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["Client No.","Last Name","First Name","Middle Name","Site Name","DOB","Address","Apt  or Unit","Zip Code","City","State","County","Phone","Gender","Household Members","Monthly Income","Client Status","Certification Start Date","Certification End Date","Ethnicity","Race","Income Eligibility","Proxy 1","Proxy Phone","Proxy 2","Notes","Veteran","Disabled","Receive Texts","Home Delivery","Check to order a Card","Modified Date","Modified By"]
[50003,"Sample","Sample","S","163","1960-02-02","123 Main","Lot 602","78041","Laredo","TX","Webb","9567263120","Male",{"v":5,"d":"5.00"},{"v":1200,"d":"$1,200.00"},"Active","2022-05-10","2023-04-30","Hispanic or Latino","White","Social Security","Proxy Sample","9567263120","Proxy Sample 2","","No","Yes Other","Yes","Yes",0,"2022-05-10","Juan Solis"]

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[null,"South Texas Food Bank",{"$nulls":18}," "]
[null,"Commodity Supplemental Food Program (CSFP)"]
[]
[]
["PRINTING MENU"]
[null," "]
{"$rows_empty":7}
[{"$nulls":7},"DOB:",{"$f":"L45","v":"1960-02-02"},null,null,{"$f":"N45","v":"Age is Ok"}]
{"$rows_empty":21}
[null,"Household Information "]
[null,"Name of Individual that is Filling the Application",{"$nulls":9},{"$f":"'Attach here data'!AF2","v":44691}]
[null,"Title of Individual that is Filling the Application",{"$nulls":9},"Eligibility Specialist"]
[]
[null,"Name of Applicant",{"$nulls":7},"Last",null,{"$f":"'Attach here data'!B2","v":"Sample"}]
[{"$nulls":9},"First",null,{"$f":"'Attach here data'!C2","v":"Sample"}]
[{"$nulls":9},"(Full) Middle",null,{"$f":"'Attach here data'!D2","v":"S"}]
[]
[null,"Site Name",{"$nulls":9},{"$f":"VLOOKUP('Attach here data'!E2,Sites!A1:B100,2,FALSE)","v":"Holy Redeemer"}]
[null,"Date of Birth",{"$nulls":9},{"$f":"'Attach here data'!F2","v":"1960-02-02"},null,{"$f":"IF(L45<1,\"\",IF(L107-L45>=21915,\"Age is Ok\",\"Warning not 60 years old yet !\"))","v":"Age is Ok"}]
[]
[null,"Address",{"$nulls":7},"Street",null,{"$f":"'Attach here data'!G2","v":"123 Main"}]
[{"$nulls":9},"City",null,{"$f":"'Attach here data'!H2","v":"Lot 602"}]
[{"$nulls":9},"State",null,{"$f":"'Attach here data'!I2","v":"78041"}]
[{"$nulls":9},"ZipCode",null,{"$f":"'Attach here data'!J2","v":"Laredo"}]
[]
[null,"Area Code and Telephone No.",{"$nulls":9},{"$f":"'Attach here data'!L2","v":"Webb"}]
[null,"Alternate Telephone No."]
[null,"Total Number of Household Members",{"$nulls":9},{"$f":"'Attach here data'!N2","v":"Male"}]
[]
[null,"Total Gross Income of all Household Members:",{"$nulls":7},"Weekly"]
[{"$nulls":9},"Monthly",null,{"$f":"'Attach here data'!O2","v":{"v":5,"d":"$5"}},null,"Note: SNAP benefits do not count as income."]
[{"$nulls":9},"Yearly"]
[]
[null,"Gender"]
[null,"Male",{"$nulls":9},{"$f":"IF(('Attach here data'!M2)=\"MALE\",\"X\",0)","v":0}]
[null,"Female",{"$nulls":9},{"$f":"IF(('Attach here data'!M2)=\"FEMALE\",\"X\",0)","v":0}]
[]
[null,"Have you ever received food from the Commodity Supplemental Food Program?"]
[null,"Yes"]
[null,"No"]
[null,"If yes Where?",{"$nulls":7},"(City and State)"]
[null,"Date applicant last received food from the CSFP:"]
[]
[null,"Race"]
[null,"Black or African American",{"$nulls":9},{"$f":"IF(('Attach here data'!$U$2)=\"Black or African American\",\"X\",0)","v":0}]
[null,"Native Hawaiian or Other Pacific Islander",{"$nulls":9},{"$f":"IF(('Attach here data'!$U$2)=\"Native Hawaiian or Other Pacific Islander\",\"X\",0)","v":0}]
[null,"American Indian or Alaska Native",{"$nulls":9},{"$f":"IF(('Attach here data'!$U$2)=\"American Indian or Alaskan Native\",\"X\",0)","v":0}]
[null,"Asian",{"$nulls":9},{"$f":"IF(('Attach here data'!$U$2)=\"Asian\",\"X\",0)","v":0}]
[null,"White",{"$nulls":9},{"$f":"IF(('Attach here data'!$U$2)=\"White\",\"X\",0)","v":"X"}]
[]
[null,"Ethnicity"]
[null,"Hispanic or Latino",{"$nulls":9},{"$f":"IF(('Attach here data'!$T$2)=\"Hispanic or Latino\",\"X\",0)","v":"X"}]
[null,"Not Hispanic or Latino",{"$nulls":9},{"$f":"IF(('Attach here data'!$T$2)=\"Not Hispanic or Latino\",\"X\",0)","v":0}]
[]
[null,"Eligibility  (presented documentation)"]
[]
[null,"Does the Applicant meet the Income Guidelines for the Elderly?"]
[null,"Yes, the applicant meet the Income Guidelines",{"$nulls":9},"X",null,"Compare the applicant's income against the "]
[null,"No, the applicant doesn't meet the Income Guidelines",{"$nulls":11},"most recent Income Guidelines for the Elderly."]
[null,"Income documentation presented:"]
[null,"Social Security Award Letter",{"$nulls":9},{"$f":"IF(('Attach here data'!$S$2)=\"Social Security Award Letter (Pension)\",\"X\",0)","v":0}]
[null,"Pay Stub from previous month",{"$nulls":9},{"$f":"IF(('Attach here data'!$S$2)=\"Pay Stub From Previous Month\",\"X\",0)","v":0}]
[null,"Income Tax Return",{"$nulls":9},{"$f":"IF(('Attach here data'!$S$2)=\"Income Tax Return\",\"X\",0)","v":0}]
[null,"Bank Statement  (only gross income)",{"$nulls":9},{"$f":"IF(('Attach here data'!$S$2)=\"Bank Statement\",\"X\",0)","v":0}]
[null,"SSI Award Letter",{"$nulls":9},{"$f":"IF(('Attach here data'!$S$2)=\"SSI Award Letter (Disability)\",\"X\",0)","v":0}]
[]
[null,"Categorical proof? (This means that the aplicant has 60 years or more)"]
[null,"Yes",{"$nulls":9},"X",null,"The applicant must show proof that"]
[null,"No",{"$nulls":11},"he/she is 60 years old  or older."]
[null,"Address proof?"]
[null,"Yes",{"$nulls":9},"X",null,"Bank Statement can be used as"]
[null,"No",{"$nulls":11},"proof of address."]
[]
[null,"Category"]
[null,"Elderly",{"$nulls":9},"X"]
[null,"Not categorically eligible"]
[]
[null,"Determination"]
[null,"Eligible",{"$nulls":9},{"$f":"IF('Attach here data'!P2=\"Active\",\"X\",0)","v":0},{"$f":"IF(L45<1,\"\",IF(L107-L45>=21915,\"Age is Ok\",\"Warning not 60 years old yet !\"))","v":"Age is Ok"}]
[null,"Eligible – On Waiting List",{"$nulls":9},{"$f":"IF('Attach here data'!P2=\"Waiting List\",\"X\",0)","v":0}]
[null,"Determination Date",{"$nulls":9},{"$f":"TODAY()","v":"2023-12-08"}]
[null,"Date of Initial Visit",{"$nulls":9},{"$f":"TODAY()","v":"2023-12-08"}]
[null,"Certification Period",{"$nulls":11},"thru"]
[]
[null,"Proxy"]
[null,"Name of Proxy 1 —Optional",{"$nulls":9},{"$f":"'Attach here data'!Y2","v":"Proxy Sample 2"}]
[null,"Name of Proxy 2 —Optional",{"$nulls":9},{"$f":"'Attach here data'!AA2","v":"No"}]
[null,"The following part must be completed only when the applicant is not eligible."]
[null,"Not Eligible "]
[null,"If ineligibility was determined, that was based on :"]
[null,"Income"]
[null,"Residency"]
[null,"Age"]
[]
[]
[]
[{"$nulls":15}," "]
{"$rows_empty":20}
[null,"Oops ! ….."]
[]
[null,"You are using the wrong procedure to print your application."]
[]
[null,"Please use the buttons located in the PRINTING MENU"]
[]
[null,"Thank you !!"]

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["Site_Number","Site_Name","Site_Number_B"]
["2","Nuestra Gente ADC","2"]
["4","Villa San Luis","4"]
["6","Father Ed Kircher","6"]
["7","Las Flores ADC","7"]
["8","Tanis Valdez Village","8"]
["9","Santa Teresita Community Center","9"]
["13","Buenos Dias ADC","13"]
["14","Lulac Haven","14"]
["15","Hamilton Senior Citizen Home","15"]
["16","Guadalupe Housing","16"]
["17","Rio Bravo Community Center","17"]
["18","San Vicente de Paul Church","18"]
["19","San Martin de Porres Church","19"]
["20","Larga Vista Community Center","20"]
["21","El Cenizo Community Center","21"]
["23","Fiesta ADC","23"]
["30","Senior Citizen Home","30"]
["36","South Texas Food Bank","36"]
["38","Mirando E.J. Salinas Comm. Center","38"]
["39","Bruni Community Center","39"]
["43","Mission Santo Nino","43"]
["44","Christ Church Episcopal","44"]
["45","Lilia Perez Community Center","45"]
["49","La Hacienda ADC","49"]
["56","Laredo Manor Apartments","56"]
["58","Civic Center","58"]
["59","San Jose Church","59"]
["60","El Paraiso ADC","60"]
["64","Santa Margarita de Escocia Church","64"]
["68","Zapata Pavilion","68"]
["69","San Ygnacio Community Center","69"]
["92","Hebbronville Food Pantry","92"]
["93","Kinney County Brackettville","93"]
["96","Val Verde County Community Center","96"]
["98","Maverick County Food Pantry","98"]
["99","Carrizo Springs Food Pantry","99"]
["100","Big Wells Food Pantry","100"]
["101","Asherton Food Pantry","101"]
["102","Catarina","102"]
["103","Val Verde Roswell","103"]
["104","Val Verde Home Bound","104"]
["105","Loaves and Fishes","105"]
["107","San Isidro Food Pantry","107"]
["109","Templo Rosa de Saron","109"]
["111","Precint 4 Colonias Unidas","111"]
["112","Precint 1 La Rosita","112"]
["113","Precint 2 Roma","113"]
["115","Precint 3 La Casita","115"]
["124","Zapata Home Bound","124"]
["126","La Luz ADC","126"]
["133","Laredo Caring Hearts ADC","133"]
["134","Esmeraldas ADC","134"]
["135","Zapata Falcon","135"]
["140","CSS Senior Center","140"]
["141","Dominion ADC","141"]
["142","Kickapoo Traditional Tribe of Texas","142"]
["143","Day Break ADC","143"]
["144","Gladiator Youth and Families","144"]
["145","Fasken Community Center","145"]
["146","Ladrillera Senior Center","146"]
["147","Ana Maria Lozano Housing","147"]
["148","Casa de Esperanza","148"]
["149","Rancho Penitas FMAB Comm. Center","149"]
["150","Alto Bonito Food Pantry","150"]
["151","La Presa Community Center","151"]
["152","Ladrillito Community Center","152"]
["153","Casa Verde Apartments","153"]
["154","Val Verde County Comstock","154"]
["155","Pueblo Nuevo","155"]
["156","Russell Terrace","156"]
["157","Carlos Richter","157"]
["158","229th, Food Pantry Roma","158"]
["159","Turkey Distribution","159"]
["160","Val Verde County Pct. 2","160"]
["161","San Judas Tadeo Church","161"]
["162","Door Dash","162"]
["163","Holy Redeemer","163"]

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[null,"Commodity Supplemental Food Program"]
[null,"Participant Application"]
[null,"Print pages 1 – 2 for Certification."]
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[null,"Name of applicant/Nombre del solicitante",{"$nulls":14},"      Address/Dirección",{"$nulls":17},"Date/Fecha"]
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[null,"Date of birth/La fecha de nacimiento",{"$nulls":10},"     Phone number/Número de teléfono",{"$nulls":11},"    Site name/Nombre del sitio"]
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[null,"Name of proxy/Nombre del proxy",{"$nulls":10},"     Phone number/Número de teléfono",{"$nulls":11},"    Dates of proxy/Fechas de proxy"]
[null,{"$f":"'Attach here data'!W2","v":"Proxy Sample"},{"$nulls":6},"/",{"$f":"'Attach here data'!Y2","v":"Proxy Sample 2"},{"$nulls":5},{"$f":"'Attach here data'!X2","v":"9567263120"},{"$nulls":9},{"$f":"IF(B13<=\" \",\" \",V26)","v":"2022-05-10"},{"$nulls":4},{"$f":"IF(B13<=\" \",\" \",AD26)","v":"2025-04-01"}]
[]
["Income Information",{"$nulls":9},{"$f":"MENU!L67","v":0}]
[null,"Total gross income (before deductions) of all household members. SNAP benefits do not count as income."]
[null,"Ingreso brutos total (antes de deducciones) de todos los miembros del hogar. Beneficios de SNAP no cuentan como ingreso."]
[null,"$_________    Weekly/Semanal",{"$nulls":12},"$",{"$f":"IF('Attach here data'!P2<=0,\" \",'Attach here data'!P2)","v":{"v":1200,"d":"1,200"}},null,null,"  Monthly/Mensual",{"$nulls":7},"  $_________    Yearly/Anual"]
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[null,{"$f":"'Attach here data'!O2","v":5},null,null,"Number of household members/Número de miembros del hogar"]
[]
["Eligibility"]
[]
[null,{"$f":"MENU!L105","v":0},null,null,"Eligible/Eligible    Applicant is eligible when they meet income, residency, and age requirements./El solicitante es elegible "]
[null,null,"cuando cumple con los requisitos de ingresos, residencia, y edad.",{"$nulls":48},"mas ","un año","menos"]
[{"$nulls":4},"Dates of certification/Fechas de la certificación:",{"$nulls":15},"from/de ",{"$f":"'Attach here data'!R2","v":"2022-05-10"},{"$nulls":5}," to/a ",null,{"$f":"VALUE(BC26&\"/\"&BD26&\"/\"&BE26)","v":"2025-04-01"},{"$nulls":20},{"$f":"MONTH(V26)","v":5},11,{"$f":"AZ26+AY26","v":16},12,{"$f":"IF(BA26-BB26<=0,12,BA26-BB26)","v":4},1,{"$f":"IF(AY26=1,YEAR(V26)+2,YEAR(V26)+3)","v":2025}]
[null,{"$f":"MENU!L106","v":0},null,null,"Eligible and on waitlist/Eligible y en la lista de espera",{"$nulls":45},"today","11 mese","despues",12]
[]
[]
[null,{"$f":"MENU!L115","v":0},null,null,"Ineligible/Inelegible        I have been advised in writing that I am ineligible to participate in the CSFP and have the right to a fair "]
[null,"hearing. I am ineligible to participate based on the following criteria:/He sido informado por escrito que soy inelegible para participar en el "]
[null,"programa de comida suplemental y tengo derecho a una audiencia imparcial. Soy inelegible para participar en base a los siguientes "]
[null,"criterios:"]
[null,{"$f":"MENU!L117","v":0},null,null,"Income/Los ingresos",{"$nulls":9},{"$f":"MENU!L118","v":0},null,null," Residency/La residencia",{"$nulls":11},{"$f":"MENU!L119","v":0},{"$nulls":3},"Age/La edad"]

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{"$rows_empty":8}
["Ethnicity and Race"]
[null,"Ethnicity  (select one category)/Origen étnico (seleccione una categoría)"]
[null,null," Hispanic or Latino/Hispano o Latino",{"$nulls":9},{"$f":"MENU!L78","v":"X"},{"$nulls":4},"Not Hispanic or Latino/No hispano o Latino",{"$nulls":11},{"$f":"MENU!L79","v":0}]
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[null,"Race  (select one or more categories)/Raza (seleccione una o más categorías)"]
[null,null,{"$f":"MENU!L71","v":0},null,"Black or African American/Negro o afroamericano"]
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[null,"  Applicant or Proxy’s Signature/Firma del participante o representante",{"$nulls":17},"   CE or Site’s Signature/CE o firma del sitio"]
[null,"X",{"$nulls":18},{"$f":"'Attach here data'!AG2","v":"Juan Solis"}]

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{"$rows_empty":50}
["   Nondiscrimination Statement"]

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{"$rows_empty":53}
["  Declaratoria de No Discriminacion"]

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[{"$nulls":8},"July 2016"]

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[null,"Texas Department of Agriculture",{"$nulls":13},"Commodity Supplemental Food Program",{"$nulls":15},{"$f":"'Attach here data'!A2","v":50003},{"$nulls":6},"July 2022"]
[{"$nulls":15},"Proxy Form",{"$nulls":22},"FD 099-2016"]
[null," Participant’s name (print) / Nombre del solicitante      ",{"$nulls":19}," Name of distribution site / Nombre del sitio de la distribución      "]
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[]
[null," I authorize / ",{"$nulls":7},"     "]
[null," Autorizo",{"$nulls":3},{"$f":"'Attach here data'!W2","v":"Proxy Sample"},{"$nulls":12},"to be my proxy in the CSFP. / que me representante en la CSFP.",{"$nulls":13},{"$f":"IF('Attach here data'!W2<=\" \",\" \",Front!AH7)","v":"2022-05-10"}]
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[null,null,"   Participant’s signature / Firma del participante",{"$nulls":12},"   Duration of proxy / Duración de representante",{"$nulls":11},"   CE or site’s signature / Firma del CE o sitio"]
[]
[null," I authorize / ",{"$nulls":7},"     "]
[null," Autorizo",{"$nulls":3},{"$f":"'Attach here data'!Y2","v":"Proxy Sample 2"},{"$nulls":12},"to be my proxy in the CSFP. / que me representante en la CSFP.",{"$nulls":13},{"$f":"IF('Attach here data'!Y2<=\" \",\" \",Front!AH7)","v":"2022-05-10"}]
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["South Texas Food Bank"]
["C.S.F.P. Program"]
["Temporary List Placement Notification"]
[]
["I uderstand that due to the limited number of spots in this Program, I will be receiving the bag in"]
["Temporary basis. With the understanding that this benefit will end in "]
[{"$f":"'Temp Spa'!A8:L8","v":"2023-02-28"}]
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[]
["(Please report any information update to: (956) 726-3120 CSFP Department)"]
[]
[]
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[]
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[null,"Participant's Signature",{"$nulls":5},"Program Oficial's Signature"]
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[]
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["South Texas Food Bank"]
["C.S.F.P. Program"]
["Temporary List Placement Notification"]
[]
["I uderstand that due to the limited number of places in this Program, I will be receiving the bag in"]
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["At that time I might 1)receive a temporary certification extension, 2) be certified for a period not to"]
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[]
["(Please report any information update to: (956) 726-3120 CSFP Department)"]
[]
[]
[null,{"$f":"B14","v":"Sample, Sample S"}]
[null,"Participant's Name"]
[]
[]
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[]
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[null,"Date",{"$nulls":5},"Date"]

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["South Texas Food Bank"]
["Programa de C.S.F.P. "]
["Notificación de que su aplicación quedará en Forma Temporal "]
[]
["Entiendo y estoy de acuerdo de que, debido a el número limitado de lugares en este programa,"]
["mi aplicación quedará en forma temporal."]
["Con el entendimiento de que este beneficio terminará en"]
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["En esa fecha yo podre 1) recibir una extension del beneficio, 2) ser certificado por un periodo que no"]
["excedera tres (3) años, o 3) ser puedto de nuevo en lista de espera."]
[]
["(Puede reportar cualquier cambio al: (956) 726-3120 Departamento de C.S.F.P.)"]
[]
[]
[]
[null,{"$f":"Front!B7","v":"Sample, Sample S"}]
[null,"Nombre de Participante "]
[]
[]
[null,"x"]
[null,"Firma de Participante ",{"$nulls":5},"Firma del oficial del Programa de CSFP"]
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["South Texas Food Bank"]
["Programa de C.S.F.P. "]
["Notificación de que su aplicación quedará en Forma Temporal "]
[]
["Entiendo y estoy de acuerdo de que, debido a el número limitado de lugares en este programa,"]
["mi aplicación quedará en forma temporal."]
["Con el entendimiento de que este beneficio terminará en"]
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["En esa fecha yo podre 1) recibir una extension del beneficio, 2) ser certificado por un periodo que no"]
["excedera tres (3) años, o 3) ser puedto de nuevo en lista de espera."]
[]
["(Puede reportar cualquier cambio al: (956) 726-3120 Departamento de C.S.F.P.)"]
[]
[]
[]
[null,{"$f":"B16","v":"Sample, Sample S"}]
[null,"Nombre de Participante "]
[]
[]
[null,"x"]
[null,"Firma de Participante ",{"$nulls":5},"Firma del oficial del Programa de CSFP"]
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[]
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[null,"Fecha",{"$nulls":5},"Fecha"]

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[{"$nulls":28},{"$f":"'Attach here data'!A2","v":50003}]
[null,"Commodity Supplemental Food Program"]
[null,"Temporary Certification"]
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["Participant Information"]
[null,"Name",{"$nulls":14},"      Address/Dirección","Signature",{"$nulls":14},"Date"]
[null,{"$f":"MENU!L40&\", \"&MENU!L41&\" \"&MENU!L42","v":"Sample, Sample S"},{"$nulls":15},"X",{"$nulls":15},{"$f":"'Attach here data'!R2","v":"2022-05-10"}]
[]
[null,"Address",{"$nulls":23},"Area Code and phone number",{"$nulls":9},"ZIP code"]
[null,{"$f":"Front!M7","v":"123 Main Lot 602, Laredo TX 78041"},{"$nulls":23},{"$f":"'Attach here data'!M2","v":"9567263120"},{"$nulls":10},{"$f":"'Attach here data'!I2","v":"78041"}]
[]
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[]
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[{"$nulls":9},"Your certification begins on",null,{"$f":"'Attach here data'!R2","v":"2022-05-10"}]
[{"$nulls":11},"Date"]
[{"$nulls":9},"and ends on",null,"2023-02-28"]
[{"$nulls":11},"Date"]
[null,"At that time, you might 1) receive a temporary certification extension, 2) be certified for a period not to exceed three (3) "]
[null,"years, or 3) be placed back on the wait list."]
[null,"If you disagree with this determination, you have the right to an appeal."]
[null,"Inform the food bank or site that you want to appeal."]
[]
[{"$nulls":51},"mas ","un año","menos"]
[{"$nulls":50},"today","11 mese","despues",12]
[{"$nulls":50},{"$f":"MONTH(L16)","v":5},11,{"$f":"AZ27+AY27","v":16},12,{"$f":"IF(BA27-BB27<=0,12,BA27-BB27)","v":4},1,{"$f":"IF(AY27=1,YEAR(L16)+2,YEAR(L16)+3)","v":2025}]
{"$rows_empty":25}
[null,"CE or Site Information"]
[null,"Name",{"$nulls":14},"      Address/Dirección","Signature",{"$nulls":14},"Date"]
[null,{"$f":"MENU!L44","v":"Holy Redeemer"},{"$nulls":31},{"$f":"AH7","v":"2022-05-10"}]
[]
[null,"Address",{"$nulls":23},"Area Code and phone number",{"$nulls":9},"ZIP code"]
{"$rows_empty":40}
[null,"In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, "]
[null,"and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, "]
[null,"disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA."]
[null,"Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign "]
[null,"Language, etc.), should contact the Agency (State or local) where they applied for benefits.  Individuals who are deaf, hard of hearing or have speech "]
[null,"disabilities may contact USDA through the Federal Relay Service at (800) 877-8339.  Additionally, program information may be made available in languages "]
[null,"other than English."]
[null,"To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: "]
[null,"http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the "]
[null,"information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:  (1) mail: "]
[null,"U.S. Department of Agriculture; Office of the Assistant Secretary for Civil Rights; 1400 Independence Avenue, SW; Washington, D.C. 20250-9410;  (2) fax: "]
[null,"(202) 690-7442; or  (3) email: program.intake@usda.gov.   This institution is an equal opportunity provider."]
[null,"De conformidad con la Ley Federal de Derechos Civiles y los reglamentos y políticas de derechos civiles del Departamento de Agricultura de los EE. UU"]
[null,"(USDA, por sus siglas en inglés), se prohíbe que el USDA, sus agencias, oficinas, empleados e instituciones que participan o administran programas del "]
[null,"USDA discriminen sobre la base de raza, color, nacionalidad, sexo, discapacidad, edad, o en represalia o venganza por actividades previas de derechos "]
[null,"civiles en algún programa o actividad realizados o financiados por el USDA."]
[null,"Las personas con discapacidades que necesiten medios alternativos para la comunicación de la información del programa (por ejemplo, sistema Braille, "]
[null,"letras grandes, cintas de audio, lenguaje de señas americano, etc.), deben ponerse en contacto con la agencia (estatal o local) en la que solicitaron los "]
{"$rows_empty":11}
[null," • Income tax return • Bank statement • SSI award letter"]
[null,"Ethnicity  (select one category)/Origen étnico (seleccione una categoría)"]
[null,null,"Hispanic or Latino/Hispano o Latino  ",{"$nulls":25},"Not Hispanic or Latino/No hispano o Latino  "]
[]
[null,"Race  (select one or more categories)/Raza (seleccione una o más categorías)"]
[null,null,"Black or African American/Negro o afroamericano ……………………………………………"]
[]
[null,null,"Native Hawaiian or Other Pacific Islander/Nativo de Hawai o de otra isla del Pacífico ….."]
[]
[null,null,"American Indian or Alaskan Native/Indio americano o nativo de Alaska ………………….."]
[]
[null,null,"Asian/asiático ………………………………………………………………………………………."]
[]
[null,null,"White/el blanco ………………………………………………………………………………………"]

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["South Texas Food Bank"]
["C.S.F.P. Program"]
["Waiting List Placement Notification"]
[]
["I uderstand that due to the limited number of spots in this Program, I will be included in a"]
["Waiting List, until a place is available for me."]
[]
["I am also notified that I have to inform to this office, of any change in the information I provided today"]
["(telephone number, address, income, household members number, etc)"]
["no later than 10 days of the information's date change."]
["(Please report any information update to: (956) 726-3120 CSFP Department)"]
[]
[]
[null,{"$f":"Front!B7","v":"Sample, Sample S"}]
[null,"Participant's Name"]
[]
[]
[null,"x"]
[null,"Participant's Signature",{"$nulls":5},"Program Oficial's Signature"]
[]
[]
[null,{"$f":"'Attach here data'!R2","v":"2022-05-10"},{"$nulls":5},{"$f":"B22","v":"2022-05-10"}]
[null,"Date",{"$nulls":5},"Date"]
{"$rows_empty":20}
["South Texas Food Bank"]
["C.S.F.P. Program"]
["Waiting List Placement Notification"]
[]
["I uderstand that due to the limited number of places in this Program, I will be included in a"]
["Waiting List, until a place is available for me."]
[]
["I am also notified that I have to inform to this office, of any change in the information I provided today"]
["(telephone number, address, income, household members number, etc)"]
["no later than 10 days of the information's date change."]
["(Please report any information update to: (956) 726-3120 CSFP Department)"]
[]
[]
[null,{"$f":"B14","v":"Sample, Sample S"}]
[null,"Participant's Name"]
[]
[]
[null,"x"]
[null,"Participant's Signature",{"$nulls":5},"Program Oficial's Signature"]
[]
[]
[null,{"$f":"B22","v":"2022-05-10"},{"$nulls":5},{"$f":"B65","v":"2022-05-10"}]
[null,"Date",{"$nulls":5},"Date"]

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["South Texas Food Bank"]
["C.S.F.P. Program"]
[]
["Notificación de que su aplicación quedará en Lista de Espera"]
[]
["Entiendo y estoy de acuerdo de que, debido a el limitado número de lugares en este programa,"]
["mi aplicación sera incluida en una Lista de Espera, hasta que un lugar este disponible para mi."]
[]
["También estoy siendo notificado de que deberé informar a esta oficina por cualquier cambio"]
["en la información proporcionada por mi el dia de hoy."]
["Debere actualizar mi información dentro de los 10 dias posteriores a que cualquier cambio ocurra."]
["(número de télefono, domicilio, cantidad de ingresos, número de miembros de la familia en mi domicilio, etc)"]
["(Puede reportar cualquier cambio al : (956) 726-3120 Departamento de CSFP)"]
[]
[]
[null,{"$f":"'WL Eng'!B14:F14","v":"Sample, Sample S"}]
[null,"Nombre del Participante"]
[]
[]
[null,"x"]
[null,"Firma del Participante",{"$nulls":5},"Firma del oficial del programa de CSFP"]
[]
[]
[null,{"$f":"'WL Eng'!B22:F22","v":"2022-05-10"},{"$nulls":5},{"$f":"B24","v":"2022-05-10"}]
[null,"Fecha",{"$nulls":5},"Fecha"]
{"$rows_empty":20}
["South Texas Food Bank"]
["C.S.F.P. Program"]
[]
["Notificación de que su aplicación quedará en Lista de Espera"]
[]
["Entiendo y estoy de acuerdo de que, debido a el limitado número de lugares en este programa,"]
["mi aplicación sera incluida en una Lista de Espera, hasta que un lugar este disponible para mi."]
[]
["También estoy siendo notificado de que deberé informar a esta oficina por cualquier cambio"]
["en la información proporcionada por mi el dia de hoy."]
["Debere actualizar mi información dentro de los 10 dias posteriores a que cualquier cambio ocurra."]
["(número de télefono, domicilio, cantidad de ingresos, número de miembros de la familia en mi domicilio, etc)"]
["(Puede reportar cualquier cambio al : (956) 726-3120 Departamento de CSFP)"]
[]
[]
[null,{"$f":"B16","v":"Sample, Sample S"}]
[null,"Nombre del Participante"]
[]
[]
[null,"x"]
[null,"Firma del Participante",{"$nulls":5},"Firma del oficial del programa de CSFP"]
[]
[]
[null,{"$f":"B24","v":"2022-05-10"},{"$nulls":5},{"$f":"B69","v":"2022-05-10"}]
[null,"Fecha",{"$nulls":5},"Fecha"]

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[]
[{"$nulls":64},"*","*"]
[{"$nulls":5},"South Texas Food Bank"]
[{"$nulls":5},"CSFP Program"]
[{"$nulls":5},"Participant's Temporary ID"]
[]
[{"$nulls":16},"Last Name:",null,{"$f":"'Attach here data'!B2","v":"Sample"}]
[{"$nulls":16},"First Name:",null,{"$f":"'Attach here data'!C2","v":"Sample"}]
[{"$nulls":16},"Middle Name:",null,{"$f":"'Attach here data'!D2","v":"S"}]
[{"$nulls":16},"DOB:",null,{"$f":"'Attach here data'!F2","v":"1960-02-02"}]
[{"$nulls":16},"Site:",null,{"$f":"MENU!L44","v":"Holy Redeemer"}]
[{"$nulls":16},"Number ID:",null,{"$f":"'Attach here data'!A2","v":50003}]
[]
[{"$nulls":13},{"$f":"CONCATENATE($BM$2,S12,$BN$2)","v":"*50003*"}]
[]
[]
[]
[]
[{"$nulls":13},{"$f":"S12","v":50003}]
[]
[{"$nulls":5},"Welcome to the CSFP Program !"]
[{"$nulls":5},"This is a temporary ID. A permanent ID will be provided as soon as it is ready."]
[{"$nulls":5},"Please show this paper along with your photo ID every time you come to pickup your food bag."]
[]
[{"$nulls":5},"Very Important !"]
[{"$nulls":5},"By instructions of the Texas Department of Agriculture (TDA),"]
[{"$nulls":5},"Photo ID is required every time you pickup your food bag."]
[{"$nulls":5},"We apologize, but we are not allowed to provide help to "]
[{"$nulls":5},"program's participants who don't show a valid ID."]
[{"$nulls":5},"Muy Importante !"]
[{"$nulls":5},"Por instrucciones del Texas Department of Agriculture (TDA),"]
[{"$nulls":5},"se requiere presentar identificación con fotografía cada vez "]
[{"$nulls":5},"que acuda usted a levantar su bolsa de comida."]
[{"$nulls":5},"Le pedimos nos disculpe, pero no nos esta permitido proveer"]
[{"$nulls":5},"ayuda a los participantes del programa que no muestren"]
[{"$nulls":5},"una identificación válida."]
[]
[{"$nulls":5},"For any questions or concerns, please call Sandra Chavez or Juan Solis"]
[{"$nulls":5},"at (956) 726-3120 ext 102 or 105."]
[" Nondiscrimination Statement"]

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[]
[]
[{"$nulls":15},"1 BAG"]
[]
[null,"South Texas Food Bank"]
[null,"CSFP"]
[null,"Commodity Supplemental Food Program"]
[]
[null,"Please show a valid ID and give this paper"]
[null,"to the STFB Warehouse personnel in order to pickup your food."]
[]
[null,"This document is valid only for today."]
[{"$nulls":5},{"$f":"TODAY()","v":"2023-12-08"},{"$nulls":5},{"$f":"NOW()","v":45268.396841898146}]
[null,"This document expires one hour after its expedition."]
[]
[{"$nulls":6},"Number:",{"$f":"'Attach here data'!A2","v":50003}]
[{"$nulls":6},"Last Name:",{"$f":"'Attach here data'!B2","v":"Sample"}]
[{"$nulls":6},"First Name:",{"$f":"'Attach here data'!C2","v":"Sample"}]
[{"$nulls":6},"DOB:",{"$f":"'Attach here data'!F2","v":"1960-02-02"}]
[{"$nulls":6},"Address:",{"$f":"'Attach here data'!G2","v":"123 Main"}]
{"$rows_empty":8}
[{"$nulls":6},"Staff's Signature"]

{"sheet":"Veteran-Disabled","index":19,"n_rows":16,"n_cols":7,"rows_kept":16,"hidden":true,"merged":[[0,0,0,7],[1,0,1,7],[2,0,2,7],[11,0,11,7]]}
["South Texas Food Bank"]
["C.S.F.P. Program"]
[]
[]
[]
[null,null,"Number",null,null,{"$f":"'Attach here data'!A2","v":50003}]
[null,null,"Name",null,null,{"$f":"Front!B7","v":"Sample, Sample S"}]
[null,null,"DOB",null,null,{"$f":"MENU!L45","v":"1960-02-02"}]
[null,null,"Site",null,null,{"$f":"MENU!L44","v":"Holy Redeemer"}]
[null,null,"Today's Date",null,null,{"$f":"'Attach here data'!Q2","v":"Active"}]
[]
["Participant's Additional Infofrmation"]
[]
[null,null,"Is the Participant a Veteran?",{"$nulls":3},{"$f":"'Attach here data'!AC2","v":"Yes"}]
[]
[null,null,"Is the Participant Disabled?",{"$nulls":3},{"$f":"'Attach here data'!AD2","v":"Yes"}]

{"sheet":"Instructions","index":20,"n_rows":0,"n_cols":0,"rows_kept":0,"hidden":true}