civil Rights Act shall be prepared and#ept
on Mace the local -agency. Anyammplsint-received by the local -agency shall be sent to the Colorado Department
of Social Services, Food Assistance Division —Donated Foods Unit immediately.
4
951999
13910.302
CSFP PROGRAM
APPLICATIONFORI.OGAL AGENCIES
•
The APPLICANT auumesand assures that it will comply-i ithtSFP-program regulations if selected. The information contained in
thisapplication for a- SFP Program Grant is traeand accurate tot bestial" my -knowledge.
Signature of Local Official Responsible for CSFP.
NAME DATE
TITLE
The statemgency shall notify the local agency of the status of itsapplieation within 30 days of receipt of theagencys application. If
the-appliationaa-denied.Jhe stateagency shall advise_the agency of -the -reasons forlheAenial and the right toappeal the decision.
If selected, aline -item budget application and narrative met be completed which includes:
A. Staffing pattern to ensure -provision of nutrttionand health services for attifcation and nutrition -education.
B. Administrative and clinical costs.
C. Potential carload -and plans for expansion.
&
- 951999
13.910.303
LETTER OF AGREEMENT
between
THE COLORADO SPECIAL SUPPLEMENTAL
F000 PROGRAM FOR WOMEN, INFANTS,
AND CHILDREN (WIC)
THE COLORADO COMMODITY SUPPLEMENTAL
FO00 PROGRAM (CSFP)
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,
Loth 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 F000 PROGRAM COMMODITY SUPPLEMENTAL
FOR WOMEN, INFANTS. AND CHILDREN (WIC) F000 PROGRAM (CSFP)
7r Date
f��� r
Director p
Nutrition/WIC Section ram
Food Assistance Prog ection
951999
13.910.304
Division Titte,
Program Title,
or Category
STATE OF COLORADO
DEPARTMENT OF HUMAN SERVICES
Indirect Rate Proposal
For the Period July 1, 1995 -to June 30, 1996
Computation of Indirect Cost Rate
FOOD ASSISTANCE
SCHEDULE A
Less Exclusions DIRECT
Total 1994 8 2osts not Indirect Salaries _and Other
Expenditures Allowed Costs Fringes Expenditures
EXPENDITURES 283,140,546
ROLL -FORWARD 46,103
STATEWIDE COST ALLOCATION PLAN 1992 RENT ADJ (5,012)
265,878,876
2,195,064
46,103
(5,012)
10,011,899 5,054,708
TOTALS 283,181,637 265,878,876 2,236,155 10,011,899 5,054,708
INDIRECT EXPENSE 2,236,155
DIRECT SALARIES 8 FRINGES 10,011,899
22.33%
951399
3.910.400 CSFP ADMINISTRATION INFORMATION - FORMS
1310.401 CSFP ADMINISTRATION REVIEW FORM - 5 PAGES
13.910.402 CSFP LOCAL AGENCY CERTIFICATION FILE REVIEW FORM
13.910.403 CSFP LOCAL AGENCY ACTUAL EXPENDITURES FORM
13.910.404 CSFP STATE AND LOCAL AGENCY EXPENDITURE PLAN
13.910.405 COUNTY QUARTERLY STATEMENT OF EXPENDITURES
13.910.406 COLO. DEPT. OF HUMAN SERVICES ORGANIZATIONAL CHART
SUMMARY OF NUTRITION EDUCATION PLANS
LISTING OF CSFP LOCAL AGENCY EQUIPMENT
APPROVAL AUTHORITY
951999
13.910.401
COMMODITY
SUPPLEMENTAL
FOOD
PROGRAM
Revised 4/95
LOCAL AGENCY
REVIEW FORM
951999
CSFP REVIEW FORM (4/95) LOCAL AGENCY
LOCAL AGENCY PROGRAM OVERVIEW
1. Who is responsible for what program responsibilities? List names, job titles and time
spent on CSFP.
Name
Job Title Time spent on CSFP
2. Are there any current vacancies or hiring problems? Yes No
3. Does the Local Agency administrator feel that present staffing is adequate? Yes
No
4. Are the State Plan of Operation and -Administration. information and policy letters on
file? Yes No
5. Does the Local Agency administrator have any recommendations to improve the State
Plan or Information Newsletters from the State? Yes _ No
6. Is -there a current copy of the signed CSFP Agreement on file? Yes No
7. Are there any program functions which are handled by another agency? If so, name the
agency/ies and functions involved.
Aaencv Functions
6. Is there an Agreement or Memorandum of Understanding -0n file between the Local
Agency and the sub -agency -outlining the program responsibilities of the sub -agency?
Yes No Comments:
9. Does the Local agency administrator anticipate any major program changes within the
next 12 months? Yes _ No _ Comments:
10. What changes would the Localadministratorlike to see implemented -for CSFP either on
a local, state or national level?
11. Other Local agency recommendations -for programs improvements:
State Aaencv Recommendations:
1
951999
LOCAL AGENCY CERTIFICATION PROCEDURES ... (Continued)
1. Are CSFP-certifications coordinatedmith health care services? Yes -No_
What types of referrals are made?
2. Are foods issued to new clients within 10 days of certification? Yes_No_
3. Is there a waiting list? Are proper waiting list procedures being followed? Yes
No What is your procedure?
4. Are persons found ineligible at the time of certification advised in writing with a DF-14
Notice of Adverse-Action/Rights of Appeal form? at -es_ No
5. Are persons found ineligible during thetertification period advised in writing with a
DF-14 Notice of -Adverse Action/Rights of Appeal form?
6. Has the Local Agency received any requests for a fair hearing? If so, what was the
outcome?
7. Are clients notified of the iilegalityiofidual participation? Yes No
8. Has there been any dual participation found? Yes No_ If o, what action was
taken?
9. Arexiients-given nutrition education information at each certification? Yes_ No
10. Aretlients advised of the CSFP nondiscrimination policy? Yes _ No
11. Are recertifications done at leastevery six months? Yes No
12. Are clients notified when their certification is -about to expire? Yes No How?
13. Are Verification of Certification cards issued to eligible CSFP clients who are
relocating to another-CSFP or WIC service area? Yes_ No_
14. What-accomodations has -the Local agency made for special populations, such as
migrants and non-English speaking populations?
15. After a -review of approximately 30 client certification files, were there any certification
errors? (Form attached) List findings below:
LOCAL AGENCY NUTRITION EDUCATIONT ROCEDURES
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?
2
951999
LOCAL -AGENCY NUTRITION EDUCATION PROCEDURES... (Continued)
3. Does the Localagency-haveassistance from other nutrition programs in the area to
provide nutrition'education for CSFP clients? Yes_ No
4. Are the nutrition education requirements of theState Plan of Operation -And
Administration being met? Yes No
5. Has the Nutrition Education Planteen submitted to the State agency for approval an a
timely basis,ty July 1 of each year?
6. Has the results of a particioantsurvev beensubmitted, along withfhe Nutrition Education
Plan which evaluates the effectiveness of the -previous year's nutrition -education?
Yes No
7. Was the most recent Nutrition Education Plan approved? Yes_ No . If there
were deficient areas, have they been corrected?
8. 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. Yes_ No_ How:
b. Specific nutritional -and -dietary needs of the CSFP client. Yes No
How
c. The CSFP food package is supplemental, not a total -food package. Yes,
No How:
d. Howtest to use the foods and their nutritional value to the CSFP client.
Yes No How:
e. The benefits of breastfeeding. Yes_ No_ How:
f. The importance of ongoing health care and - health care referrals. Yes_
No How:
9. Are any food demonstrations being conducted? Yes_ No If so, what typesand
how often?
10. What nutrition education materials have been developed by thelocal agency?
Attachsample copies.
11. Is the CSFP nondiscrimination statement printedron all nutrition education materials?
Yes No
3
951999
LOCAL AGENCY CIVILRIGHTS POLICIES AND PROCEDURES
1. Is the Local-agencyaware-of the -proper -nondiscrimination and civil rights complaint
process? Yes No
2. Is the nondiscrimination and civil rights complaint procedureprinted on all materials
given to CSFP-clients? Yes -No
3. Is the Localagency notifying the public at least annually -of the availability ofCSFP,
including the nondiscrimination and civil-rights complaint process? Yes_ No
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 eertifrcationand distribution
areas? -Yes No
6. Hasthelocal agency submitted the annual FNS -191 to the Stateegencymn a timely
basis? Yes No
7. Are CSFP-materials available for non-English speaking CSFP clients? Are translations
available? Yes No
LOCAL AGENCY DISTRIBUTION AND WAREHOUSE PROCEDURES
1. Are foods issued monthly or every two months?
2. Aftera review of the 30 client -certification files, were those clients issued the correct
food package? Yes_ No (See attached form).
3. Have the monthly inventoryreports (FNS -153's) been submitted to -the State agency on
a timely basis on the 5th of the month following the report month? Yes_ No_
4. Have the reports beenaccurate? Physically inventory and identify 3 -5 -items inthe
warehouse. ( ,, ( 1,1 1.
( ). Use the endingtalance 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? Yes_
No_ If so, what was the causeand howtras the problemteen resolved?
6. How is -normal warehouse damage disposed-ofandaccounted for?
7. How are foods distributed toxlients? Prepackaged _or grocery store concept_
8. Did the clientssign for foods received at the timeaf issuance? Yes No
4
951-999
LOCAL AGENCYIIISTRIBUTION AND WAREHOUSE PROCEDURES ...(Continued)
9. Are all foods in the warehouse stacked on pallets and away from the walls?
Yes_ No
10. Is there an underer oversupply of any items? Yes No
11. Are first in/filst out procedures being followed? Yes No_
12. Are pack dates- current? Yes No_
13. Is there a procedure formnonthly pest control? Yes -No
14. Are there thermometers in a114ry,sooledand frozen storage areas? Yes No
Isa temperature log being kept? Yes_ No
LOCAL AGENCYfINANCIAL PROCEDURES
1. Have the Quarterly Statement of Expenditure Reports been -submitted to the State
agency on a timelytasis,ty the 15th of the month following the close of the quarter?
Yes No
2. Has the Federal Fiscal Year Actual Expenditure Reportbeen submitted to the State
agencyion a timelytasis,-90 daysefter the close of the=FY? Yes_ No_
3. Does the Localegency have proper documentation 9f actual paid expenditures to
support the Quarterly Statements oftxpenditures submitted to the State agency?
Yes_ No_ If not, list areas of deficiencies below
Areal' expenditures allowable? Yes No
4. Did the Local agency receiveapproval-from the USDA and theitateagency forany
capitaloutlay purchases over $2;500?
5. Has the Localagency hada financial audit in the past two years? Yes No
What findings were there, if any?
Hasa copy of the financialaudit beensubmitted to the State agency? Yes_ No
6. Haveipayments to commercial distributorsleen madeen-a timelytasis? Yes No
7. Were the expensesxlaimed on the most recent quarterly report found to be
appropriate? Yes No
8. Hasa list of CSFP owned _capitalequipment-beensubmitted to the Stateagency in a
timely manner, by July 1 -of each year? Yes_ No
A current.Equipment List shall be provided to the reviewer.
9. Has the reviewer verified the equipment? 'Fes No
State Agencv Recommendations:
5
951999
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COLORADO FOOD DISTRIBUTION PROGRAMS
FEDERAL FISCAL YEAR 1995
Commodity Supplemental Food Program
Actual Expenditures
LOCALAGENCYNAME:
DATE:
Number -of Distribution Sites
Number of Certification Sites
ITEMS FUNDED
BY CSFP GRANT
General
Administration
Warehouse
Food Delivery
System
Nutrition
Education
Total
Full -Time Equivalent
(RTE) Staff Years
(A) Salaries and
Benefits
(B) Automated
Management Systems
(C) Space Utilization
(D) Equipment
(E) Supplies
(F) Communications
& Travel
(G) All Other
(H) Indirect Costs
(I) SUBTOTAL
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(K) Value of Staff
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-(L) Value of Other
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(M) Total Value of
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(N) TOTAL
PROGRAM COST
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951999
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551-999
STATE OF COLORADO
COLORADO DEPARTMENT OF HUMAN SERVICES
1575 Sherman Street
Denver, Colorado 80203-1714
Phone (303) 866-5700
TDD (303) 866-6293
FAX (303) 8664214
August 28, 1995
Ms. Lois Booth, R.N., Public Health Administrator
Conejos County Nursing Service
P O Box 78
La Jara, CO 81140
Dear Ms. Booth,
Roy Romer
Governor
Barbara McDonnell
Executive Director
Karen Beye
Managing Director
Thank you for taking the time to answer my questions concerning the 1996
Nutrition Education Plan. Your 1996 Nutrition Education Plan is approved.
The suggestions I have are, the meals cooked for your staff could be used as
-outreach; many people think that commodities are inferior products, the menu
could consist of all commodities, and the recipes developed could be
collected in a manual to give to the recipients. The staff would be asked to
spread the word about how nutritious and good the food was. Since many
recipients do not like the non fat skim milk, your project could develop
innovative ways to use this product in every meal, such as drinks, bakery
products, and vegetable dishes.
If you have any questions please call me at 303-620-4151
JPM
Sincerely,
Jgfirf Miller, RD,
ogram Specialist
Division of Aging and Adult Services
Malkdng Partnerships to Improve OPpof unities for Safety, selFsulllclency,, and Dignity for the People of Colorado
251999
TO:
FROM:
-MEMORANDUM
Lu Stofer
Donated Foods
Joan P. Miller, R.
Aging and Adult Se
DATE: August 14, 1995
SUBJECT: Check list for Commodity Supplemental Food Program Nutrition
Education Plans
Agency
I 1
Description of methods used.
24 hour recall
Pre and post test of nutrition knowledge
Sow does participant use this nutrition knowle
Nutrition assessment
Individual interview or nutrition classes
Description. of material
Materials are both in English and Spanish
Description of Staffing / /
-Registered Dietitian /�/,( lie
-Registered Nurse
Public Health Nutritionist
Paraprofessional, if supervised by CSU Extension Agent
or County Health Department
Must include the number of staff providing and their
classification.
At a minimum the agency must employ a
part-time nutritionist or-R.D.
Annual evaluation of program included with plan
Were elderly evaluated
-alas the information used in the preparation of the
annual plan -submitted
Participant Involvement
Were clients surveyed to determine what type
of education classes of information they would lik
Plan Approve
Corn
YES NO
951999
NU i RITiON EDUCATION PLAN CO vEJO_ COUNTY 1995-1999
Cone,os-County Nursing SeR'ice hes occupied the NEW BUILDING for one year and 4 months
-Have we become disallusioned cy the if cnlysand what ifs that usual y eefatl the new buildin;
owners Emphatically NOI Oh yes, we have recognized some areas that could have been
improvec such as venting the refrigeration unit for the CSFP ware house. cundinc a larger
building ;already??;I adding a few more closets etc etc. We still are enamored by our space.
the great :doatlen the parking (if does nave to 'The evnanded) grin most cf al: the vrtchepr
meeting room Having ail of this under one roof a marvelous vve are even talkiro tout
expanding, but of course the big issue is 'Who knows what Clinton and the Repuphoans are
going to do We like -every one else win wait catientr' or impatiently until something is workeu
out.
;OC TIONl_' PLAN
H:Iv 1• t_llvh
Our Agency is located about 1 mlie scutr, c''_aJai a, ano 13 mile north ct =tnterllto. Since
certification i5 a: our a_encyevery tnur 5da1'. it makes it convenient for most of the recipients to
pick JD commodities when they certify. We have not changed the floor plan ir: any way" Tne
Puiir'..g :a arCO - feet 7'0 Sd fast is ''saw for rr'SCD clot-= and -'irrfributicn.. _„Ia:
noi
space is needec: for certification 'raining ano :,Doti 1 1 :5 space totaJr so 1_
et
Office flours are o N. t::.--..30Pmcn-fri Commodity distribution is mor'.-thur-s -A L'I.-5.30P M
NUTRITION EDUCATION ANNUAL EVALUATION
See attaL c.. cope, ofevaluation questions it y-'res CSFP recipients were coked to avaluo e
the program The numoe'I of responses is tabulated. .,
CSFP STAFF
The Orre:oc County Nursing Service CSSrP staff ;s as follows, Laic Scorn A.drr:nistraror Angela
_ [� ._
aflcia;,c certification �'y a,LC- Romerodistrinuticri. June iy�al ICL. iuu rI LIVnISi
NUTRITIONAL EDUCA T ICN/TRAINING
June Martinez was hired in 1994 to help develop our nutritional plan It was not without struec.ies
and modifications'Na derided to prepare meats for the state Fach-≤toff mourner r• mrib :ea
• U. ,J -II IUitll IIIS : tLiliey IS 4JCU LV 4.4) :I It I.GJU a C.7 .all) VV' aL VVu u>'=J a. ..
the cos:. P.ii recipes are eve ,ua e( and fl speciai ones are out the monthly ' shone: J tits
CSFP clientsiSee=_ttacned newsletters Tr s-las turcec into an increo:oie experience. Not
oniv has this nroi ea to be an eye opener in many areastut it nas providec a -practical way O-
furnlSr.ing meats to a very busy staff
June prepared ;1503 meals for staff from Jan -JJre 1:7.)9.5 at a cost of J __r`. We nave ar. orcx
1-514 staff tnat now eat gaily so totai meats WII, increase. Staff nas Increased from 11 to )
house Tbserdat:ons ma: have bean -mace. Aromas are an integre: part or preparing ones
o ldest "e system T_-:ey have also provoked clients to go name and prepare similar meals
t -c auac ante::: a e -w. Staff th-at sped a uc , .,I ._ . the fieiden,jCy5 the maraderie
that comes from sitting down to a not mewl with friends. I i ;s^ practice has really provoked al:: of
us to work nerd a: flaying ramily meals a: horme evert though it is2 busy world -An early concern
was thatit wouid be Ard to have aiot anety. V'vith so many alot of ideas have been
generated along wi+,¢ cipe swappin ultural diversities nave beer explored. Cultural
sensitivities ha✓e. ieenjlscussed. Pr baring food Nit--; creative settings is important Canning
and freezing: with many staff members being involved is:being done thus fresh vspreserved
has given many -new msignts budging generat..on .daps. How do leftovers get used?
r.,._ i�
iv' - kl
951399
June has been an ,rrwaivaole reso.rrce to our Personal Care Providers. We haceapprioxlmate :
50 who go into the eideriies homes. Mealprepara:ior can be cifficuft if there isn't much food to
orepare if the client is notmungR'. if there isn't mucmtime, etc. Jane has-been acie to give t::em
ideas. the,. know they Can Ooh she trains new PCP's ann she has two classes a Year that they
along vvith the public can steno atone with the CISFP clients -The The f::st Cass was ir
demonstration or preparing Quinoa,(ctmplete protein grain; pamicar,-es -.vas p;asenteJ
Quinoa breadsamctes-hanoed cut for sampling. 25 attencea
June attended severai-lasses put on by tne-extensionnfrice.
Vie feet that win drproximately 100 empioyees, this arose _s -rites .'tine Our o:,treacr. a ane
touches 100's of lives The agency serves the county population c, ,:,PuLtlic Heath
programs involving children weft child Immunlzauons heads art. phys:ca.iy a:sablea_tens
pregnant moms, EPSDT etc.Ther, we naLe-Home Healtit. PCP's ,n_ Cc:,ors for Long e-,
Care wnicn was formervrll.E'S., Th-s not 'Joni: pan of Our.. ii-roiciianit has generate:: aid: of
interest on?nany':eiieis
Ytiiraits-r oranges ate ouiie:ir� o g OatG monthly it cibC with ':itciaw.c 2ii., i^.e neyysietter CiivP5 C! -.E
CSFP olients-sometninc to trunk do= every month.
NLITRiTIONAL EDL CATION OBJECTIVES
of tn_ s. -.29 19r -
All ,. „`.P ..=i2'_,.._n�-_ ;,,. _ _-, Vic. All of the objectives nave not been
completed. MVlany will continue to pe a part of this 1995-1gcio Dian
#1. Is being addressed by out-Pubiic health. staff th • ugh an nil-dr:iiatl r yiiiant
#2 3 The vestibule continues to be a woncertui area to aisseritinate iarcrmaaon.
#4 Thesurvey bemrid usec was excanoed to address_ other !ssLes as ,.Ayer and is :n the final
stage of compietior wlti, ire information also being shares worn the restructuring group
developed under H S.:005
#5.We continue to use the -medium foradkertising :ve purcr.aseo a sign that is caservaaie from:
hiohwa:2E5 to also advertise CST -P
#5 This training is going -on to work wroth young Moms
Our man objective for 19-9E--1.99-5 will be to focus on -education and increase numbers.
Complete previous committments and work -on a new evaluation form for 1996
EVALUATION
Monthly etters Ere erlclased. This was 1994 19955 educat-or,al too' a .,th tiimei
I - nc �, literature
that arr'vea Al: or the literature that was enclosed last ;ear was maceavaiiabie to the CSFP
clients aria wiij continue to be used in 1995-1996.
I feel our C-SFP program nes-grown tremeaousl'y' in Quality Ho,.' forti:neate ::e are to have so
many resources under one roof This year we rap continue to .,oar, or; Increasing :ne CSFP
clients.
951999
ANNUAL EVALUATION
(Jf
('.O'. E J C)S t:(')L'NTy (:' S F I,
WE W()('LL) APPRECIATE YOUR AS :1S'iANt'E IN EVALUATING THE r.O'.1MOL)ITV SUPPLE:1EN1:'.i.
PROGRAM BY ( 1 RCL I NG V:)LR ANSWER TO THE I OLI. OWI NU OLES•I I U`:• :
I. DO YOU RECEIVE ON(,O I NO NUTRITION F.DL UAl ION MATE1•:IAI.'.
A. VLS
F.. N') 3
- BLANK
ARE YoU SATISFIED WITH ;HE NUTRITION [.i)ICAi'ION '.;_,fFRI:;..'.
A. YES 28 ( COULD HAVE MORE 1 NFOR ,1.=.T I ON ')N
HOW TO CONV1: RT TO LESS I AT.
LOWER r'Al..l:R I i.S . I
B. NO
- BL.A::K
3. WHICH \\'OVLi► OU I. i lit=. T" kO\'. '.'RI
A. '.tIL1; ALL.ER(•►ES C.
H. FAST FuOE) NUTR: I It)'•.A .-AL.[:L
c'. HIH BLOOD I'i;ESSUI•:L. 12
I(.'. \ 1..I'1.T:S 4
J. ;1t)\t' T(. LOSE wiIGHT S
F. II'.I.kSE1uH'l/i NU1.1:WLi!iti'1 CHILD 2
NI'TR 1 T 1')NAL ‘.-;1.!.:L :7F ('Sf P PACKAGE
H. OTHER - ;-tiAIN WEIGHT I-t:OOkiNo FOR AL:,EROTLS
HAVE I'c►\1\1ODIT\ oF1I(.'E =•I.AFI REFERRED \'O1. TC• OTHER HEALTH
SF.R\ I r.'1 S OR A" I sl .-;r: 1 .'R►)t,RA •t:. WHIN NEEDED
LD':
A. VI:S It
F. NO .
1 E:N(i'I H OF \\'.A I i' l \t; "I i \IE TO RL'..E: I vE; Fr.)..)L i' \u .\uL
A. ('-2q M1N1'ILS .'it
i::. .+0-6U 'II :: L'TL.i
6. DISTANCE YOU TI A\ EI. TO i• 'AREST COM'1 0I;ITV SITE
A. LESS TFii.N 1() I LF S 13
R. I o-_4 :i I.l.s l-
c. '5-5;) '•i I L.ES 1
1). '.1ORF 1H.'.N 5U MILLS
IN THI. 1'ASi YEAR WHAT DID 1`r►i.' LIKE AttOUT
A. STAFF WAS I•R1F Dl.\' ?(;
B. :TAI F i.�:P'I.AFNCD 'iHiNt S 1\'LLL 1u
c. NUTR J 1' I (IN 'H ..Ai -H I NFURM.AT I ON S
D. RF.c'E1\ ING FOOD 14
F. cOM oDI T\_ C►1 F I.'E CLoS1•./COX\ F N I E T _
951999
S. HOW MAi Ti +1I.S A DAY DO YOU EAT '.'?.:iT.AliLLS AND I Rt.]--r •
OR DR1 tit: JUICES"
A. ON('E - 4 {.'. :HFL.E 'TIMES - h E. 1\'E O1: MORE TIMES - rt
t. TWIC.:E - 12 D. FOUR TIMES — c,
Do Yc;I' K\(1W YOU m1.'ST P: ('K I P SrHEDU .)O `s 'P� 1 ...£D T I. 'I•' fa i hUi � i
F ROM THE (.'OtilMOI) I : Y PRUORA M':
A. YES N
E. No
10. FOR
11
WH I''H FOODS DO \:)LNILE) I:NSTRUt' I iONS
A. I.\'APORAT L•I` \I 1 :.K
B. i)(fl 1.k:.l) MILK 13
C. RICL
D. EGOS S
E. DRY BLA.NS
F. CORNMEAL
U. HONEY
H. ''F.A::1:•F BL"a'fF:v 4
DO YOU USE THE RE L' I PES 6I \•L.": ".O Y(;L:':
A. YES 1,.
B. NO
C. SOMETI.'•1FS
A:.L 1ii..C: ; i'LS':
i2. HOW OFTEN DO Vol :5::•yc::K ')% 1IiINOS LIKE ..'AICES. POP. ETC.
A. F\'ER\ L):=.1' 1'
L. S PE(. I AL Ol'C :\T I TN S 13
C. OTHLE - I - ONCE IN A WHILE
1 - El'LI•'Y TW(. WLER5
I - N/A
1 - QQUITI. UI Tr::
1 3 . IN1 VOL' LIKE THE FOOL) SAMPLES PREPARED FOR ': Oi :'
A. Y}S
B. NO
C. BLANK 4
D. I HADN'T HA:: .\NY
14. ARF. WE PROV f); NO E\c)1'UH (:':'i.1 U RAL REC I PI S
A. YES 3(1
B. NO
C. BLANK
IF NOT. WHAT KIND OF RECIPES DO YOU :•:F.E7':
1 5 . DO YOU HAVE REC I PI S USING c:OMMOI) I T I ES THAT YOU WOULD LIKE
TO SHARE WITH US':
A. YES 2 ti.;:'.1f.. IDA :;AI.AZ AR . $43-;; 3:
B. NO 23
C BLANK 6
951999
I6.
YOU REELS' SOME
EGG MIX 1
DRY MILK 4
FOOD 1 TIMS . PLEASE Li S7 THE ITEMS BELOW:
CORNMEAL 1
BUTTER I
IF WE HAD A RECIPE CONTEST. WoULL, YoU PAR IC1 'AJE:
A. YES
B. NO 1A
C. MAYBE
NO1E: 1 INDIVIDUALS ItARTItIPATED IN THI: SURIEY.
951999
STATE OF COLORADO
COLORADO DEPARTMENT OF HUMAN SERVICES
1575 Sherman Street
Denver, Colorado 80203-1714
Phone (303) 8665700
TDD (303) 866-6293
FAX (303) 866-4214
August 28, 1995
Vivian Gallegos, Director
Costilla County Nursing Service
P 0 Box 99
San Luis, CO 81152
Roy Romer
Governor
Barbara McDonnell
Executive Director
Karen Bey.
Managing Director
Dear Ms. Gallegos,
The nutrition education plan for 19-96 was conditionally approved for the
following reasons:
There were no results to the nutrition evaluation. Your letter stated
that you were using the existing plan, and implementing changes as
needed and these changes would be included in next year plan.
If you are planning to make changes as needed, why aren't you using the
expertise of Katie Baer, R.D.?
Please submit the evaluation by Oct. 1 1995, and explain how you will utilize
the expertise of Ms. Baer.
JPM/scj
'ncerely,
!/ 7ti
AC
an Miller, RD
rogram Specialist
Division of Aging and Adult Services
Bulling Parinemhips to Improve Opportunities for Safely, Self -Sufficiency, end Dignity brills People of Colorado
951999
MEMORANDUM
TO: Lu Stofer
Donated Foods
FROM: Joan P. Miller,
Aging and Adult
DATE: August 14, 1995
SUBJECT: Check list for
Education_Plans
Agency
R.D.
Servis
Commodity Supplemental _Food -Program Nutrition
Description of methods
24 hour recall
Pre and post test of
How does participant
Nutrition assessment
Individual interview
Description of material
Materials are both in English and Spanish
used.
nutrition knowledge
use this nutrition knowledge
or nutrition classes
Description of Staffing
Registered Dietitia�
Registered Nurse
Public Health Nutritionist
Paraprofessional, if supervised by CSU Extension Agent
or County Health Department
Must include the number of staff providing and their
classification.
At a minimum the agency must employ a
part-time nutritionist or R.D.
Annual evaluation of program included with plan
Were elderly evaluated
Was the information used in the preparation of the
annual plan submitted
Participant Involvement
Were clients surveyed to determine what type
of education classes of information they would like?
Plan Approved
Corer s
1
-41c-frzaida-07-frotote„e A. -66_44e6
YES NO
951999
COSTILL A COUNTY
NURSING SERVICE
Post Office Box 99
San Luis, Colorado 81152
(719) 672-3332 or 672-4167
August u, 1993
LD STOFER
DEPT. OF ROMAN SERVICES
DONATED FOODS UNIT, 3RD FLOOR
1575 SHERMAN ST.
DENVER, CO 80203
DEAR MS 1.0 STOFER:
Enclosed is -the -nutrition -education plan Tor 1'995. This has:been developed
using *he existing -plan, implementing changes s. nPosed. Theta will be included
in the next year -plan. Any questions or:concerns please call my -office.
Sincerely.
atIbin
Vivian B. Gallegos 3+
CONS Administrator
951999
CIOc
''A&E
NUTRITION EDUCATION FY -95
The Costilla County CSFP Program will make -nutrition education
available to all adult participants and, when possible to the
children themselves at the time of certification. This nutrition
education -shall be thoroughly integrated into the program
operation in collaboration with the Costilla -county Public Health
Office to ensure that CSFP foods are used -properly, and that
adequate education is being provided to assist the recipients in
making wiser nutrition choices.
This will be done primarily through the following mechanisms!
A. pamphlets are distributed to participants -On the CSFP to give
up to date information and current health tips regarding
nutrition choices. These pamphlets -will be updated via the
Costilla County public Health -Nurse.
B. Recipes -to -aid in improved use of commodities to avoid waste
and encourage healthy choices.
C. Consult with the Extension Service to assist this agency in
providing nutrition education to -participants via video on
certification and recertification days.
D. At the time of certification, participants will to informed
that the program is only supplemental and not a total feeding
program. They are advised of seeking medical -care and of the
importance -of tot -al health flare for them and their families.
E. If there are any health problems identified during our
certification, they will be referred for -follow-up rto Costilla
County Nursing Service and WIC Program, Katy Baer- Registered
Dietician. participants will be advised of the times a
nutritionist will be available in the Costilla County area for
one-on-one counseling concerning special nutritional needs and
ways to provide adequate diets or, if the participants would
like, additional nutrition education. The certification center
can also crake -recommendations to the nutritionist for follow-up
on participants with special needs.
F. Referrals will be taken from Costilla County Public #Health
Office and the local clinics and requests for special nutritional
needs be reviewed by the Public Health Nurse and if possible
changes will be made to improve the participants nutritional
health. -Records will be kept at -the Costilla County Nur-sing
Service for review. bocumentation will -be put in both records.
G. The Costilla CSFP will annually submit to the State Agency -a
plan for implementation of -nutrition education for CSFP
participants.
H. Hand outs gill be available in English and Spanish whenever
possible.
951299
08/11/1995 15:57 7196723856 CONS
PAGE 04
I. Para professionals will be required to attend continuing
education hours when assisting in providing nutrition
information. Para professionals will be utilized only with
supervision of the Registered Nurse.
J. CSFP will participate in annual health fairs to demonstrate
healthy choices using CSFP commodities.
K. Food demonstrations will be ongoing on a quarterly basis. We
will take into account cultural, age, and special diets when
demonstrating these foods.
L. Nutrition plan will be reviewed this year closely by a
t< Registered Nurse and a pare professional. Changes will be made
where improvements are needed and implemented as needed.
Evaluation: The local agency will annually evaluate the program
to determine the effectiveness of the nutrition education. This
shall be accomplished by questionnaire on basic nutrition and the
use of supplemental foods. Homebound elderly will also
participate in the questionnaire. Survey enclosed.
951999
7 "367271: -
PAGE 5
WE WOULD APPRECIATE YOUR REPLY ON THIS SURVEY
1. Do you find the pamphlets useful? yes no
2. Are you getting the five food groups? _
(milk, meat, fruit, vegetable, and grain)
3. Are we providing enough cultural recipes?
yes no
yes no
4. Do you have recipes using commodities you would like to share
with us? yes no
5. Would you like to see nutrition videos? yea no
(heart, diabetes, and high blood pressure)
6. Do you use every food items you receive or is there some you
refuse? yes no
7. Is there something we could do to help serve the community
better?
8. Do you have any special dietary needs? yes no
9. Do you currently have any medical conditions that require
nutrition education? Would you want a one-on-one visit with
the Public Health Nurse to help with improved nutrition? If
yes, please call this office at 719-672-3323 for an
appointment.
It W the policy at the U.S. Dept. a Aptcwute
not to dNonninste to MMCII for nand
oeat colon la sok Solon. or rand
951999
STATE OF COLORADO
COLORADO DEPARTMENT OF HUMAN SERVICES
1575 Sherman Street
Denver, Colorado 80203-1714
Phone (303) 866-5700
TDD (303) 866-6293
FAX (303) 866-4214
August 28, 1995
Tony Quintana, Administrator
Denver County Food Assistance Programs
80 So. Anta Fe Drive
Denver, CO 80233
Dear Mr. Quintana
The 1996 Nutrition Education Plan is approved.
JPM/scj
Sincerely,
Jb�ff Ci1ler, RD
ogram Specialist
Division of Aging and Adult Services
Roy Romer
Governor
Barbara McDonnell
Executive Director
Karen Beye
Managing Director
_Bullring Partnerships to Improve Opportunities for Safely, Self -Sufficiency, and Dignity foram People of Colorado
951999
MEMORANDUM
TO:
Lu Stofer
Donated Foods
FROM: Joan P. Miller, R.D.
Aging and Adult Services
DATE: August 14, 1995
SUBJECT: Check list for Commodity Supplemental Food Program Nutrition
Education Plans
Agency/64."f�'
Description of methods
24 hour recall
-Pre and post test of
How does participant
Nutrition assessment
Individual interview
used.
nutrition knowledge
use this nutrition knowledge
or nutrition classes
Description of material
Materials are both in English and Spanish
Description of Staffing
Registered Dietitian
Registered Nurse
Public Health Nutritionist
Paraprofessional, if supervised by CSU Extension Agent
or County Health Department
Must include the number of staff providing and their
classification.
At a minimum the agency must employ a
part-time nutritionist or R.D.
Annual evaluation of program included with plan
were elderly evaluated
was the information used in the preparation of the
annual plan submitted
-Participant Involvement
Were clients surveyed to determine what type
of education classes of information they would like?
Plan Approved
Comments Plyinibs
YES NO
V
C-
•
•
xfinee A-.42 91-s
951999
JaE-..509P a.01
WeMass E X41:
Mayor
DATE:
TO:
FROM:
SUBJECT:
CITY AND COUNTY OF DENVER
DEPARTMENT OF SOCIAL SERVICES
FOOD ASSISTANCE PROGRAMS
INTER -DEPARTMENTAL CORRESPONDENCE
9Xasea*&As. aV.
Laramr, Ha Ream=
efiginspZ 2a -loans
Adaia error
August 14, 1995
Lu Stofer, State Food Distribution
Anthony R. Quintana, Administrator DFAP
1995 State Plan:
Paragraph #13.301.600, 1905 Nutrition Education
Subsection #13.301.640, Evaluation
Subsection #13.301.660, Participant Involvement
re: 1995 Participant Nutrition Education Evaluation
The 1995 Participant Nutrition Education Evaluation for Denver Commodity
Supplemental Food Program consists of the following:
1. An overview of the client interview questionnaire survey, given over
a period of 20 days (i.e. 07/05/95 through 08/01/95; Saturdays and
Sundays excluded) to 337 Denver CSFP clients (pp. 1-2)
2. The results of the client interview questionnaire survey (pp. 3-4)
Analyses of data obtained from the client interview questionnaire
survey (pp. 5-11)
4. Plan for 1996 data collection (p. 12)
1. OVERVIEW
The client interview questionnaire survey was given both in English and Spanish
(Russian and Vietnamese peoples were not surveyed, excepting those speaking
English). Questions from the client Interview questionnaire survey were
'Formulated to incorporate evaluation criteria required/recommended concerning
the content of such a data collection device, as per the language used in the
1995 State Plan of Operation, specifically paragraph #13.301.600, 1995 Nutrition
80 South Santa Fe Drive • Denver, Colorado 80223-1614 • Phone: 303/436-2800 • FAX: 303/436-2824
951999
Denver Department of Social Sevices
Food Assistance Programs
Commodity Supplemental Food Program
1996 Nutrition Education Plan
The Denver County Commodity Supplemental FOOd Program (CSFP) began distributing
nutritious food packages to pregnant women, postpartum women, children under six years
of age and seniors over 60 years of age in September 1989. We currently have a full time
registered dietitian on staff to implement our comprehensive nutrition education progrrtru.
The Nutrition Education Goals and Objectives in 1995 are as follows:
To promote the importance of a healthy diet and emphasize the relationship between
nutrition and health to program participants. To provide program participants with
applicable methods to acheive a nutritious diet. To identify clients that are at increased
health risk and provide appropriate services or referrals.
The following includes our nutrition education approach to each specific
client population.
Pregnant, post partum and breastfeeding women:
s AB pregnant, postpartum, and breastfeeding women will complete a nutrition
assessment questionnaire upon initial certification. Case Service Aides trained in nutrition
will screen clients based on this questionnaire.
If Case Service Aide detemines client to be at low nutritional risk, they will
proceed to discuss and provide written information on healthy eating during pregnancy,
postpartum and breastfeeding. Benefits of breastfeeding will be discussed with all
pregnant women upon certification.
If Case Service Aide detemines client to be at nutritional risk, they will proceed to
refer the client to the dietitian. High.risk clients include:
Clients with poor weight gain during pregnancy
Clients with gestational diabetes
Clients who are less than 18 years of age
Clients using alcohol/drugs or smolcinj during pregnancy
Clients experiencing significant GI upset
Clients with a history of giving birth to low birth weight babies
Clients with > 1 pregnancy in past year
Clients who may benefit from additional nutrition counseling
951999
* Case Service Aides will verbally rescreen nutritional status of clients at each
recertification session
if Case Service Aide determines that the client continues to be low risk, they will
proceed to provide additional healthy eating recommendations.
If Case Service Aide detentes the client is at nutritional risk based on rescreening
questions, they will proceed to refer the client to the dietitian.
Case Service Aides will refer previously "at risk" clients to the dietitian at
recertification sessions.
* Nutrition education classes will be offered on a monthly basis covering topics related to
healthy eating during this particular lifecycle stage Participants will be oared incentives
for attending.
• Written nutrition education material and individual nutrition counseling will be available
to clients on a walk-in or appointment basis.
Written material available includes -
Baby on the Way Basics Magazine
Eating For Two
Help Give Your Baby a Healthy Beginning
Healthy Foods, Healthy Babies
Give a Gift To Your Baby
Plan a Smoke Free Pregnancy
Breastfeeding For All the Right Reasons
T'hinlang About Breastfbeding.
Breastfeeding, Getting Started in 5 East Steps
Expressing and Storing Breastmilk
Diet Guide During Breastfeeding
Infants and children:
* Parents/guardians of all infants and children 0 - 6 years will complete a nutrition
assessment questionaire for each child upon initial certification. Case Service Aides
trained in nutrition will measure and weigh each child. This information will be recorded
on a growth chart. Case Service Aides will screen clients based on the questionnaire and
growth chart status.
if Case Service Aide determines clients to be at low nutritional risk, they will
proceed to discuss andprovide written information on healthy casing and feeding
recommendations based on age of child.
951999
4[1
If Case Service Aide determines clients to be at nutritional risk, they will proceed
to refer the client to the dietitian. High risk clients include:
Premature infants
Infants born weighing < 5.5 pounds
Infants/children with feeding problems
Infaitts/chiidren with•signifcant allergies or intolerances
Infants/children who are failing to gain weight or grow according to growth chart
7nfi its/children who are <25th percentile.ongrowth chart
Clients who may benefit from additional nutrition counseling
* Infants and children will be weighed and measured at each recertification session.
These values will be recorded. Case Service Aides will rescreen nutritional status of
clients based on these values and verbal information from parent/guardian
If Case Service Aide determines client to be at low nutritional risk, they will
proceed to discuss and provide additional healthy eating and feeding recommendation
information.
If Case Service Aide determines client to be at nutritional risk, they will proceed to
refer the client to the dietitian
Previously "at risk" clients will also be refeuxl to the dietitian at each.
recertification session.
* Nutrition education classes will be offered to parents/guardians on a monthly basis
related to healthy eating recommendations and techniques for infants and children.
Participants. will be offered incentives for attending.
* Written nutrition education material and individual nutrition counseling will be available
to parents/guardians on a walk- in or appointment basis.
Written material available includes:
Infant Feeding Guide
Feeding Your One Year Old
Food 5or Young Children 1 - 5
Baby Bottle Syndrome
Ways to Help Your Child Gain Weight
Eat the Five Food Group Way
Mom.. I Hate Vegetables
Prevent Fond Choking in
Baby Bottle Syndrome
Ways to Help Your Child Gain Weight
Eat the Five Food Group Way
Mom._.1 Hate Vegetables
Prevent Food Choking In Young Children
Vaccinate
S&1999
* Handouts and activities promotingleahhy_eating choices will be available to children in
the program
Material available includes:
CSPP/DenverNutrition Coloring Book
Let's Make aMeal
Score More With Breakfast
Brush Your Teeth At Least Twice A Day Chart
* Aaewsletter focusing on infant/child nutrition and feeding issues will be provided to all
parents/guardians of childrenin the -program on a quarterly basis.
* Several -sessions ofNutrition Summer Camp will be offered to program participants
aged 4 - 9years. Children will attend a free, one week camp program promoting healthy
eating habits, fitness andgood health.
-Seniors:
* All seniors will -complete a nutrition assessment questionnaire upon initial certification
Case Service Aides trained in Nutrition will screen clients based on this questionnaire.
If Case Service Aide determines client to be at low nutritional risk, they will
proceed to discuss and provide written information -on healthy eating recommendations.
If Case Service Aide determines client to be at nutritional risk, they will refer the
client to the dietitian. High risk clients include:
Clients with history-ofheartdisease, hypertension or diabetes
Clients with other diseases that may affect nutritional intake
Clients on MD -ordered diets
Clients experiencing unintentional weight loss
Clients unable to shop, cook or feed sell
Clients experiencing, significant decline in appetite/intake
Clients -that have > 3 alcoholic beverages/day
Clients who may benefit from additional nutrition counseling
* Homebound clients will re eiveand complete a nutrition assessment _questionnaire from
CSFP employee upon delivery of commodities. Dietitian will screen nutritional status of
-clients using these questionaires.
If -dietitian determines client to be at nutritional risk, she will proceed to contact
_client by telephone or home visit for further assessment
• Case Service Aides will verbally rescreen nutritional status of clients upon
recertification
If Case Service Aide detemines client continues to -be at low nutritional risk, they
will proceed to discuss and provide additional information on healthy eating
recommendations.
951999
If Case Service Aide determines client to be at nutritional risk, they will proceed to
refer the client to the dietitian.
Previously "at risk" clients will be referred to the dietitian upon recertification.
* Nutrition education classes will be offered on a monthly basis covering topics relevant
to particants in this particular lifeatage. Participants will be offered incentives for
-attending.
Written nutrition education material and individual nutrition counseling will be available
to clients on a walk-in or appointment basis.
-Written material available includes:
Determine Your Nutritional Health Questionnaire
Cooking For One or Two
-Eating For Your Health
Tor Mature Eaters Only
Making Healthy Choices
* A newsletter focusing on senior nutrition issues will be available to seniors in the
program on a quarterly basis.
General nutrition education services provided:
* Written nutrition education materials and individual nutrition counseling will be
available to clients on a walk-in or appointment basis. Nutrition education material will be
available in English and Spanish_
* Food demonstrations will be offered on a daily basis during peak hours of operation.
These demonstrations will show clients various ways to use commodity foods and
incorporate them into a healthy diet. Fact sheets on how to use specific commodity foods
will be available to clients. Recipes featuring nutritious ways to prepare various
commodity foods will also be available.
* Nutrition videos will be played daily in the certification waiting area to peak client
interest and provide additional nutrition education.
* Case Service Aide training will consist of completion of Nutrition Modules developed
by the Colorado Department of Health. These modules cover information on$eneral
nutrition, nutrition during pregnancy and breastfeeding, infant and child nutrition, and
dental nutrition. Case Service Aides will also participate in a weekly training session
covering information on senior nutrition needs, and client -screening and counseling
-techniques.
• The dietitian will participate in outreach events to educate eligible community members
on the benefits ofgood nutrition and the CSFP ,program.
951999
* The dietitian and Case Service Aides will be aware of community resources available to
clients and will make appropriate referrals as necessary.
TOTAL P.07
95199,9
6bb5d9 -.Cc.
e.Wati
Mayor
DATE:
TO:
FROM:
SUBJECT:
CITY AND COUNTY OF DENVER
DEPARTMENT _OF SOCIAL SERVICES
FOOD ASSISTANCE PROGRAMS
INTER DEPARTMENTAL CORRESPONDENCE
%Xc$aUn. at.
Direaloraiummaltesourras
s refer yR 2.rtfertrit
Administrator
August 14, 1995
lultofer, State Food Distribution
Anthony R. Quintana, Administrator DFAP
1995 State Plan:
Paragraph #13.301.800, 1005 Nutrition Education
Subsection #13.301.640, Evaluation
Subsection #13.301.660, Participant Involvement
re: 1995 P-articipant Nutritiontducation Evaluation
The 1995 Participant -Nutrition Education Evaluation for Denver Commodity
Supplemental'Food Program consists of the following:
1. An overview of the client interview questionnaire survey, given over
a period of20 clays (i.e. 07/05/95 through 08/01/95; Saturdays and
Sundays excluded) to J37Denver OSFP clients (pp. 1 2)
2. The results of the client interview questionnaire survey (pp. 13-4)
3. Analyses'of data obtained from the client interview questionnaire
survey (pp. 5-11)
4. Plan for 1896 data collection (p. 12)
1. OVERVIEW
The client interview questionnaire survey was given both in English and Spanish
(Russian end Vietnamese peoples -were not surveyed, excepting those speaking
English). Questions from theclient interview iuestionnairesurvey were
formulated to incorporate evaluation _criteria required/recommended concerning
the content of such a data collection -device. saner the lanouane_ased in the
1995 PLAN OF OPERATION -'CLJENTNUTRITION QUESTIONAIRE SURVEY RESULTS CONT.
951399
ducatior,, apsectors il AC, .aria. and #'2.. ".660, Participant
Involvement. -Client interview questionnaire survey evaluation criteria includes
-the following:
-a. Input from participants (including homebound elderly)
b. Survey content can include questions regarding:
-> Basic nutrition
-> The use of supplemental foods
➢ The types of nutrition education preferred
• The types of nutrition information preferred
Y Suggestions for improvement of service overall
-> The assessment of client satisfaction overall
1a_ INPUT
Direct input from clients was obtained using a questionnaire as a data
collection device.
1b_ SURVEY CONTENT
Client names and identification numbers -are requested initially to enable
the use of automated survey tools available within the client data base
-maintained by Denver CSFP's computer system. The first question,
- regarding eligibility status, is demographic in nature. Question two (2)
assess client satisfaction overall. Questions three (3) and four (4) not only
_assess client satisfaction, but also address basic nutrition (e.g. tends in
client taste, which can in turn improve service by affecting ordering
trends), the use of supplemental foods (e.g. often, foods that clients
refuse are products they have difficulty understanding how to use, which
can in turn spur the development of instructions regarding preparation).
Questions five (5) through nine (9) assess the types of nutrition education
and information preferred by clients, also indirectly involving suggestions
- for the improvement of service. Question seven (7) is'also a good
indicator of whether referral information for health maintenance services,
f ood banks, immunizations, etcetera, is being properly disseminated
t hrough daily staff contact with clients. Question ten (10), regarding the
ease of client access to transportation, also addresses client satisfaction.
For corroborative reference of the preceding, please compare content
narrative to the numbered questions in section #2, entitled RESULTS OF
THE CLIENT INTERVIEW QUESTIONNAIRE SURVEY, which follows the
SURVEY CONT-ENT subsection.
2
TOTAL P.-02
9519
?r'r:' 098 _.. NN.'.
wee,a•S.area
Mayor
CITY AND COUNTY -OF DENVER
DEPARTMENT OF SOCIAL SERVICES
-FOOD ASSISTANCEPROGRAMS
INTER -DEPARTMENTAL CORRESPONDENCE
911oaal/aldu.
Director, ilumaassources
,4an6 R. -2tact
Atalanta
DATE: August 14, 1995
TO: Lu Stoler, State Food Distribution
FROM: Anthony R. Quintana, A-dministratorDFAP
SUBJECT: 1995 State Plan:
Paragraph -#1_3.301.6O0, 1995 Nutrition Education
Subsection #13.301.640, Evaluation
Subsection #18.301.660, Participant Involvement
re: 1995 Participant Nutrition Education Evaluation
The 1995 Participant Nutrition Education Evaluation -for Denver Commodity
Supplemental Food Program consists ofthefollowing:
1. An overview of the client interviewsluestionnaire survey, given over
a period of 20 days (i.e. D7/05/95 through 08/01/95; Saturdays and
Sundays excluded) to 337 Denver CSFP clients (pp. 1-2)
2. The resultsofthe client interview questionnaire survey (pp. 3-4)
3. Analyses of data obtained from the client interview questionnaire
survey (pp. 5-11)
4. Plan for1996 data collection (p. 12)
1. OVERVIEW
The client interview questionnaire survey was giventoth in English and -Spanish
(Russian and Vietnamese peoples were not surveyed, -excepting opting those speaking
English). Z2uestions from the client interview questionnaire survey were
formulated to incorporate evaluation criteria required/recommended-concerning
the -content of such a data collection device, as per the language used in -the
1995 State Plan of Operation, specificallyiparagraph #13.301.600,1995 t y(rition
10lsouth Sart Fc Drivc • Denver,Colorado 10223-1614 • Phone: 303/4367800.4AX: 303/436-2824
951999
1995 PLANDF OPERA110N- CLIENT NUTRITION QLESTIONA1RESIIRVEYRRESULTS CONT.
Education, subsections413.3D1.640, Evaluation and #1-3.301.800, Participant
Involvement. Client interview questionnaire -survey evaluation- criteria includes
the following:
a. Input from participants (including homebound elderly)
b. Survey content can include questions regarding:
➢ Basic nutrition
➢ The use -of supplemental foods
• The types of nutrition education preferred
• The types of nutritioninfomsationpreferred
• Suggestions for improvement of service overall
D Theassessment of client satisfaction overall
la. INPUT
Direct input -from clients was obtained using -a questionnaire asa data
collection device.
1 b. SURVEY CONTENT
Client names and identification numbers are requesteu uunallylo enable
the use.of automated survey toolsavailable within the -client data base
maintained by DenverCSFP's'computer system. The first question,
regarding eligibility status, is demographic in nature. Question two (2)
assess clientsatisfaction'overall.-Questions three (3) and four (4) not -only
assess client satisfaction, but also address basic nutrition (eg. trends In
client taste, which can intum improveaervice byaffecting'crdering
trends), the use of -supplemental -foods (n g often, fonds that clients
refuse are-productsthey have diffrcultyunderstanding how to use, which
can in turn spur the'development of instructions regarding preparation).
Questionsfive (5) through nine (9) assess thetypes of nutrition education
and information preferred by clients, also indirectly involvingsuggestions
forthe improvement ofservice. Question seven (7) is also a good
indicator of whether referral informationior health maintenanceservices,
food banks, immunizations, -etcetera, is being properly disseminated
through daily staff contactwith clients. Question -ten (to), regarding the
ease of client access to transportation, also addresses client satisfaction.
for corroborative reference'of the preceding, please compare content
narrative to the numbered questions Insectlon #2, entitled RESULTS DF
THE -CLIENT INTERVIEW QUESTIONNAIRE SURVEY, which follows the
SURVEY DONTENTsubsection.
2
9.5999
�`i FiC'.�Yltir
1995 PLAN OF -OPERATION -CLIENT NUTRTLmON OUESI'IONAIRE SURVEY RESULTS CONE.
2. RESULTS OF CIENT INTERVIEW QUESTIONNAIRE SURVEY
Client Satisfaction Survey
1. Please check your program-eligibilitytatus.
a.
b.
c.
d.
e.
24% Senior
3% Pregnant
1% Breast-feeding
26% Infant (0-1 year)
46% Child (1-5 years)
2. How would you describe ourservices?
a. 68% Very Good
b. 31% Good
c. 1% Bad
d. 0% VerySad
3. Whichonesupplemental food item do you regularly refuse?
a. 24% dry milk
b. 13% -egg mix
c. 4% farina
d. 1% dry cereal
e. 2% instant=otatoes
f. 0% milled rice
.2% dry beans
It 0% canned fruit
1. 0% canned vegetables
J. .8% -canned meat
g.
4. Why do you refuse it?
a. 15%
b. 29%
c. 15%
d. 41%
k.
I.
m.
n.
o.
p.
9•
r.
1%
-evapuraled milk
.8% canned juice
14% cnm meal
.2% butter
.8% peanut butter
.2% formula
1% infant cereal
37% none
I don't know how to use it
I don't like it
I receive -too -much per month
I don't refuse anything
5. Do you take the available recipe andfact'sheets?
a. 30% I always take them home to use in my cooking
b. 39% I sometimes take -them home to use in my cooking
C. 31% I seldom take them#wme to use in my cooking
3
951999
1995 PLAN OF OPERATION - CLIENT NUTRITION QUESTIONAIRE SURVEY RESULTS CONT.
6. Have you watcheda food demonstration or tasted a food sample made by
the nutritionist?
a. 40% Yes
b. 60% No
7. Have you beenxgiven information aboutanyLther services such as food
stamps, food banks, share, child immunizations, or where to go to get
medic -al care?
a. _61% Yes
b. 39% No
8. Do you -want to learn moreabout nutrition and Looking with the
supplemental foods?
a. 62% Yes
b. 38% No
0. What one form of nutrition information would yuu benefit moat from in the
future?
a. 54% more-rscipesandfactaheets
b. 9% more food demonstrations
c. 12% nutrition games and activities fur children
d. 3% nutrition videos
a 16% nutrition newsletters
f. _ 6% private counseling
10. Do you have a difficultiime getting transportation to pick up your
commodities?
a. 33% Yes
b. 67% No
4
951999
JJbbserb, -.06
1995 PLAN OP OPERATION - CLIENT NUTRITION QUESTIONAERE SURVEY RESULTS CONT.
3. ANALYSES OF DATA OBTAINED
The following is a detailed analysis ofall data obtained -as a result of giving the
client interviewquestionnairesurvey. All percentage points were rounded to the
nearest integer, with the exception of those that range belowa whole percentile
which arexiecimaliaed. Analyticalassessments werexieduced from method of
tabulation as -expressed inihe following mathematicalstatements,
337+10O=3.37; (response-totals=M Count) -M Count+3.37=x%; x%=given
percentiles; margin of error=.6%.
3a. QUESTION#1
The greater majority of clients served -are thoseages 113 (46%), tollowed
by infants ages 0-1 Year (26%) and seniors (24)%). Pregnant (3%) and
breast feeding (1%) women make up the population least servedty
Denver CSFP.
SPECULATIVE ASSESSMENT:
The low percentile points for pregnant -and breast feeding women can be
directly attributed to Denver WICserving those individuals whom they
have determined to be priority -one, high -risk clients — that is, Denver WIC
has determined that-allpregnantand-breast feeding women are at risk.
This determination was made without the input of Denver CSFP and steps
are being taken to regain the participation of these particular population
groupings. Evidence offhisassumption may be obtained by reviewing
correlative data involving decreasing participation figures and funding for
Denver CSFP in the area of pregnant and breast feeding women and
increasing figures in the sameareas for Denver WIC.
3h. QUESTION *2
Thegreater majority of participants agree thatiheaervices rendered by
Denver CSFP are verygood (6t3%), tollowed by those clients -who rate
services rendered as -good (31%). Only oneperoent (1%) indicated that
services -rendered were bad and no clients rated servicesas very bad.
SPECULATIVE ASSESSMENT:
Given hat a very high level ofolient satisfaction is reflected in thegiven
percentiles, it can beassumed that Denver CSFP is exceptionallyadept-at
delivering qualityclient service. This assumption contrasts sharply in a
positive manner -with current public opinion concerning government
services rendered in America today.
5
951999
1995 PLAN OP OPERATION -CLIENT NUTRITION QUESTIONAIRE SURVEY -RESULTS CONT.
3c. QUESTION #3
A littleover one-third (1/3) of those clients surveyed refuse no food items
(37%). Dry milk wasthe most refused item (24%), followed by corn meal
(14%) and egg -mix (13%) respectively. Farina received four -percent
(4%), followed by instant potatoes at two-perc-ent (2%), dry cereal,
evaporated mild, and infant cereal, all atone -percent (1%). Canned meat.
canned juice, and peanut butter all -received percentage points of less
thanonepercent (specifically .8%). Likewise, dry beans, butter, and
formula also fall below the one -percentile mark (specifically .2%).
SPECULATIVE ASSESSMENT:
Those who -refuse no -rood Items (37%) are obviously satisfied with _all food
products being distributed by Denver CSFP, possiblya reflection of
current economic trends and public -concerns regarding possible
economic downturns. Please see subsection 3d for speculative
assessment forpossible reasoning behind -client refusals.
3d. QUESTION #4
Almost one-half (1/2) of participants surveyed do not refuse items (41%).
Almost one-third (1/3)of participants-surveyed-agreethatthe reason they
refuse items is because they -don't like the products (29%). Almost one-
third (1/3) of those surveyed indicate that they refuse food items either
because they don'tdcnow-how to use the products (15%) orTeceive too
much per month (15%).
SPECULATIVE ASSESSMENT:
Given that thexgreater majority ofparticipants (41%) never refuse food
Items, a deductioncanbe made that most clients havenoxirfticutties with
the food Items distributed by Denver CSFP. Dislike of certain food items
(29%) is the -primary reason clients seem to refuse food items suchas dry
milk, corn meal, and egg mix, followed by -those who either don't know
how to use the items (15%) yr believe they -receive too much of the
products per -month (t5%)_ Adirect correlation exists between the dislike
of certain foods and a lack of understanding of how to use the foods,
which in turn can mean -that the products, if taken, go unused in -client
households, possibly leading to the incorrect conclusion (on the client's
part) that too much is received each month.
For example, a client may not use the egg mix received because the taste
of dehydrated eggs is somewhat different to -the adult pallet than is the
taste -of fresh -eggs. after growing accustomed throughout life to eating
'6
O
951999
1995PIAN OF OPERATION- CLIENT NUTRITION QUESTIONAIRE SURVEY RESULTS CONT.
fresh, as opposed to dehydrated eggs, the general conclusion clientsiend
to draw is that they dislike dehydrated -eggs and so refuse the item
thereafter. However, when apprised ofthefact, either through literature -or
client/staff communication, that dehydrated eggs can be used in many of
the culinary applications clients regularly engage in on a -daily basis, such
as French Toast, cake making, quiche, pancakes. breading coagulant for
frying preparatory measures, etcetera. In short, when clients are informed
that dehydrated eggs can be used in much the same way asiresh eggs,
often this item ceases to become a refused item.
Likewise, in their refusals of dry milk , there is no direct indication that
clients do not like the product, but they could be using the prescribed
mixture of evaporated milk and dry milk incorrectly, showing a preference
for richer tasting milk drink than the prescribed mixture yields.
Contributing -to the disparate refusal percentiles in dry milk (24%) as
opposed to evaporated milk (4%) may reflect the fact that clients are mere
apprised of how to use evaporated milk in cooking and baking, lowing to
ongoing aggressive advertising campaigns set funward by Uie
manutactunng arm of Carnation Evaporated Milk (i.e. for years, this
manufacturer has included in their advertisements recipes involving the
use of evaporated milk in cooking). These same measures were not as
aggressivelypursued in advertising for dry milk, meaning clients need -to
be made more aware that dry milk can also be used in cooking and food
preparation, not just as a drinkable food product.
3e. QUESTION #5'
The survey population was divided very nearly in thirds concerning the
use of recipe and factsheets. Thirty -nine -percent (39%) of clients
surveyed indicate that they sometimes take recipe and fact sheets for use
in their home cooking, following by those who seldom do so (31%) and
those who -always do so (30%)Tespectively.
SPECULATIVE ASSESSMENT:
Most clients do take advantage of recipe and fact 5heet5 'concerning the
use of supplemental foods, whether it be consistently (30%) or
occasionally (39%). Almost one-third (1/3), however, seldom take
advantage ofthese available items (31%). The deduction is then that,
while a -majority of clients use this education literature, nearly one-third of •
those surveyed are not being reached regarding the importance of such
literature in their cooking with supplemental foods and so -could be
basically unclear -about how to use certain food items distributed.
Supermarkets tend to display recipes for food items beside the bin
whichcorresponding food items are stocked. Currently, efforts to set up
7
951999
1r !.. 9F
1995 PLAN OF OPERATION — CLIENT NUTRITION QUESTIONAIRE-SURVEY RESULTSY.ONT.
such displays are being made, which might help clients better understand
how to use commodity food products.
3f. QUESTION'6
S'ixty-percent (6D%) of those surveyed have never seen a food
demonstration nor have tasted a food sample made from afood
demonstration. Forty -percent (40%) of thosesurveyedihaveseen a food
demonstration and have -tasted a food sample made from a food
demonstration.
SPECULATIVE ASSESSMENT:
While the -greater majority -of survey -participants indicate that they have
never -watched or tastedanythingpwduced from a food demonstration, it
must be noted that Denver C5FP#Iastiad. axlifficulttime in keeping an
on -site -nutritionist whotan perform food Demonstrations, _owing to the lure
of higher paying positions with Denver WIC. Denver C& l' has taken
steps to correct this -difficulty in seeking iv raise thebase-salary for the
CSFP nutritionist and by uppradingihe position from a nutritionist-toa
registered -dietitian, which carries with ittrrorestringent hiring criteria.
3g. QUESTION47
Over one-half (1/2) d those participants surveyed indicated -that they are
receiving referrals to outsideservices asper required protocol (611%). A
IittleDver one-third (1/3) surveyed indicate that they receive nosuch
referrals.
SAECULA11VE ASSESSMENT:
While the greater majority -of thosebeing served are being referred to
outsidemervices as per -required protocol,one-third (1/3) are not being
reached, suggesting that -either Denver CSFP is -failing -to disseminate
such informationas required-orare giving referrals only to -those who
request said referrals. Steps are being taken to correct this problem in
keepingstaff apprised of thefact that they are required to offer clients
referrals to outsideserviees or -agencies whether asked forcer not-andDy
experimenting with various -advertisement mailing techniques -designed to
inform clients.
3h. QUESTION48
Sixty -two -percent (62%)of thosesurveyed indicate that they'are ve
interested in learning more about nutrition and Looking with supplemental
s
951999
Ir.-
1995 PLAN OF OPERATION - CLIENT NlrrRION QUESTIONAIRE SURVEY RESULTS CONT.
foods. Thirty -eight -percent (38%)surveyed indicate they ere not
interested.
SPECULATIVE ASSESSMENT:
Most participants are interested in learning more about nutrition and
cooking with supplemental foods. Thirty -eight -percent (38%) indicate -that
they are not interested, which could mean that theytiave no interest in
learning about how to better provide for the -nutrition of themselves -and
their families; however, a more plausible answer could be found in two
alternate explanations:
Clients are not being aggressively pursued through advertising oT
theienefits of the nutrition education being offered or the
information that canoe obtained through _classes in cooking with
supplemental foods. One reason -for -this could be that Denver
CSf P's 1295 Cooking Classes were postponed due to
complication regarding liability insurance, a problem Denver CSFP
Is taking steps to solve.
It is possible that the survey results were skewed by factors
involving human error and basic communication. For example,
adults who have literacy problems and who are given a survey to
complete will sometimes check the first item in each category,
hoping it to be a positive answer, rather than explaining that they
are unable to read the survey. In addition, those clients who are in
-a hurry will often respond much in the same way.
Thesedifficulties in:urveytaking methods revolvearound
problems inherent in multiple-choice questioning -techniques and
may be solved by changing the artier of responses available and
combining multiple-choice questions with questions requiring
-written responses#hat are tagged with and correspond to particular
values. The values could then beJigured in at a later -date by those
tabulating the resultsof the survey.
at. QUESTION #9
Over one-half (1/2) of thoseparticipants surveyed indicate that they -would
most like to -have available in the -future more recipe and factsheets
concerning nutrition and the preparationet supplemental foods (54%).
Sixteen -percent (16%) would prefer to have available nutrition
newsletters. Twelveipercent (12%) would prefer more nutrition gmmn
and activities for children. Nine -percent (9%) would like more food
0
9
951999
1995 PLAN OF OPERATION -- CLIENT NUTRITION QUISTIONAIRESURVEY RESULTS CONT.
demonstrations and six -percent (6%)more private counseling. The least
-desiredfutureclient benefit ismore nutrition videos (3%).
SPECULATIVE ASSESSMENT:
Most clients -prefer having -more recipes and fact sheets available to them
to take home. Although nutrition newsletters, -games and activities for
children, food demonstrations, private counseling, and nutrition videos
seem to be lessened in demand by the desire for more basic literature on
thesupplemental foods themselves, it should be noted that mostpeople
do not go to a food distribution outlet with the idea of spending a great
deal of time. All client benefits beyond giving recipe and nutrition
literature involve clients staying at the facility to engage in activities in
-addition to the time they spend picking up -their food and certifying.
This behavior is a reflection of the fact that must -Denver CSFP clients are
not public assistance -recipients, but work and so have very little time to
manage their households, let alone make themselves available for
activities not associated with work or child-care. This means there:re
likely otherfactors in playbeside the promotion of (or lack of promotion as
the case may be)clientbenefits.
The lack of interest in nutrition counseling could be the result -of actual
-disinterest; however, it could also be a reflection of society's view of the
term counseling, which can have -negative connotations. The term
counseling is viewed as negative possibly because the terms
psychological counseling and legal _counseling often prompt negative
reactions. The terms are -also generically referred to in these professions
(especially in -the case otpsychological counseling) simply'as counseling.
In general, people don't like to be counseled, unless court ordered to do
-so. They done mind being advised, but they don't like to be -counseled.
Although the two terms are virtually Interchangeable, -advised carries an
air of choice, whereas counseling has a more ominous sound, suggesting
the idea of being compelled through necessity ofsome sort.
31. QUESTION #10
The greater majority of participants surveyed indicate that the availability
-of transportation is not an issue when comingtopick up supplemental
foods (67%). Just over one-third (1/3) of participants surveyed indicate
that they do in fact have difficulty finding transportation to the main facility
(33%).
951999
1995 PLAN OF OPERATION- CLIENT -NUTRITION QUES IONAIRE SURVEY RESULTS CONT.
SPECULATIVE ASSESSMENT:
While most clients do -not have problems finding transportation -to the main
facility, one.third those surveyed indicate transportation is a problem.
Denver CSFP is looking into acquiring the means to regularly transport
those -expressing that they are having transportation difficulties.
0
11
951299
-23-:l o - c • v
1995 PLAN OF OPERATION — CLIENT NUTRITION QUESIIONA1RE SURVEY RESULTS COM.
4. PLAN FOR 1996DATA COLLECTION
The 1996 client interview questionnaire survey will include postpartum clients as
testisubjects. Three different types of surveys will be given to -the following
groups:
➢ • Clients coming to the facility
➢ . Homebound clients
Y Elderly clients living outside Denver City and County
The surveys will be given in three separeteinonths of the year (not yet
determined which months will beselected). Thesurveys will be given to fully 1/4
of all clients maintained in the Denver CSFP client database. Questions used in
the client interview questionnaire survey will be formulated to Incorporate
evaluation criteria required/recommended -concerning thecontent ofsuch a -data
collection -device. as per the language used In the 1998 State Plan of Operation
The content -of the three surveys will reflect concerns involving the use of
multiple-choice questions, also,the order of -the responses available will be
changed — that is, the order of theTeeponses available in the 1996 surveywrll
bexiifferentthan that used in the 1991 -surveys.
12
60
951
TDM_P9 .1
9
M E M O R A N D II M
TO:
Lu Stofer
Donated Foods
FROM: Joan P. Miller,
Aging and Adult
DATE: August 74, 1995
SUBJECT: Check list for Commodity Supplemental Food Program Nutrition
Education Plans
Agency _
Description of methods ued
24 hour recall
Pre and post test of nutrition knowledge
How -does participant use this nutrition knowledge
Nutrition assessment
Individual interview or nutrition classes
Description. of material
Materials are _both in English and _Spanish
Description of Staffing
Registered Dietitian
Registered Nurse
Public Health Nutritionist
Paraprofessional, if supervised by CSU Extension Agent
or County Health Department
Must include the number of staff providing and their
classification.
At a minimum the agency must employ a
part-time nutritionist or R.D.
Annual evaluation of program included with plan
Were elderly evaluated
Was the information used in the preparation -of the
annual plan submitted
Participant Involvement
Were clients surveyed to determine what type
of education classes of information they would like?
Plan Approved Comments Ajar.24- Lac' -teeD/'
YES/, NO
951999
SUPPLEMENTAL FOODS (NUTRITION -PLAN _JULY 1995
MESA COUNTY -HEALTH DEPARTMENT
The supplemental food program for Mesa County -is managed by the Mesa
County Health Department. The determination of eli-gibility and
certification of clients for the women, infants and children's -portion
of CSF-P was processed -at the MCHD until May of 1995. The program for
the Elderly is managed at the warehouse where the CSFP commodities are
stored and dispensed to the clients.
During an evaluation of our CSFP by a Masters in Nursing student in
1954 it was noted that 30% of the cli-ents who certified for
commodities did not pick up their foods. It was decided to move the
certification process to the warehouse in an attempt to increase
caseload by that 3-0%. This change took place in May of 1995.
Mesa county's current caseload i-s 19100 for women infants and children.
The client -makes an appointment and is seen for certification within
10 working days. As of May 1995 theactualwaiting time was 2 working
days. We do not have a waiting listat-this time. Mesa County CSFP
warehouse is open for client pickup 9 or -more -days per month and with
certifications now being done at the warehouse cli-ents are served at
the time of their recertification. The program is managed by a
supplemental food clerk [28 hrs/week] under the supervision of Larry
Chynoweth the CSFP director. We provide evening hours for client
certification until f:0D pm three evenings per week to serve our
clients who work. The current CSFP clerk has been with the program for
several years and we do try to have her attend some inservices on
nutrition. We also have a dietician at the MCHD to evaluate nutrition
literature and be available as a consultant for the CSF-P clerk. -The
dietician can also see clients in need of special nutritional advice
on a limited basis.
The client is assessed as to eligibility for CSFP and is given
information that the program is a supplemental rather than a total
food program. The client is also asked about special nutritional needs
for any participant and is told of the importance of the foods being
consumed by the person they are prescribed for. Attached is the
documentation sheet and the items will have the dates entered when
these items have been discussed. #1
The client is given a questionnaire to complete at -each visit [see
att-ached] # 2. Part of that questionnaire has a diet recall for
participants. The remainder of the questionnaire is to assess family
health and their ability to get care. The questionnaire also addresses
growth and development, substance abuse and learning problems.
On the first certification -visit the client is given the information
required by the CSFP protocols. [food stamp information, child support
enforcement information, SSI. and medicaid assistance] #3
951999
The Mesa County CSF2 program was fortunate to have a student in the
CU. Masters of Science in Nursing -Program who did an evaluation of our
program in 1994 and some of the suggestions were as follows.
1: Evening hours at the warehouse. We have evening -hours until 6:pm
three evenings per week.
2: More _recipes at the warehouse. We have -made more recipes available
to the clients and the Tri - Ztiver Extension office has developed a
CSFP cook book that we intend to use for all new clients to the
program. This rook book contains tips on shopping, storing food,
handling and how to prepare CSFP foods as well as recipes # 4
3: Better map and directions to the warehouse. We are now doing the
certifications at the warehouse so this is no longer a problem.
4: Do a survey if possible to find out reasons certified clients fail
to pick up their CSFP commodities. -To help with this problem
certification was moved to the warehouse in May of 1995.
5: Try to address parking problems. This continues to be a concern and
the MCHD is looking for better facilities to house the CSF.P.
7: Classes at the warehouse. 7heplans for cooking demonstrations are
still being considered but the facility must meet all MCHD food
handling requirements and we are working on being able to meet those
requirements.
The client questionnaires for one month were -evaluated and the
following information was found.
1. 901 of children in families receiving CSFP were current on their
immunizations
2. '72% of children had Health Insurance and 61% of the insured had HMO
coverage, 4 were on the Colorado CHP.
3. 25% of respondents had health care concerns but only 1 respondent
did not have a heath care provider.
4. 44% of people needed dental care, &% had concerns regarding their
child's growth and development and 1-0% had some nutrition concerns.
5. 5D% of CSFP families contained a smoker and only 101 of the smokers
were interested in information regarding effects of smoking on family
members or information on smoking cessation.
6. 67% felt they received enough recipes and 22% felt they could use
more recipes.
The findings on a client survey of the csn, for the last month
indicated the following:
1. 93% reported receiving nutrition information and 95% felt the
nutrition Education was useful to them
2. 76% of people traveled 10 miles or less to pick up their food. 77%
rated friendly staff as what they liked best about CSFP with food
products second at 6D% and location and nutrition -education third at
32%
3. 43% of people have pop and sweets daily 33% eat fruits and
vegetables three times a day, 27% twice a day with 10% once a day and
four or more times per day.
4. 93% of the people surveyed used recipes provided.
5. -The CSFP recipients would like more information on, picky eaters,
children's nutrition, infant nutrition and the nutritional value of
the CSFP food package.
6. Foods reported as a problem to use are in order, canned meat,
evaporated milk, powdered milk and dry eggs.
951-999
NUTRITION EDUCATION
Nutrition education is provided by the CSFP clerk at the time - of
certification to the responsible adult as applicable to the individual
situation. The questionnaire is reviewed including diet recall and
services the family needs to be referred to. Nutrition education is of
course tailored for the person receiving the commodities.
Ereastfeeding would be encouraged for a pregnant client and
information on dietary needs of the pregnant woman would be given to
the client.[see attached information # 5 ] Clients have an opportunity
to ask questions and recipes are given to the client to use [It has
been found from - our survey that clients have problems using canned
meat, evaporated milk, powdered milk and egg mix. The nutritional
value of the commodities are -discussed when time allows [calcium in
milk , Vit. C in juice etc.] We are using the food pyramid in our
nutrition education and use many of the WIC materials as hand outs
[see attached # 6] Clients are given information on food stamps to
increase their ability to buy nutritious foods to round out their
diet. Recipes are available at the warehouse for clients to chose and
take home with them on all CSFP commodities.
On each recertification visit a nutrition topic that is pertinent to
the client is discussed. For example, a newborn on formula would be
given information as to how much formula that baby requires in 24 hrs
and a food guide for the first year. Correct mixing of formula and
cleaning of bottles would be discussed. The postpartum mom would be
given diet information and be referred to services such as medicaid or
CCHP for the baby, immunizations and family planning services for
herself. If the mother has many concerns a referral to a public health
nurse is made. When that client returns in 6 months the questionnaire
is again reviewed for concerns and at this time discussing solids ,
introducing the cup and preparing baby foods may be the topics
discussed. When that client returns at 1 year of age the questionnaire
is again assessed for concerns that would be dealt with and safety
concerns and diet in the first year may be the topics for discussion.
The nutrition education is tailored to meet the needs of the client at
that particular moment in time. Literature is available on main
nutrition topics in both Spanish and English and ethnic practices are
considered in the teaching. The MCHD supplemental food clerk ie
bilingual in Spanish.
As MCHD is both a WIC and a CSFP county we are careful to prevent
dual participation and have a good working relationship between
programs. Each time a client comes into the MCHD for CSFP
certification or recertification that chart is read by the PHN for
that area of the county. The nurse reviews the CSFP clerks charting
and questionnaire and follows up as needed such as assisting with
formula mixing or helping families who need more help to access a
particular service.
At the time of certification the clients are referred to other MCHD
services such as family planning, well child clinic, WIC, HCP and
immunizations. Clients are also referred to community agencies and
medical providers. EPSDT referrals can also be made.
951299
Nutrition education plans for this year 95/B6 are as follows:
1. Use -kitchen for food _demonstrations.
2. Feature a recipe of the month.
3. Have all new £SFP clients receive the new CSFP recipe took on their
first visit.
4. Provide the information requested by the client from the review we
did of our -survey and questionnaire.
A. Provide nutrition information on, picky eaters, children's
nutrition, infant nutrition, nutritional value of CSFP foods, under
weight and over weight and nutritional value of fast foods.
B. Address use of foods Been as problem foods in our survey -s. The
problem foods or foods not used are as follows, canned meat,
evaporated milk, powdered milk and dry eggs,
951999
SUPPLEMENTAL FOODS NUTRITION EDUCATION DOCUMENTATION SHEET
Are you or have you been on W.I.C. Yes_ No_
TOPIC
DATE ADDRESSED
SPECIAL NUTRITION NEEDS TO BE MET BY CSFP
CSFP IS FOR THOSEFOR WHOM IT IS PRESCRIBED
IMPORTANCE OF ONGOING HEALTH CARE
ADMISSION INFO -PACKET -AFDC, FS, CHID SUPPORT ENF
IMPORTANCE OF BREAS1 F t.DING
CSFP IS NOT TOTAL NUTRITION PROGRAM
NUTRITIONINFORNIATION"DISCUSSED AT VISIT
LITERATURE
DISCUSSION
LITERATURE
DISCUSSION
CLIENTDIVEN AISIST OF FOODS THEY WWI RECEIVE
DATE
CLIENT NAME
951999
._'aOGcRaaM
NUTRITION EDUCATION/HEALTH CARE NEEDS QUESTIONNAIRE
NAME: DATE:
PLEASE LIST ALL THE FOODS YOU, AND YOUR CHILDREN IF APPLICABLE, ATE
YESTERDAY. PLEASE INCLUDE BEVERAGES ALSO.
YOU
First meal
YOUR CHILDREN) SNACKS
Second meal
Third meal
ARE YOUR CHILDREN UP TO DATE ON THEIR IMMUNIZATIONS?
ARE YOU OR ANY MEMBERS OF YOU FAMILY COVERED BY INSURANCE?
IF YES, WHAT IS THE NAME OF YOUR INSURANCE.
DO YOU OR DO ANY -OF YOUR FAMILY MEMBERS HAVE ANY HEALTH CARE PROBLEMS
AT THIS TIME? IF YES, DO YOU HAVE A DOCTOR OR HEALTH CARE
PROVIDER THAT SEES YOU OR YOUR -FAMILY MEMBER FOR THIS PROBLEM?
DO YOU OR ANY OF YOUR FAMILY MEMBERS NEED DENTAL CARE? IF YES,
WHO NEEDS CARE AND IS IT FOR A -ROUTINE CHECK-UP OR BECAUSE OF PAIN OR
ANOTHER CONDITION?
DO YOU HAVE ANY CONCERNS ABOUT YOUR CHILD(REN)'S GROWTH AND
DEVELOPMENT? ABOUT NUTRITION?
IF ANY OF YOUR CHILDREN ARE IN SCHOOL ARE YOU CONCERNED ABOUT THEIR
PROGRESS IN SCHOOL. OR THEIR ABILITY TO LEARN?
DO YOU OR ANY OF YOUR FAMILY MEMBERS SMOKE? IF YES, DO YOU
WANT ANY INFORMATION ABOUT QUITTING AND OR THE EFFECTS OF SECOND HAND
SMOKE ON YOUR CHILDREN?
DO IOU DR A FAMILY MEMBER HAVE -A PROBLEM WITH ALCOHOL OR DRUGS?
DO IOU WANT TO -TALK WITH SOMEONE ABOUT ALCOHOL OR DRUGS?
DO YOU NEED RECIPES FOR ANY OF THE FOODS IOU -RECEIVE THROUGH
SUPPLEMENTAL FOODS? IF SO, WHICH FOODS?
Thank you for your time to answer this. It helps us with our
program and services. A Public Health Nurse is available to discuss
any of the above issues with you. She may call you to -arrange a visit
with you about any of the above items you have checked.
951999
1996
CHANGING NEEDS FOOD PROGRAM
COMMODITY SUPPLEMENTAL FOOD
NUTRITION EDUCATION PLAN
951999
MEMORANDUM
TO: Lu Stofer
Donated Foods
FROM: Joan P. Miller, R.
Aging and Adult Ser
DATE: August 14, 1995
SUBJECT: Check list for Commodity Supplemental Food Program Nutrition
Education Plans
Agency
)f Iv
ces
Description of methods used.
24 hour recall
Pre and post test of nutrition knowledge
How does participant use this nutrition knowledge
Nutrition assessment
Individual interview or nutrition classes
Description of material
Materials are both in English and Spanish
Description of Staffing
Registered Dietitian
Registered Nurse
Public Health Nutritionist
Paraprofessional, if supervised by CSU Extension Agent
or County Health Department
Must include the number of staff providing and their
classification.
At a minimum the agency must employ a
part-time nutritionist or R.D.
Annual evaluation of progr-am included with plan
Were elderly evaluated
Was the information used in the preparation of the
annual plan submitted
Participant Involvement
Were clients surveyed to determine what type
of education classes of information they would like?
Plan Approved
Comments
YES NO
'I
951999
NUTRITION EDUCATION PLAN FOR
THE CHANGING NEEDS FOOD PROGRAM
Tri County Senior Citizens and Housing, Inc.is the administrative agency for the
Changing Needs Food Program who is the agency responsible for the xlistribution of
CSFP foods in Rio Grande, Saguache and Mineral Counties.
Rio Grande, Saguache and Mineral Counties are located in the San Luis Valley, a rural
area in she southwest part of Colorado. The figures below were taken from the most
recent census.
COUNTY
SQUARE _
MILES
TOTAL
POPULATION
MOTHERS
INFANTS A
CHILDREN
60 +
YEARS
OFAGE
Rio Grande
912.6
10,770
2,982
2,064
Saguache
3,168.7
4,619
1,303
752
Mineral
873.8
558
152
116
This is an agricultural area dependent upon seasonal workers who affect she fluctuation
of the ethnic make-up of the area.
The primary languages spoken in the area are English -and Spanish.
Changing Needs Food Program currently has six distribution sites and homebound
certification and delivery to the elderly. -Mothers, Infants and Children use a grocery
store shopping method; the elderly have pre racked boxes.
951999
GOALS AND OBJECTIVES
In developing Ile 1996 Nutrition1'lan for the Changing Needs Food IProgram,- he
following goals were established:
GOAL #1: Provide nutrition information and referral to the Elderly, Mothers, Infants
and Children in Rio Grande, Saguache and Mineral Counties as required
by the 1996 State Nutrition Plan.
OBJECTIVE: Coordinate the goals of -the 1996 State Nutrition Plan by active
distribution of CSFP.
PLAN: Provide easily accessible pick-up sites, transportation to
distribution sites and delivery to home -bound -elderly participants.
GOAL #2: Provide health and nutrition information in conformity with the 1996 State
Nutrition requirements for the Elderly, Mothers, Infants and Children.
OBJECTIVE: Encourage and assist participants of all ages in developing correct
nutritional habits by providing food demonstrations, videos, participating in
health lairs, visual displays -and handouts.
PLAN: Food Demonstrations - Caregivers, breast feeding and _postpartum women,
and the elderly will be given load samples and recipes using
commodity foods. Efforts are made -to show use -of commodity
foods in a variety of ways.
Video - Caregivers will be encouraged to immunize birth to three month
old babies.
Animated videos relative to The importance of'ruits and vegetables
will the shown to ages three tot.
Caregivers will have available information on calcium, anemia, snack
facts with high nutrition.
Pregnant and breast feeding women will have available visual
information regarding bottle and breast feeding.
All participants will receive handouts on current up -dated nutritional
information and other topics relating 10 their health and well being.
Health Fairs - participation in the health fairs sponsored by Public -Health
in each county, booths will consist of a_food pyramid using CSFP
foods and nutrition information for all ages.
951999
Visual Display Fat jars, these show the actual amount of fat in food
including fast food. Sugar jars, showing -actual amount mf sugar in
various foods. Sodium jars, showing sodium in various foods.
Effort will be made to shown similarfood with less fat, sugar or
sodium.
Handouts - All participants will receive -handouts on current up -dated
nutritional information and othertopicsielating to -their -health and
well being.
GOAL. #3: Refer participants to appropriate medical, nutritional and social services.
OBJECTIVE✓: Help the participants to be aware of other community services available
to them.
PLAN: The Public Health Nursers available at designated distribution sites.
Information posters will are displayed. The quarterly newsletter -will contain
health and nutrition information. Changing =deeds Fool' Program staff will
be available as a resource for information.
951999
The Changing Needs Food Program nutrition education is supervised by nutrition
experts, Rio Grande County Nursing Service Administrator, Saguache County Public
Health Nurse, Mineral County Public Health Administrator. Each of these services assist
with referrals to other agencies.
ORGANIZATIONAL CHART
TRI COUNTY SENIOR CITIZENS & HOUSING BOARD OF DIRECTORS
ADMINISTRATOR
Re : 'stered Nurse
Staff hours: Nurse:
Certification:
Distribution:
dministrative Assistant
Certifiers
i utrition Coordinator
arehouse
Four times a month or as needed.
8:30 AM - 4:30 PM
Monday through Friday
The first three Tuesdays, Wednesdays and Thursday
of each month.
In fiscal year 1996 staff nutrition training will be supplemented by taking advantage of
appropriate workshops/seminars sponsored by the State Commodity Agency and classes
through the local CSU Area Extension office.
951999
Certificate of Achievement
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951999
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In developing the 1996 Nutrition Plan an annual survey was conducted. Questions
included primary language, helpfulness of office and warehouse staff, usefulness of
recipes and referrals to supportive service agencies, whether needs are being meet by
CSFP foods, satisfaction with certification and distribution systems and reasons why
participants skipped picking up their food.
Generally the participants were happy with the methods and the helpfulness of staff.
The main reason that some have skipped picking up their food is that cheese is no
longer available, that transportation is sometimes a problem, and they just forget.
Tri-County now has public transportation available; we continue to encourage the use of
this service to pickup commodities. The staff will be calling those individuals who have
not picked up their foods by the last week of official distribution and reminding them to
pickup their food, they will be .offered a makeup day.
We are unable to address the cheese issue.
Changing Needs Food Program has developed a check list to use as a tool to assure that
the certifier has obtained all the necessary information to assist participants. A copy has
been included.
95199S
CHANGING NEEDS COMMODITY
SUPPLEMENTAL FOOD PROGRAM
ANNUAL SURVEY
At which distribution site do you pick up your food?
III Monte Vista 134Del Norte aCenter
,3(oSaguache I I Moffat Creede
Primary language spoken? 141 English Only 34 Spanish Only lR English & Spanish
Which category? .„,940 7 Senior
1. The staff for the certification office are
helpful and friendly.
If no, please explain:
95 Mothers - Infants - Children
?,(D7Yes jNo
2. The staff for the warehouse/distribution
are helpful -and friendly.
If no, please explain:
5_7bYes QNo
3. Information provided to me by -the Commodity
Supplemental food Program (CSFP) is helpful.
(Information can include: recipes, referral
to other supportive service agencies, etc.)
if no, explain:
17qYes £No
4. The supplemental food provided by the USDA
for the CSFP meets my needs.
If not, explain
3nYies LNo
5. -How 'do you rate the effectiveness of the -current
system for certification?
For 'distribution'?
If you are dissatisfied with either system, what
can we do to make the system better?
Low High
91 2283'r4 31`1
.201 22o3s:s4 56/7
OVER
951999
COMMODITY CHECK LIST
-Control`
REQUIRED INFORMATION
Initial Certification Date
Certification Expiration Date
New Card or Date Change
Proxy
-Responsible Adult
Date of Birth
Address - proof of residence in
Responsible Adult
COMMENTS
Rio Grande, Saguache or Mineral Counties
Phone #
Ethnic -Origin
Monthly Income
Verification of Income
Number in Household
Identification
Proof of Pregnancy
Social Security Number (Elderly)
Birth Certificates for each child
Each qualified _child -weighed &
measured
Explain program is Supplemental
Immunizations Current
Refer to Public Health
Nutrition Education
Certification Administrator Date
Program Administrator Date
revised 6/15/95
951-999
Listed -below is -the Nutritional Education Material that will be utilized in implementing
the 1996 plan. Sample material _has been included.
CHILDREN -WITH PROBLEMS
Is Your Child Under Weight
Children & Weight Control, Building Lifelong Habits
Tips to Help Your Over Weight Child
Feeling Good - Tips to Prevent Constipation
Conquer Anemia
Wise Tips for Avoiding Infant Allergies
If You are Worried About Your Child's Weight
Progress With Food Problems
HAND OUTS DIRECTLY TO CHILD
Coloring -books which focus on nutrition and healthy eating habits
Colorful stickers showing the food groups and food pyramid
Coloring sheets and word games depicting -the five food groups and fitness
Eat the Five Food Group Way! Parents are encouraged to reward their child for
eating from each food group and rewarding them with a star.
TO CAREGIVERS REGARDING CHILDREN AGES ONETHROUGH FIVE
Foods Kids Like
Teach Your Baby to Drink From a Cup
Your Growing Child
Foods for Young Children
The Teeth Snatchers
Feeding Your Toddler
But Mom....I Hate Vegetables
TO CAREGIVERS REGARDING INFANTS TO AGE ONE
The First Twelvemonths
INFANT FEEDING SERIES
Bottle Feeding
BabyFirst Food
Starting Solid Foods
Teething
Adding New Foods
More Food - -Eight to Twelve Months
After the First Year
Weaning
Over Weight Baby
95199
PREGNANT WOMEN
The Time to Start Feeding a Child is Nine Months Sooner Than People Think
Moms To Be Make the Difference - Low Birth Weight Can Be Prevented
Feeling Good - Tips to Control Nausea
Relief tom Common Problems
Mothers & Fathers lave you thought about breastfeeding?
Thinking About Breastfeeding?
Give a Gift to Your Baby
To Slip and Smoke Doesn't Mean You Bailed
Keep Your Baby Smoke Free
BREAST FEEDING WOMEN AND PREGNANT WOMEN
Breast Feeding - Baby's Best Start
Special Tips for Breast Feeding and Working Moms
QuestionsYour family & Friends May Have About Breastfeeding
Breastfeeding Doesn't Have to Tie You Down
Breastfeeding Doesn't Have to Be Embarrassing
Breastfeeding Won't Keep You From Doing What You From Doing What YOU
Want To Do
Breastfeeding Doesn't Have to Change the Way -You Eat
Breastfeeding is Easy to learn
Breastfeeding: Getting Started
How do I Know My Baby is Getting Enough Milk?
Breast Feeding Problems
POST PARTUM, ELDERLY, CAREGIVER
Donated Government Commodities
The Food Glide pyramid
Guide to Good Eating
Healthy Dividend
Age Page
951999
STATE OF COLORADO
COLORADO DEPARTMENT OF HUMAN SERVICES
1575 Sherman Street
Denver, Colorado 80203-1714
Phone (303) 866-3700
TDD (303) 866-6293
FAX (303)866.4214
August 28, 1595
Walter Speckman, Executive Director
Weld County Dept. of Human Resources
P O Box 1805
Greeley, _CO 80632
Dear Mr. Spec
The nutrition education plan for 1996 is approved.
J-PM/scj
Sincerely,
oan Miller, RD
Program Specialist
Division of Aging and Adult Services
Roy Romer
Governor
Barbara McDonnell
Executive Director
Karen Beye
Managing Director
Building Partnerships to improve Opportunities torsataty, SeUSulBcbney, and Dignity for the People -of Coto adn
951999
M E M O RAINt U M
TO: Lu Stofer
Donated Foods
FROM: Joan P. Miller, R.
Aging and Adult Servil��s
DATE: August 14, 5995
SUBJECT: Check list for Commodity Supplemental Food Program Nutrition
Education Pans
Agency flak/r
Description of methods used.
24 hour recall
Pre and post test of nutrition knowledge
How does participant use this nutrition knowledge
Nutrition assessment
Individual interview or nutrition classes
Description of material
Materials are both in English and Spanish
Description of Staffing
Registered Dietitian
Registered Nurse
Public Health Nutritionist
Paraprofessional, if supervised by CSU Extension Agent
or County Health Department
Must include the number of staff providing and their
classification.
At a minimum the agency must employ a
part-time nutritionist or R.D.
Annual evaluation of program included with plan
Were elderly evaluated
Was the information used in the preparation of the
annual plan submitted
Participant Involvement
Were clients surveyed to determine what type
of education classes of information they would like?
Plan Approved
Comments
YES NO
orb 7 / 1 iti
,I
951999
Weld County Division of
Human Services
Nutrition Education -Plan
The Weld County Division of Human Services will make Nutrition Education
available to participants of the Commodity -Supplemental -Food Progr-am (CSFP).
This will be done primarily through the following mechanisms:
1. A -nutritionist -on -a part-time basis will direct the Nutrition Education
component to reach the goals as identified:
a. To ensure that CSFP foods are used properly.
b. Encourage continued selection and consumption of nutritious food
necessary to good health.
c. Demonstrate the -relationship between proper -nutrition and good health
with an emphasis on pregnant, postpartum, and breastfeeding women.
d. To effect a positive change in eating habits through maximum use of
supplemental foods within the context of ethnic, cultural, and
geographical preferences.
2. At the time of certification, participants will be informed that the program
is only supplemental and not a total feeding program. They are advised of
seeking medical care and of the importance of total health care for them and
their families. Many of our participants are referred for certification
from the other two (2) clinics in Weld County, Sunrise Health Center, and
Plan de Salud del Valle.
Participants will also be advised of the times -a nutritionist will be
available at the Division of Human Services for one-on-one counseling
concerning special -nutritional needs end ways to provide adequate diets, or,
if the participants would like, additional nutrition education. If
necessary, the nutritionist will make these services available in the home.
The certification center can also make recommendations to the nutritionist
for follow-up on participants with special -needs.
3. At the point of certification, nutrition information is provided to the
participants. The information is approved and/or developed by a
nutritionist. The various tools used are recipes for balanced meals,
nutritional information, snack ideas, and when available, information as it
relates to nutrition, shopping trips, etc. The following is a more detailed
description of the information tole distributed in the packets:
a. Menus:
The Food Pyramid will be used in planning a balanced diet of -breakfast,
lunch, and supper menus of the month. When the menu is developed,
consideration will be given to Distribution for the -month, if possible.
This will provide participants with ideas when they are planning family
meals.
951929
b. Recipes:
Recipes for each item on the menu will be provided. the recipes will
contain different ways of using the commodities and will be written in
English and Spanish. Consideration will be given in providing recipes
from the ethnic background of participants.
c. Nutritional Information:
Information concerning the benefits of nutrients contained in foods
presented in the menus will be included. They will be given an
explanation of the areas of the body the nutrients are helping -and -what
foods are providing these vitamins.
d. Snacks:
Ideas for snacks to give the children between meals will be made
available. These snacks will be nutritionally sound and nor the "junk
food" usually provided as snacks.
e. Other Information:
Information concerning breastfeeding, nutrition during pregnancy, etc.,
will be provided by their doctors. Shopping tips and other information
will be provided in the plan.
.All information used in the packet will be provided in both English and
Spanish whenever possible.
The _packet will also re -identify when the nutritionist is available for
one-on-one counseling.
4. Nutrition education classes will be offered at various times throughout the
year. The major topic will be the use of the commodities.
951999
COMMODITY SUPPLEMENTAL FOOD PROGRAM
Organizational Chart
Colorado State Department
of Human Services (State Agency)
Weld County
Commissioners
ADMINISTRATION/CERTIFICATION
Weld County Division
of Human Services
Walter J. Speckman
Executive Director
Marilyn Carlino
Fiscal Officer
Leona Martens
Joyce Johnson Director
Nutritionist
Subcontractor
DISTRIBUTION/WAREHOUSE
Weld Food Bank
Susan Talmadge
Administrator
Ray Lopez
Maria Nino CSFP Manager
Office Technician
Debbie Pfalzgraff
Admin. Assistant
Robert Melvill
CSFP Technician
Gerald Nichols
CSFP Technician
Green Thumb/Supplemental Foods
951999
June 5, 1995
Joyce E. Johnson, Weld County Nutrition Consultant
Nutrition Etbir+tion Plan for Supplemental Food Program
The following dates have been scheduled for nutrition counseling and demonstrations at the Supplemental
Foods receiving building. Menus Of The Month will be available for all clients. Recipes using current
commodities and samples of recipes will be available for children and parents.
October 1995 "Peanut Butter Jack 0 Lanterns"
( Peanut Butter, Honey, Dry Milk)
November 1995 "Turkey , Corn Bread Stuffing"
(Corn Meal, Dry Milk, Dry Eggs)
December 1995 "Christmas Tree Jigglers Cut Outs"
(Gelatin and Fruit Juice)
January 19% "Hot Cocoa Mix"
(Dry Milk)
February 1996 "Tuna Heart Sandwich"
(Tuna and heart cookie cutter)
March 1996 "Commodity Casserole"
Canned Beef, Vegetables and Noodles
April 1996 "Benefits of Breastfeeding"
Video: Leleche League
May 1996 "May Baskets"
(Fruit Salad in muffin cups)
June 1996 "Cereal Bars"
Cereal, Butter, Marshmallows
July 1996 "Orange Cow Drink"
Orange Juice and Dry Milk
August 1996 "Fruit Juice Popsicles"
Fruit Juice frozen in cups
September 1996
"Fall Harvest"
Menu of the Month
(using all commodities)
951999
Persons Served With Supplemental Foods May 1995
Sables 4.12 mo Children 14yr
$0 & older
prewar* women
SaMee 04 mo
951999
SUPPLEMENTAL FOODS
Summary
for
Survey and Evaluation Tools
The Evaluation Tool used for the Supplemental Food Program was designed for elderly participants,
pregnant and postpartum mothers, and their infants and young children.
The Survey Tool for the Supplemental Food Program, administered by Maria, was given upon certification
of the participant. Although -the form is short and written in both Spanish and English, the participant
seldom fills in the check mark herself, but will answer the questions for Maria.
The same was true with the Evaluation Tool. The participant would answer the question if I (nutrition
consultant) would make the check mark for their answer and comments. This too was beneficial, talking
cue to one with participants gave additional information about their needs and their children's needs.
Of approximately 3521 persons served with Supplemental Foods during the month of May, 1995, 1100 are
60 years or older, 430 are women that are pregnant or have babies and young children, 110 are babies age
0-3 months, 330 are babies 4-12 months and 1542 are children ages 1 to 6 years old.
In designing the NutritionEducation Plan, consideration was given to the elderly to provide them with
recipes that they could prepare for one or two people. The cornmeal, dry milk and dry eggs were created in
a Cornbread Stuffing. The Commodity Casserole uses canned beef, vegetables, and noodles, all foods that
She elderly finds difficult to use by individual items but welcomes recipe ideas
Many of the demonstrated food items have great appeal for the young child. The Fruit Juice Jiggles and the
Fruit Juice Popsicles are favorites for the child ages 1 to 6. Also included are practical, beneficial
information on Breastfeeding, and Videos for Feeding the Young Child.
Administering the Survey and Evaluation Tool requires a great deal of time as each participant questioned
is visited with one to one and their form is filled in for them. Each year we will be able to evaluate a larger
number of both mothers and the elderly. Most participants have no special requests, but some have
children with special dietary needs. Almost all desire recipes and seemingly get encouragement from seeing
the food demonstrations.
Most mothers learn about the Supplemental Food Program by talking to a friend or through Sunrise Clinic
or Social Services. The elderly often hear about Supplemental Foods from a friend at their subsidized
apartment complex, at the Senior Nutrition Congregate Meal Program, or from Social Services.
It is a challenge to reach each participant with nutrition education. Pamphlets, written information, and
Menus of the Month are available at all times at the Supplemental Foods certification desk.
r
251999
SURVEY
for
SUPPLEMENTAL FOOD PROGRAM
1. How did you learn about the Supplemental Food Program?
2. What are your child's needs?
•
�-�-� ri2-
3. Are you or your child on a especial diet?
yes / no
-4. Would you like to talk to the nutritionist about your or your
needs?
yes no,
5. What are your needs?
t7---/ ' e
child's dietary
6. Are you a pregnant or breast feeding your baby?
yes }, no
7. Are you elderly?
yes no
8. Would you like to see demonstrations using the supplemental foods?
yes to
951999
EVALUATION OF SUPPLEMENTAL FOODS PROGRAM
for
MOTHERS, INFANTS, YOUNG CHILDREN -AND OLDER ADULTS
1. Do you find the supplemental foods provided for you a great help in preparing
your meals?
yes " no
2. Do you Let enough food from the Supplemental Food warehouse each month to
feed your children for the month?
yes no
3. Do you enjoy going to the warehouse, and do you find it clean and -organized?
yes ` no
4. Is. -the staff at the warehouse friendly and helpful?
yes Y no
5. Are the nutrition demonstrations given by the nutritionist helpful?
yes � no
6. Do you take the -recipe handouts homeanduse them for food preparation?
yes _ no
,2 a ate „
7. Do you enjoy and find the nutrition films and videos helpfuli
yes ✓ no
8. -Do you talk to the nutritionist about your children's diet -needs?
yes no tfeirazt- ..
9:-1.999
I
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P.0.33ox 78 ' 12 Jar, CO 81140 ' 719.274-4307
1995-1990 CSFP EQUIPMENT LIST
CONEJOS COUNTY NURSING SERVICE
JULY1n65
COMP) JDYNE LOMPUTER/SCREEN
S EPSON LQt5013RINTER
MINOLTA COPIEREP 4210
BROTHERFAX MACHINE 380
SOFTWARE LOTUS
SOFT WARE WINDOWS
WALK-IN COOLER/FREEZER
j II REFRIGERATOR/FREEZER
386 EPSON WINGATE COMPUTER
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1\71
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u 199
ADMINISTRATOR
JOS COUNTY NURSING SERVICE
Roots _Sood
951999
COSTILLA COUNTY
NURSING SERVICE
Post Office Box 99
San Luis, Colorado 81152
(719) 672-3332 or 672-4107
-CAPITAL EQUIPMENT
DESCRIPTION
STEREO COMPUTER SPEAKER SYSTEM
WITH 2 SPEAKERS
-PACKARD BELL COMPUTER
HARDDRIVE, KEYBOARD, MOUSE
OKIDATA PRINTER MICROLINE 380
FAX MACHINE RICOH FAX 12
MINOLTA EP410Z COPIER
OKIDATA PRINTER MICtOLINS 182
IBM TYPEWRITER
DESTINY COMPUTER
SHARP ADDING MACHINE
SHARP ADDING MACHINE
FRIGIDAIRE FREEZER
WHITE WESTINGHOUSE REFRIGERATOR
PORTABLE KITCHEN UNIT
MUNSEY TOASTER OVEN
GOLDSTAR-MICROWAVE
1IESTBEND COFFEE MAKER
MR. GOFERS MAKER
770 COPIER WITH STAND
1 RED CART
2 GRAY CARTS
3 PANASONIC TELEPHONES
TELRPWDNE WITH ANSWERING MACHINE
VICTOR ADDING MACHINE
2 BOOK SHELVES
1992 1/2 TON FORD PICKUP
1 CAMPER SHELL FOR PICKUP
-WALK-IN COOLER FREEZER UNIT
2 COMPUTER TABLES
PRINTER STAND
TLECPRIC FRY PAN
-HOT PLATE
$LECPRIC KNIFE SHARPENER
#HAMILTON BEACH BLENDER
ISLECTIC PENCIL SHARPE=
IDENTIFICATION
LABTEC CS -150
19853CZ3353 A
304A10167611
01100030
1673493
002 A 1130030
11NRH71
SO -9101416W
08013079
08008219
580124567
AT&T 5600
12377939
TATE OF
PURCHASE 5 AMOUNT"
6-06-91 1,295.00
3-94
1,355.64
1 FTDS15YINPA22091 10-21-91 10,752.00
MA105MLP-1 5-92
22,400.00
951999
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NITHOUT LOCKS
2 TWO DRAWER PILING CABINETS
WITHOUT LOCKS
3 WOODEN DRSRS
I SURGE PROTECTOR -BACKUP 400
2
2 BULLETIN BOARDS
A. PC POWER CENTER 80 DATA
1 PAPER RACK
1 RADIO- GPX
1 FAN
11 FOLDING CHAIRS
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MESA COUNTY SUPPLEMENTAL FOOD
715 4TH AVENUE
GRAND JUNCTION, CO
OFFICE INVENTORY
FY95-96
TAG # QTY ITEM DESCRIPTION
2 ANSWERING MACHINES
1 BELT, BACK-W/STRAPS
3 BELTS, BACK -WEIGHT (XXL-XL-LG)
6689 1 BUFFER, FLOOR
2673 1 CABINET,METAL BLK 4 -DR
1401 1 CABINET,METAL BLK 4 -DR
2711 1 CABINET,METAL GRAY DBL DR
4 CABINET,METAL TAN 4 -DR
1 CABINET,METAL TAN 4 -DR
5498 1 CALCULATOR, SHARP COMPET VX-1652
2715 1 CALCULATOR, SHARP CS -1606
1 CALCULATOR, TEXAS INST. TI -8250
2713 1 CHAIR, SECRETARY BRN
1 CHAIR, SECRETARY W/ARMS'
2 CHAIRS, SECRETARY BRN
2 CHAIRS, SECRETARY GRAY
7 CHAIRS, STACKABLE BLUE
8 CHAIRS, STACKABLE BRN
8 CHAIRS, STACKABLE MAUVE
2 CHAIRS,COMPUTER
2 CHEST FREEZERS
1 COFFEE MAKER (40QT)
3 COMPUTER HUTCHES
6696 1 COMPUTER, IBM PC -XT
3276 1 COMPUTER, IBM PS2 MOD 30-286
6695 1 COMPUTER, IBM PS2 MOD 30-286
6262 1 COMPUTER, MATRIX
6430 1 COMPUTERS, MATRIX 386-33
6251 1 COPIER STAND
6251 1 COPIER STAND
6688 1 COPIER, HARRIS 3M W/STAND SN918179
1 CORDLESS PHONE
1 CORDLESS PHONE W/ANSWERING MACHINE
1 DESK„WOODEN BRN
1 DESK,METAL GRAY
2716 1 DESK,WOODEN GRN/BRN
1 FORKLIFT CHARGER
6661 1 FORKLIFT, ELEC-MONA
5154 1 FREEZER, UPRIGHT
2 FRFF7ERS, CHEST
17949 1 GATEWAY 2000 MONITOR *
17946 1 GATEWAY 2000 P4D-33 *
1 HAND TRUCK, BLK
2 HAND TRUCKS, GRN
1 METAL DESK-GRN
17960 1 MICROWAVE OVEN
17690 1 MONITOR, GOLDSTAR
3271 1 MONITOR, IBM PS2
LOCATION
MANN/CHERRY
JIM'S DESK
WAREHOUSE
STORE RM
TEFAP SECTION
TEFAP SECTION
STORE-RM
SUSAN -2 / CHERRY -2
M.ANN
CHERRY'S DESK
VOLUNTEER DESK
M.ANN'S OFFICE
TEFAP SECTION
JIM'S DESK
CHERRY, TEFAP SECTION
VOLUNTEER/DIST AREA
FRONT HALLWAY
LUNCH RM/M.ANN OFFICE
FRONT HALLWAY
MANN/SUSAN
WAREHOUSE
LUNCH RM
JIM'S DESK
M.ANN 'S OFFICE
JIM'S DESK
SUSAN'S DESK
DIST. AREA
FRONT OFFICE
FRONT OFFICE
FRONT OFFICE
SUSAN'S DESK
SUSAN'S DESK
CHERRY'S DESK
SUSAN'S DESK
M.ANN'S OFFICE
WAREHOUSE
WAREHOUSE
LUNCH RM
WAREHOUSE
CHERRY'S DESK
CHERRY'S DESK
WAREHOUSE
WAREHOUSE
VOLUNTEER'S DESK
LUNCH RM
SUSAN'S DESK
JIM'S DESK
951999
6428 1 MONITORS, SUPER VGA MEGAVIEW
2 MULTI -LINE PHONES
1 PALLET JACK, GRAY
1 PALLET JACK, YELLOW
6662 1 PALLET JACK,ELEC/SN 339359 BIG JOE
17980 1 PANASONIC KX-P2123 COLOR *
1 PORTABLE KITCHEN
3 PRINTER STANDS
1 PRINTER, EPSON FX-286
4029 1 PRINTER, EPSON FX-286E
6427 1 PRINTER, PANASONIC KX-P1180
6259 1 PRINTER, PANASONIC, KXP1624
5156 1 REFRIERATOR
3638 1 REFRIGERATOR
1 SHOP VAC
6664 1 TABLE, FOLDING 6FT
1 TABLE, FOLDING 6FT BRN
1 TABLE, METAL GRAY
3 TABLES, FOLDING 8FT BRN
2 TABLES, WOODEN (38X28)
2718 1 TYPEWRITER, ADLER ELECTRIC
6665 1 TYPEWRITER, WHEELWRITER ELEC/SN 112009
1 TYPING TABLE, BRN
1 TYPING TABLE, GRAY
1 VACUUM CLEANER
6426 1 WALK-IN FREEZER
THESE ITEMS HAVE BEEN PURCHASED WITHIN THE LAST FISCAL YEAR
JUNE 7, 1995
DIST. AREA
MANN/CHERRY
WAREHOUSE
WAREHOUSE
WAREHOUSE
CHERRY'S DESK
TEFAP SECTION
CHERRY/SUSAN/JIM
JIM'S DESK
M.ANN 'S OFFICE
DIST. AREA
SUSAN'S DESK
LUNCH RM
LUNCH RM
WAREHOUSE
DIST. AREA
TEFAP SECTION
WAREHOUSE
WHS/LUNCH RM
FRONT OFFICE
TEFAP SECTION
TEFAP SECTION
TEFAP SECTION
TEFAP SECTION
STORE RM
WHS LOT
951999
CHANGING NEEDS FOOD PROGRAM
Equipment purchased with CSFP Funds
1
ITEM
IGluantitylDescription, Serial No, Etc.
IPurchased
1Mo. (Year
I I
1 (Dolly - Blue/Gray 4 Wheel 500# Rating I 6 11990
6 11991
1 I Blue 2 Wheel Dolly #400 lb Cap I 11 11992
! I 1
1 I Gray 4 Wheel Dolly #1000 1 11 11992
I I
1 (Dolly 4 -wheel I I
I I I
1 IDolly 2 -wheel I !
I I I
1 I Pallet Jack DT Lifters I i
j I I
1 York Lift Motolift SN# 8660 ! 1
I ! I
1 11973 Ford Enclosed Truck 1 5 11995
I I f
1 I Trailer 16 ft. VI -n 041090 I 9 11994
f I I
2 (Blue tarp 110 11994
! 1
1 (Schauer Battery Charmer mdl J512 111 11993
I ( !
1 (Black: °: Decker Shop Vac 1.5HP mdl 331.51
I 1 1
1 (Chest Freezer Gibson HD mdl FH2.=,MSWX I I
I I I
1 (Walk-in Cooler Carrol Comm SN# 2807 I 7 11992
I I I
1 (Walk-in Freezer Superior ! 2 11992
I I I
1 (Gibson Upright Rifrigerator I S 11992
I I I
1 (Kenmore Chest Type Freezer I B 11992
I I 1
1 I Emerson Microwave MT ::,055 SN#00207803 I 11991
t 1 1
1 (Hand Cart - Red 2 Wheel 600# Rating
1 (File Cabinet Tan 4 drawer I
{ 1
1 (Minolta Copier EP300 I I
i I
1 (Copier Table Folding_ 4' I 2 11991
I 1
1 (Office Desk - grey 4 drawer I 2 11991
I I 1
1 iComputer Credenza Desk Oak look I I
I I !
1 (Computer table I 2 11991
951999
1 Computer SN# 51828
1 Computer 80 -Data SN#32977 ID FCCIDFPF4Y
1 18088 Computer with monitor
1 IRelisys Monitor RE5154E Color
1 (Samsung Monitor mdl# MA 2565
2 (Keyboards
1 I Modem 80 -Data 2400 -SN# 71108770
1 I PC Power Center 80 -Data.
1 (Star Printer NX-1000
1 I Epson Printer Laser EPL-7000 I 1 1992
1 (Citizen Printer i 6 11992
1 ILabelwriter II Plus COStar
1 I PC Wand PW-100
1 I-WordProcessor - Smith Corona
1 SSharp Calculator EL -2192C
o 11991
4 (Lumbar Support Belts 110 11992
S 1999
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951999
APPROVAL AUTHORITY
The State Plan of Operation and administration for the Commodity Supplemental Food
Program for Federal Fiscal Year 1995 is hereby approved.
Barbara McDonnell
Executive Director
Colorado Department
of Human Services
Date of Signature
33
951999
3
COLORADO
mEmoRADU
Dale K. Hall, Chairman
To Board of County Commissioners
From
Subject:
Date _September 22, 1995
Walter J. Speckman, Executive Director, Human Services
Oat
Contract between the Colorado Department of Human Services
and the Weld County division of Human Services
Enclosed for Board approval is the Contract between the Colorado Department of
Human Services and the Weld County Division of Human Services for the
administration and operation of the Commodity Supplemental Food Program.
This is a continuing Contract which defines -the responsibilities and -requirements
governing the Commodity Supplemental Food Program.
The period of this Contract is October 1, 1995 through September 30, 1996.
If you have any questions, please telephone me at 353-3800.
Hello