TEFAP Intake Form With No Address Line
Federal TEFAP rules no longer require a pantry to collect a household’s address, and a State agency may not require an address or ID to confirm residency. This free one-page form keeps what the federal record rule still names: who received the food, how many people are in the household, and why the household is eligible. Print it or save it as a PDF, in English or Spanish. Nothing you type leaves your browser.
Your State agency or food bank sets the actual form. If it gives you a TEFAP form, or requires one, use that form, not this one. State agencies decide how residency is determined, what the income limits are and how a household shows it meets them. Pick your State below to see the form and rules we found for it.
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What the rule says, in USDA’s words
The rule is Food Distribution Programs: Improving Access and Parity, published in the Federal Register on 31 October 2024 (89 FR 87228). Checked on USDA FNS and eCFR pages on 23 October 2026.
1. Address and ID are not eligibility criteria
The amended regulation, 7 CFR 251.5(b)(3), requires the State’s criteria to
“Include a requirement that the household reside in the geographic location served by the State agency at the time of applying for assistance, and the method for how residency will be determined. Length of residency, address, or identification documents shall not be used as an eligibility criterion.”
FNS’s summary of the change (page updated 7 August 2026) puts it this way:
“State agencies must develop a process for requesting residency information from households to determine eligibility but may not require households to provide an address or identification to confirm residency. For example, state agencies could implement a process that would allow self-declaration of residency.”
The FNS Q&A (page updated 7 August 2026) says the rule “Removes a longstanding, burdensome requirement that requires TEFAP eligible recipient agencies (ERAs) to collect the address of all TEFAP participants.”
2. What a State agency may still ask for
The State still requires the household to live in its service area and chooses how that is shown. The final rule’s preamble (31 October 2024):
“Along with self-attestation, other options for State agencies to confirm residency of TEFAP applicants may include collecting the zip code or county of residence of TEFAP applicants.”
The State also sets the income standard. Under 7 CFR 251.5(b)(2) its criteria must “Include income-based standards and the methods by which households may demonstrate eligibility under such standards,” with a maximum income threshold “at or between 185 percent to 300 percent of the U.S. Federal Poverty Guidelines.”
On addresses collected for other reasons, the preamble says ERAs “cannot collect addresses as part of the eligibility determination process but may still collect addresses on a voluntary basis for other purposes, such as in cases of food recalls and providing information on other assistance programs, if it is clear providing the information is optional for applicants and is being collected for reasons other than TEFAP eligibility.” The form’s optional contact box is worded that way.
3. What each distribution site still records
7 CFR 251.10(a)(4), as amended:
“Each distribution site must collect and maintain on record for each household receiving USDA Foods for home consumption, the name of the household member receiving USDA Foods, the number of persons in the household, and the basis for determining that the household is eligible to receive USDA Foods for home consumption.”
Records are kept for 3 years from the close of the federal fiscal year they belong to (7 CFR 251.10(a)(5)). Part 251 does not itself prescribe a signature line; many State TEFAP forms ask for one, so the form includes signature and date and you can switch them off if your State does not use them.
4. The dates
- 30 December 2024: the rule took effect. The Federal Register notice says “This rule is effective December 30, 2024,” and the address and residency change (§§ 251.5(b)(3) and 251.10(a)(4)) was on that standard 60-day timeline.
- 31 October 2025: the 12-month deadline for six provisions. FNS: “state agencies will not need to implement them for 12 months, or by Oct. 31, 2025.” For TEFAP these are posting eligible recipient agency information and the statewide eligibility criteria (“including requirements for demonstrating income and residency”) on a public web page, and participation reporting. So 31 October 2025 is when your State’s residency and income rules should have been public, not the date addresses stopped being a federal requirement.
How to use it
- Ask your food bank or State agency first whether it has a TEFAP form. If it does, use it.
- Copy your State’s current income limits into the table on the form (or switch the table off if your State’s chart is posted at your intake table). Your State’s TEFAP page links what we found.
- Turn on ZIP or county only if your State uses it to confirm residency.
- Keep completed forms locked away for as long as your State requires (at least the 3-year federal period), then shred them.
When the paper becomes the problem
Paper works until someone has to count households and people each month. PantryPOS records the household, its size and its TEFAP declaration at the desk, logs each visit, and builds the monthly totals your food bank asks for. $39 a month for the first location, free 30-day trial, no card. Start a free trialNo signup: it opens a shared sample pantry in your browser for 2 hours, so you can check a household out and see the record it keeps.
Related: full client intake form (Service Insights fields) · TEFAP records a pantry must keep · TEFAP eligibility · can a food pantry require ID?
Frequently asked questions
Does a food pantry still have to collect an address for TEFAP?
No, not under the federal rule. USDA’s final rule (published 31 October 2024, effective 30 December 2024) removed the federal address requirement, and 7 CFR 251.5(b)(3) says address and ID documents shall not be used as an eligibility criterion. Your State agency still sets how residency is determined, so check its form.
Can a pantry still ask for a ZIP code or county?
The rule’s preamble says State agencies may confirm residency by collecting the ZIP code or county of residence, along with self-attestation. Ask for one only if your State’s method uses it.
Can a pantry collect an address for food recalls?
Only on a voluntary basis, outside the eligibility decision, and only if it is clear the answer is optional. The form’s optional contact box says so in plain words.
What did 31 October 2025 change?
It was the deadline for six provisions, including States posting their TEFAP eligibility criteria (with the income and residency requirements) online and TEFAP participation reporting. The address change took effect on 30 December 2024.
Is this the official TEFAP form?
No. State agencies and food banks set the actual form. If yours requires one, use it.
Sources
- USDA FNS, Q&As: Food Distribution Programs – Improving Access & Parity Final Rule (page updated 7 August 2026; read 23 October 2026).
- USDA FNS, Snapshot of Regulatory Changes: Food Distribution Programs Final Rule (page updated 7 August 2026; read 23 October 2026).
- USDA FNS, Improving Access and Parity in TEFAP.
- Federal Register, Food Distribution Programs: Improving Access and Parity, 89 FR 87228, 31 October 2024.
- eCFR, 7 CFR 251.5 and 7 CFR 251.10 (current text, read 23 October 2026).
This template is free and unrestricted; change it however you like. It is a generic sheet built from the federal text above. Your State agency and food bank set the actual TEFAP form and may require more or different fields; their forms govern. It is not legal advice. Questions: customer.service@0xpi.com.