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Agricultural Marketing Service
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Local Food Purchase Assistance Cooperative Agreement Program
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Participant NameName of Cooperative Agreement Recipient
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Participant UEIProvide the Unique Entity Identifier (UEI) from SAM.gov
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Participant TypeIndicate if the Participant is a State Agency or Tribal Government
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Date Range of ReportDate range covering the reporting period by calendar quarter
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Vendor Tab Fields
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For each food purchase activity that occurred in the reporting period, provide the following information.
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Participant TypeSelect whether the recipient is a state agency or Tribal Government
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Purchase QuarterSelect the quarter when the purchase activity took place
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Vendor (Contract Holder) Name
Name of the vendor that has entered into a contract with the recipient. This may be a farmer, distributor, food hub etc. (e.g. The Food Company, Inc.)
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Is Vendor Socially Disadvantaged?Drop down options: Yes or No. Indicate if the vendor is a socially disadvantaged business
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Farmer/Producer NameName of the farmer or producer that sold the food to the Vendor
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Is Farmer/Producer Socially Disadvantaged?Drop down options: Yes or No. Indicate if the farmer or producer is a socially disadvantaged business
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Purchase City Enter the City of purchase location
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Purchase StateSelect the State for the purchase location
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Purchase CountyEnter the County for the purchase location
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Purchase Zip Code5 Number Zip Code for purchase location
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ValueEnter the dollar amount of the purchased product by product type. The number can be entered without any formatting (e.g. 45000 will autoformat to $45,000.00)
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Product TypeChoose from one of the drop down options for the type of product purchased.
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CommentsOpen field for any additional information or comments
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Distribution Tab
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For each food distribution activity that occurred during the reporting period, provide the following information.
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Participant TypeSelect whether the recipient is a state agency or Tribal Government
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Distribution QuarterSelect the quarter that the distribution activity took place
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Organization Distributing FoodName of the primary organization responsible for food distribution
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Organization Receiving Food Name the organization receiving food. Complete this section of the form if a partner was involved in distribution beyond the Primary Organization.
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Is Distribution Location Underserved? Drop down options: Underserved, Yes or No. Underserved definition is in Executive Order 13985 :https://www.federalregister.gov/documents/2021/01/25/2021-01753/advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government
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Value of Food DistributedDollar value of the food distributed
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Tribal Region (if applicable) Enter the Tribal Region of the distribution location if applicable
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Distribution City Enter the City of distribution location
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Distribution StateSelect the State for the distribution location
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Distribution CountyEnter the County for the distribution location
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Distribution Zip Code5 Number Zip Code for distribution location
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CommentsOpen field for any additional information or comments
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