The new 2011-2012 USDA/TEFAP Form that must be signed by all clients of Food Pantry programs and Direct Distributions is now available. The form is effective July 1, 2011 and all Food Pantry programs and Direct Distributions must institute the new form starting July 1. No older forms will be acceptable for use after June 30, 2011.
The new 2011-2012 USDA/TEFAP Form is officially titled "Ohio Department of Job and Family Services FEDERAL AND STATE FUNDED FOOD PROGRAMS ELIGIBILITY TO TAKE FOOD HOME." This form is a self-declaration by the client stating that their household income qualifies them for food assistance. The new 2011-2012 has a central forms code of: JFS 04221 (Rev. 7/2011).
New Forms Effective July 1, 2011:
*NEW* 2011-2012 Federal and State Funded Food Programs Eligibility to Take Food Home - English
*NEW* 2011-2012 Federal and State Funded Food Programs Eligibility to Take Food Home - Spanish
*NEW* 2011-2012 TEFAP Eligibility Guidelines
Please remember that no modifications, changes or attachments may be made to the new form. This means no marks, numbers, additional words, sentences, disclaimers or notations of any kind are acceptable on the form, front or back.
The form must be completed with the client's first and last name, full address including apartment number if applicable, city, zip code and phone number. If the client is homeless, please write "homeless" on the address line. If the client does not have a phone, please write "N/A" on the phone line. The client must also provide the number of people living in their home by age group. If there is no one living in the home in a certain age group, please place a zero (0) or a dash (--) in the age group. Finally, the client must sign and date in the certification box the first time they receive food. Each additional time they receive assistance, they must sign and date the lower half of the form. If any of the household information has changed since their last visit, the form must be updated or a new form completed.
All client-completed forms must be kept for a minimum of three (3) years. These forms are subject to audit by Foodbank staff and auditors representing the state and federal government.
If you have any questions regarding the new 2011-2012 form, please contact the Member Services Department.