Tips for Filling
Out this Form

How to determine number of clients served: This number is unduplicated. Therefore, if one client eats many meals or snacks during the month, only count that client once. This number can often be obtained by determining how many people were enrolled or registered for your program during this month. If there is no better way to determine it, use the highest count for one meal as your unduplicated number.

How to determine number of meals and/or snacks served: This number is duplicated. Therefore, if one client ate a meal every time he came to your program this month (let's hypothetically assume you had programming once a week), he will have eaten 4 meals during the month. This number can often be obtained by adding together your daily attendance records or meal counts.

Common Mistakes

The number of meals/snacks served can never be less than the number of clients served. (How can 10 people eat 5 meals?

If your client and meal/snack numbers are the same, it means that each person only ate a total of one meal/snack during the entire month.

The number of clients served can never be zero or blank (unless you did not serve any food during the month).


All agencies are required to fill out a monthly Service Statistics Report Form. Reports are due the 10th of the following month (i.e. April's is due by May 10th). If you serve food (regardless of where it is obtained) you must submit a report. If you did not serve any food, a zero report may be submitted.

On-Site Stats Form

If you are unsure of how to record your statistics or you have any questions, please call us at 715-835-9415.

Statistics for the month of:



Contact Name

Contact Phone


Number of clients served a meal and/or
snack this month (without duplication):

Number of meals served
this month (duplicated):

Number of snacks served
this month (duplicated):


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