Free Form 02AG019E (SUOA-S-38) - Oklahoma


File Size: 407.5 kB
Pages: 2
File Format: PDF
State: Oklahoma
Category: Court Forms - State
Author: Planning Research and Statistics (405) 521-3552
Word Count: 305 Words, 1,525 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.okdhs.org/NR/rdonlyres/7382AD8C-C8E4-4C47-ABF7-FE8390F08BF1/0/02AG019E.pdf

Download Form 02AG019E (SUOA-S-38) ( 407.5 kB)


Preview Form 02AG019E (SUOA-S-38)
*02AG019E-001*
OKLAHOMA DEPARTMENT OF HUMAN SERVICES

Number of Meals Served
Nutrition site name Nutrition project name Month and year Project use only: Average number of days served per month: Average meals budgeted per day: Eligible meals budgeted per month: Eligible meals served this month: Eligible meals budgeted to date: Eligible meals served to date: (same as NAPIS report) Home delivered participants served 60+ (7) 60(8) Total (9) Volun -teers under 60 (11) Total persons served (13)

Site use only: Actual number of days served this month: Eligible meals served this month: Total meals prepared (2) Total meals purchased (3) Congregate participants served 60+ (4) 60(5) Total (6)

Date (1) 1 2 3 4 5 6 7 8 9 10 11

Guests under 60 (10)

Staff under 60 (12)

Other meals served (14)

0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0
02AG019E (SUOA-S-38)

0 0 0 0 0 0 0 0 0 0 0
Page 1 of 2

OKDHS issued 11-10-2006

02AG019E (SUOA-S-38) Total meals prepared (2) Total meals purchased (3) Congregate participants served 60+ (4) 60(5) Total (6)
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Number of Meals Served Home delivered participants served 60+ (7) 60(8) Total (9)
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Date (1) 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Total

Guests under 60 (10)

Volun -teers under 60 (11)

Staff under 60 (12)

Total persons served (13)
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Other meals served (14)

0

0

0

0

0

0

0

0

0

0

Page 2 of 2

OKDHS issued 11-10-2006