New 2013-2014 USDA/TEFAP Forms

The current USDA/TEFAP form is designated as JFS 04221 (REV. 7/2013) in the lower left corner. The form can not be altered in any way.  No words, sentences, or additional information can be added to the form.  Nothing can be printed on or added to the back of the form.  There is one approved version of the USDA/TEFAP form.  All food pantry programs and direct distributions must switch to this form on July 1, 2013. All older versions of the form that have been completed by clients must be archived and any blank older versions should be destroyed.

PLEASE NOTE:  The margins on the form have changed, so please make sure not to accidentally cut of the effective date or revision information on the bottom of the form when printing or making copies.

New Forms Effective July 1, 2013:

*NEW* 2013-2014 Federal and State Funded Food Programs Eligibility to Take Food Home - English
*NEW* 2013-2014 Federal and State Funded Food Programs Eligibility to Take Food Home - Spanish
*NEW* 2013-2014 TEFAP Eligibility Guidelines



USDA/TEFAP and State Products

The Akron-Canton Regional Foodbank receives products from both the federal and state governments. Both federal and state products are only available to emergency feeding programs that are open to the public. Emergency feeding programs are defined as hot meal sites, shelters and food pantries, or direct distributions where uncooked/packaged food is taken home to be prepared at a later time.

Federal products are provided by the United States Department of Agriculture (USDA) and are funded under The Emergency Food Assistance Program (TEFAP). These products are typically shelf-stable items. The Foodbank’s contract to obtain and distribute USDA/TEFAP products is administered on the state level by the Ohio Department of Job and Family Services (ODJFS).

State products are provided through State of Ohio funding to the Ohio Food Program (OFP) and the Ohio Agricultural Clearance Program (OACP). State products include both shelf-stable items and perishable items such as produce or dairy. The Ohio Association of Second Harvest Foodbanks (OASHF), which represents the 12 Ohio foodbanks, holds the contract to administer and distribute the state products.

USDA/TEFAP and State Requirements for Food Pantries and Direct Distributions:

All food pantry programs and direct distributions are required to post Household Eligibility Guidelines and use the Federal and State Funded Food Programs Eligibility to Take Food Home form as part of federal and state compliance. This form is also known as the USDA/TEFAP form.  

Each client receiving food must complete this form with a name, address, phone number and number of people living in their household by age group. No other information is required. Agencies are not allowed to ask for social security numbers or proof of income. There are no exceptions to this policy.

The USDA/TEFAP form must be signed and dated each time a client receives food.  There are no exceptions. Foodbank staff will audit these forms at least once a year to ensure compliance with all requirements of the form. 

All USDA/TEFAP forms completed by clients must be kept for a minimum of 3 years.  Completed forms are subject to review by representatives from the Foodbank, food donors and appropriate government agencies.

Ohio Food Programs Manual

Member agencies receiving USDA/TEFAP and State funded commodities must maintain a copy of the Ohio Food Programs on site and abide by the rules and regulations in the manual.

The current Ohio Food Programs Manual, the USDA/TEFAP Eligibility form and the current Household Eligibility Guidelines can be downloaded from the links below.

Ohio Food Programs Manual Rev. 2012

"And Justice For All" Poster

2013-2014 Federal and State Funded Food Programs Eligibility To Take Food Home - Effective July 1, 2013 through June 30, 2014

2013-2014 Federal and State Eligibility Form in Spanish - Effective July 1, 2013 through June 30, 2014

2013-2014 TEFAP Eligibility Guidelines - Effective July 1, 2013 through June 30, 2014

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