REPORTING FORM
The Local Food, Farms, and Jobs Act (Act 617 of 2017)
Instructions
When completing the survey, you should only include purchases of food or food products made from state funds.
State funds include the following:
· Revenue Stabilization Act (RSA) funding
· Educational Excellence Trust Funds
· Workforce 2000 funds
· Other special revenues your institution receives from the State
State funds do not include the following:
· Student tuition & fees (including meal plans)
· Point of sale revenues (purchases at an on-campus Starbucks by students, staff, faculty or visitors)
· Private funds
· Federal funds, including grants, contracts and/or appropriations
· Clinical Revenues
The Local Food, Farms and Jobs Act only applies to unrestricted education & general (E&G) expenditures on food or food products.
Each campus will need to determine the allocation of state funding as a percent of your unrestricted E&G revenues in order to calculate the purchases of food or food products made from state funds.
1. Based upon the allocation described above, in FY2017, did your institution receive at least $25,000 from the state that was used to purchase food or food products? (If your answer is no, the survey is complete - stop here).
If the answer to Question #1 is YES, please complete the following:
2. In FY2017, what was the amount of funding from the state your institution used to purchase food or food products as defined in Question #1? (This question is not limited to food or food products grown in Arkansas or packaged and processed in Arkansas).
3. In FY2017, of the amount of funding identified in Question #2, what is the amount your institution spent on “local” food or food products as defined in Question #1? (This question is limited to local food or food products defined as food products that are grown in Arkansas or packaged and processed in Arkansas, or both).
4. In FY2017, of the amount of funding identified in Question #2, what is the percentage your institution spent on “local” food or food products as defined in Question #1? (This question is limited to local food or food products defined as food products that are grown in Arkansas or packaged and processed in Arkansas, or both).
5. If your institution receives funds from the state for the purchase of food or food products for FY2018 and thereafter, what steps will your institution take in an effort to reach the procurement goals outlined in Act 617 of 2017:
6. Based upon Questions #5, what is the best estimate (forecast) for the percentage your institution will spend on local food or food products in FY2018?
If you have questions about the contents of this survey, please contact Barbara Brown (501) 537-8957 or .
Please complete the online survey no later than Friday, November 17, 2017.
In addition to completing the online survey, you may mail or email the “Word” document to:
Bureau of Legislative Research
ATTN: Barbara A. Brown
One Capitol Mall, 5th Floor, Little Rock, AR 72201
REPORTING FORM
The Local Food, Farms, and Jobs Act (Act 617 of 2017)
Respondent Information
/DATE:
/2017
Agency: / Agency / Agency No.: / Agency#Mailing Address: / Address / City/State/Zip / City/ST/Zip
Name of the person in your agency responsible for developing and administering the compliance report.
Name: / Name / Title: / Title
Email: / Email / Phone No.: / Phone
1. In FY2017, did your institution receive at least $25,000 from the state that was used to purchase food or food products? (If your answer is no, the survey is complete - stop here). / Yes / No
2. In FY2017, what was the amount of funding from the state your institution used to purchase food or food products as defined in Question #1? (This question is not limited to food or food products grown in Arkansas or packaged and processed in Arkansas). / $Recvd
3. In FY2017, of the amount of funding identified in Question #2, what is the amount your institution spent on “local” food or food products as defined in Question #1? (This question is limited to local food or food products defined as food products that are grown in Arkansas or packaged and processed in Arkansas, or both). / $Awarded
4. In FY2017, of the amount of funding identified in Question #2, what is the percentage your institution spent on “local” food or food products as defined in Question #1? (This question is limited to local food or food products defined as food products that are grown in Arkansas or packaged and processed in Arkansas, or both). / Percentage %
5. If your institution receives funds from the state for the purchase of food or food products for FY2018 and thereafter, what steps will your institution take in an effort to reach the procurement goals outlined in Act 617 of 2017:
FY18Goals
6. Based upon Questions #5, what is the best estimate (forecast) for the percentage your institution will spend on local food or food products in FY2018? / FY18Goals %
7 Agency’s Policy Statement to complying with Act 617 of 2017:
Policy Statement
Signature of Agency Director: .
8. Please list below any purchases of food or food products in FY2017 from “local” farm and food producers in Arkansas. (Please combine providers with multiple purchases) If you have more than 15 purchases please click here to download an entry form which can be upload in the online survey.
Name of the Localfarmer/food products / Address / Items Purchased / Award Spent
Example: Arkansas Farms / 123 E Street, City, ZIP / Apples-100 lbs; Pears-50lbs / $11,111
1Name / 1Address / 1item / $1spent
2Name / 2Address / 2item / $2spent
3Name / 3Address / 3item / $3spent
4Name / 4Address / 4item / $4spent
5Name / 5Address / 5item / $5spent
6Name / 6Address / 6item / $6spent
7Name / 7Address / 7item / $7spent
8Name / 8Address / 8item / $8spent
9Name / 9Address / 9item / $9spent
9Name / 9Address / 9item / $9spent
10Name / 10Address / 10item / $10spent
11Name / 11Address / 11item / $11spent
12Name / 12Address / 12item / $12spent
13Name / 13Address / 13item / $13spent
14Name / 14Address / 14item / $14spent
15Name / 15Address / 15item / $15spent
If you have questions about the contents of this survey, please contact Barbara Brown (507) 537-8957 or .
Bureau of Legislative Research
ATTN: Barbara A. Brown
One Capitol Mall, 5th Floor, Little Rock, AR 72207