Reporting Agency Monthly Reporting Network Reporting PDP Sharing PDP Reporting Snap Reporting Agencies Agency Express Ordering Delivery Schedule Update Agency Profile Critical Recall Information ServSafe Training Register A Mobile Pantry Documents and Resources Join FBEM Print: Agency Monthly Reporting Form If you prefer to print then fax or mail this report to us, please print the form out. *You will need Adobe Acrobat© to open and print forms. If you do not have Adobe Acrobat© you can download and install it by clicking here. All required fields are marked with asterisk * you must enter a value. Please enter a Zero if field does not apply. DOWNLOAD FORM Agency InfoAgency Name* Agency Number*Contact NameContact NumberEmail* Report Month and Year*County*BreakdownTotal # People*Total # New People*GenderMales*Females*Total (male & Female)*Age0 - 17*18 - 59*60+*Total by Age*RaceCaucasian / Other*African American*Native American*Asian*Pacific Islander*Total by Race*EthnicityHispanic / Latino*Non-Latino /Non-Hispanic*Total by Ethnicity*USDA Product Distributed this monthTotal # Households receiving USDA*Number of NEW households receiving USDA*I am humanPhoneThis field is for validation purposes and should be left unchanged.