DAYS/HOURS OPEN TO PUBLIC Not applicable, mobile distribution

❏ Agency Partner must ensure proper storage and handling of USDA product. Product must be stored under
sanitary conditions which are free from rodent, bird, insect, or other animal infestation, in well ventilated areas
which are safeguarded against theft, spoilage, or other losses. USDA foods must be stored off the ground, either
on pallets, or other method.

❏ During program’s hours of operations, Agency Partner must be willing to distribute USDA product to any eligible
client who asks for government food assistance.

❏ Identify/Check method of distribution of USDA commodities:
❏ Recipients select items themselves (client choice).
❏ Food is pre-boxed.
❏ Pantries must collect client signatures using the most recent “USDA Self-Declaration of Income” form each time
a client has access to USDA product. Please indicate/circle your method of intake for food recipients
❏ Please download the latest form from
When using the the paper form, the Agency Partner must comply with the following record-keeping
1. One signature per household per visit.
2. Each client must completely fill out line on the signature form. If a client has no address, use
“N/A” for address. Alternatively, to preserve client’s privacy, you may have one form per
client, signature line must be completed each visit.
3. The date of distribution must be clearly marked on each form.
4. If a client refuses to sign the USDA sheet, they may be offered non-USDA (TEFAP) product,
including donated food, or purchased food from the program.
5. Forms must be kept for 3 years in addition to the current year.
6. Grant funded mobiles must enter data into online spreadsheets within 3 business days.
❏ The Agency Partner may not ask for or require any verification of a client’s identity, residency or income, eg. no
pay stubs, drivers licenses, utility bills. Client takes responsibility for compliance with program eligibility
requirements when they sign the self-declaration of need form. Volunteers and paid staff at Agency Partner site
are relieved of both legal and all programmatic liability.