SAFB Monthly Agency Report

Due to The San Antonio Food Bank by the 5th Day of every month

FAILURE TO SUBMIT THIS REPORT WILL RESULT IN PRODUCT HOLD UNTIL ALL REPORTS ARE RECEIVED.

FAIR NOTICE: AGENCIES ON HOLD FOR REPORTS THAT BRING IN THE LATE REPORTS ON THEIR SCHEDULED WAREHOUSE PICK-UP DAY WILL NOT BE ALLOWED TO RECEIVE PRODUCTS, AS THE HOLD WILL NOT BE LIFTED IN OUR COMPUTER SYSTEM UNTIL AFTER THE WAREHOUSE CLOSES FOR THE DAY.

Required by all Agencies

Name of Agency:

Total Clients Served by Age:
If you did not serve anyone, please mark a 0 in all appropriate spaces.

Account Number:

0 – 5 Years:

Month Reporting For:

6 – 18 Years:

Total Number of Families Served:

19 – 40 Years:

Total Number of People Served:

41 – 60 Years:

Over 60 Years:

NOW, PLEASE INDICATE WHICH CATEGORIES COMPRISE THE MAJORITY OF YOUR CLIENTS THIS MONTH
(TO THE BEST OF YOUR KNOWLEDGE)

Physically Disabled:	%	Elderly:	%
Mentally Disabled:	%	Transient Homeless:	%
Abuse Victims:	%	Other: (Women, Children, Working Poor, Undocumented Clients, etc.)	%
People with Chronic Illness: (HIV, Kidney, Alcoholism, Substance Abuse, Cancer, etc.)	%		%

FOR FOOD PANTRIES OR USDA DISTRIBUTION SITES:

NUMBER OF DAYS THIS MONTH YOUR AGENCY GAVE FOOD ASSISTANCE:
(INCLUDE NON-SCHEDULED DAYS, and EMERGENCY CASES IN ADDITION TO YOUR REGULAR DAYS OF OPERATION.)

REMEMBER: YOU MUST ENSURE THAT ALL INDIVIDUALS RECEIVING USDA COMMODITIES
ARE APPROPRIATELY QUALIFIED AND COMPLETE SAFB DOCUMENTATION

FOR SOUP KITCHENS, GROUP HOMES, SHELTERS, KIDS CAFES, SR. CENTERS, DAYCARES ETC.:

NUMBER OF TIMES YOU SERVED PER DAY, THIS MONTH:

NUMBER OF TIMES YOU SERVED PER WEEK, THIS MONTH:

TOTAL BREAKFASTS:

TOTAL LUNCHES:

TOTAL SUPPERS:

TOTAL SNACKS:

Comments:

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