Tips for Filling Out this Form

How to determine number of clients served: If one person eats many meals or snacks during the month, count that person only 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 during the month as your unduplicated number.

How to determine number of meals and/or snacks served: If one person ate a meal every time he came to your program this month, and you have 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 people served.

If your number of people and number of meals/snacks are the same it means that each person ate a total of one meal/snack during the entire month.

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


On-Site Stats Form

All agencies are required to fill out a monthly Service Statistics Report Form. Reports are due the 5th of the following month (i.e. April's is due by May 5th). 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.

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 people served a meal and/or snack this month (count each person once):

Total number of meals served this month (duplicated):

Total number of snacks served this month (duplicated):