Appendix B - Forms

Missouri Emergency Food Assistance Program Policy & Procedures Manual

Form No. Title
FD-3

Report of Receipts and Distributions Form and Instructions updated 11/2025
FD-4 TEFAP Distribution Data Report
FD-5 Report of USDA-Donated Food Loss
FD-5D USDA Foods Complaint Form
FD-6 Food Bank/Eligible Recipient Agency Agreement
FD-9 Physical Inventory of USDA-Donated Foods
FD-15A Part 1

English: Application for Receipt of USDA Food - Part 1 updated 11/2025

Spanish: Solicitud Para Recibir Alimentos Del USDA - Parte 1 updated 11/2025

Bosnian: Aplikacija Za Racun Za USDA Hranu - Pvri 010 updated 11/2025

Russian: ЗАЯВЛЕНИЕ НА ПОЛУЧЕНИЕПРОДУКТОВ ОТ USDA- FD-15A-ЧACTЬ1 updated 11/2025

Korean: USDA 식품 수령 신청서 - FD-15A-1부 updated 11/2025
FD-15A Part 2

English: Application for Receipt of USDA Foods - Part 2 updated 11/2025

Spanish: Solicitud Para Recibir Alimentos Del USDA - Parte 2 updated 11/2025

Bosnian: Aplikacija Za Racun Za USDA Hranu - Pvri D10 updated 11/2025

Russian: ЗАЯВЛЕНИЕ НА ПОЛУЧЕНИЕ ПРОДУКТОВ ОТ USDA - FD-15A-ЧACTЬ 2 updated 11/2025

Korean: USDA 식품 수령 신청서 - FD-15A-2부 updated 11/2025
FD-19D Distribution Rate Chart
FD-29 Transfer of USDA-Donated Foods
FD-32D Record of Expenditures Under TEFAP Financial Assistance
FD-35 Assistance Forms Request
FD-133FB OMB Single Audit Requirement Statement
FD-155 Written Notice of Beneficiary Rights for The Emergency Food Assistance Program
FSD-21 Public Voucher – Commodity Programs