Form FDACS-06413 "Reimbursement for Expenses Request" - Florida

What Is Form FDACS-06413?

This is a legal form that was released by the Florida Department of Agriculture and Consumer Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2018;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FDACS-06413 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Download Form FDACS-06413 "Reimbursement for Expenses Request" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
REIMBURSEMENT FOR EXPENSES REQUEST
THE EMERGENCY FOOD ASSISTANCE PROGRAM (TEFAP)
NICOLE "NIKKI" FRIED
COMMISSIONER
COMMODITY SUPPLEMENTAL FOOD PROGRAM (CSFP)
7 CFR 247, 7 CFR 251
Date:
Agency Name:
_____________________
Mailing Address:
_________________________________
City:
State:
___
TEFAP
Contract No.:
Period of Distribution:
(Month and Year)
0.00
Total pounds of TEFAP foods distributed:
lbs. X $0.20
Total $
CSFP
Contract No.:
Period of Distribution:
(Month and year)
Number of cases distributed for CSFP
Number of approved applications for CSFP
Total Reimbursement Requested
$
Attach supporting documentation regarding delivery/distribution of (TEFAP/CSFP) foods, i.e., bills of lading, delivery receipts,
distribution reports, etc. All other supporting documentation must be maintained on site as required by 7 CFR §247 and/or 251.
________________________
Program Director/Coordinator (Signature)
Date
Print Name
Title
DO NOT WRITE IN THIS SPACE
TEFAP
CSFP
ORG CODE/EO:
ORG CODE/EO:
PAYMENT AMOUNT $
PAYMENT AMOUNT $
FDACS CONTRACT MANAGER (Signature)
DATE:
FDACS-06413 Rev. 09/18
Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
REIMBURSEMENT FOR EXPENSES REQUEST
THE EMERGENCY FOOD ASSISTANCE PROGRAM (TEFAP)
NICOLE "NIKKI" FRIED
COMMISSIONER
COMMODITY SUPPLEMENTAL FOOD PROGRAM (CSFP)
7 CFR 247, 7 CFR 251
Date:
Agency Name:
_____________________
Mailing Address:
_________________________________
City:
State:
___
TEFAP
Contract No.:
Period of Distribution:
(Month and Year)
0.00
Total pounds of TEFAP foods distributed:
lbs. X $0.20
Total $
CSFP
Contract No.:
Period of Distribution:
(Month and year)
Number of cases distributed for CSFP
Number of approved applications for CSFP
Total Reimbursement Requested
$
Attach supporting documentation regarding delivery/distribution of (TEFAP/CSFP) foods, i.e., bills of lading, delivery receipts,
distribution reports, etc. All other supporting documentation must be maintained on site as required by 7 CFR §247 and/or 251.
________________________
Program Director/Coordinator (Signature)
Date
Print Name
Title
DO NOT WRITE IN THIS SPACE
TEFAP
CSFP
ORG CODE/EO:
ORG CODE/EO:
PAYMENT AMOUNT $
PAYMENT AMOUNT $
FDACS CONTRACT MANAGER (Signature)
DATE:
FDACS-06413 Rev. 09/18