Milk Usuage Record

MILK RECORD Worksheet Agency Code ______Agency______Month/Year______

Number of 1/2 Pints or Gallons Date Purchased Cost of Milk Number of 1/2 pints lost 1/2 Pints Gallons Purchased due to waste or spoilage; and number of 1/2 pints Note: this column can served to anyone 19 be used for an actual count of 1/2 pints years old or older. consumed 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 TOTAL (A) (B) (C) (D)

Convert Gallons to ½ Pints: Gallons ______multiplied by (x) 16 = ______½ Pints (B) (E)

Total Reimbursable ½ Pints: ______minus (-) column D ______= ______(A) + (E) (D)

Agency’s actual cost per ½ Pint: Cost $______divided by (÷) ______= $______(C) (A) + (E) Directions for Completing the Milk Purchase Record

1. Fill out agency name and agency code.

2. Enter month and year. You will want to complete the record for each month during the fiscal year (May 1 through April 30) that you claim for reimbursement.

3. Fill out the columns that pertain to your agency’s milk accountability statement as per your contract. Below (letters A through C) you will find a description of the accountability statements available within the online contract. Please fill out the Milk Record Worksheet as indicated below each statement.

A. The milk is reported for reimbursement based on the amount purchased for the children (per definition) within each calendar month; any spoiled or stolen milk is subtracted from the total number of half-pints to be reported for reimbursement. No milk is purchased or served to adults.  Fill out the number of half-pints or gallons that your agency purchased. Fill in the number to the corresponding date it was purchased. Fill out the milk invoice amount next to the corresponding date as well. NOTE: If milk is purchased in half-gallons; you can convert that total gallons to half-pints. There are 16 half-pints in 1 gallon.  Please be sure to fill out the amount of milk (half-pints) lost to waste or theft in the last column. B. The milk is reported for reimbursement based on the amount purchased for the children (per definition) within each calendar month; half-pints served to adults and any spoiled or stolen milk are subtracted from the total number of half-pints to be reported for reimbursement.  Fill out the number of half-pints or gallons that your agency purchased. Fill in the number to the corresponding date it was purchased. Fill out the milk invoice amount next to the corresponding date as well. NOTE: If milk is purchased in half-gallons; you can convert the total gallons to half-pints. There are 16 half-pints in 1 gallon.  Please be sure to fill out the amount of milk (half-pints) served to adults and/or lost to waste or theft in the last column. C. An actual daily count is taken of the number of half-pint cartons of milk served to the children and adults separately by a ticket system, check off system, or token system. (This method is ONLY acceptable if milk is purchased in half-pint cartons.)  Fill out the number of half-pints actually served to the children and adults. Please use the first and last column respectively to fill in those amounts corresponding to the dates the milk was served.

4. If you are filling out the form in Excel, it will automatically complete the totals. Those numbers will move into their corresponding spots on the bottom to determine the total reimbursable half-pints and agency’s actual cost per half-pint.

5. If you are filling out the form by hand, please be sure to add up your totals and transfer the numbers to the corresponding spots on the bottom to determine the total reimbursable half- pints and agency’s actual cost per half-pint. Please use the letters as a guide to transfer numbers to their corresponding line. 6. A copy of the Milk Record Worksheet must be maintained on file with your other supporting documents for the claim month.