DAILY RECORD FORM FOR MILK ONLY
School________________________________							Number of Days Served___________________________
    or
System________________________________	 Preparer’s Name___________________	Number Eligible for Free Milk______________________

Year	Milk Served	Milk Accountability	Income	Charges	

Month	
Students	

Adults	On Hand Start of Day	
Milk Purchased	Available for Use Today	On Hand  End of Day	Milk Used Today	
Credit Slips	

Students	

Adults	
Total Income	

Students	

Adults	
	Free	Paid													
Date	1	2	3	4	5	6	7	8	9	10	11	12	13	14	

															

															

															

															

															

															

															

															

															

EF-N-79M (Rev.  10/01)			RETAIN WITH MONTHLY REIMBURSEMENT CLAIM FOR 3 YEARS

INSTRUCTIONS FOR COMPLETING FORM EF-N-79M
MILK DAILY RECORD

I.	GENERAL INFORMATION

* Name of school or system.
* The person filling out the form must sign it in the space provided to attest that the report is correct.
* Number milk service days during the calendar month.
* The highest number of students in the school eligible for free milk during the month.
* Year, month and dates which should be the first through last day of the calendar month.  On the same line as the date; enter information under the proper columns.

II.	MILK SERVED TO – Enter the number of milks served to:

Column 1 – FREE STUDENTS from families meeting the Federal eligibility standards for free milk.
Column 2 – PAID STUDENTS who have paid or charged their milk.

III.	MILK SERVED TO – Enter the number of milks served or used by:

Column 3 – ADULTS, all adults.

IV.	MILK ACCOUNTABILITY – The number of half pints:

Column 4 – ON HAND START OF DAY means before milk delivery.  This would normally be the amount on hand at the end of the day before.
Column 5 – MILK PURCHASED means milk delivered by the dairy.  (NOTE:  A school receiving milk three times a week would show nothing on days without delivery.)
Column 6 – AVAILABLE FOR USE TODAY total of Columns 4 and 5.
Column 7 – ON HAND END OF DAY the number left over at the end of the day.
Column 8 – MILK USED TODAY subtract Column 7 from Column 6.  To check this figure:  total Columns 1, 2, and 3.
Column 9 – CREDIT SLIPS for milk returned to the dairy for credit.  (NOTE:  Replacement of sour milk or leakers, etc., is not, in this sense, credit so do NOT record here.)

V.	INCOME – The amount of money received from:

Column 10 – STUDENTS record on the date collected.
Column 11 – ADULTS record on the date collected.
Column 12 – TOTAL add Columns 10 and 11.

VI.	CHARGES

Column 13 – STUDENTS amount of any charges made by students.
Column 14 – ADULTS amount of any charges made by adults.

EF-N-79M Inst. (Rev. 10/01)