Reporting Forms

Applications received after 9/30/2018 will be processed after 1/1/2019

Other Information

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race,color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. 


Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits.  Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339.  Additionally, program information may be made available in languages other than English.


To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at:, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:


(1) Mail: U.S. Department of Agriculture

     Office of the Assistant Secretary for Civil Rights

     1400 Independence Avenue, SW

     Washington, D.C. 20250-9410;


(2) Fax: (202) 690-7442; or


(3) Email:


This institution is an equal opportunity provider.

Agency Handbook

Agency Calendar 2020

2020 Delivery Schedule

How to Order on Primarius

Food Safety Training

One representative from each agency must be trained by MFB. Certification is valid for 2 years. If you have questions about your agency's status email

The online food safety training is available here.

USDA Forms (Click to Download)


TEFAP Quarterly Report

    1st   Quarter Due- October 15

    2nd Quarter Due- January 15

    3rd  Quarter Due- April 15

    4th  Quarter Due- July 15

Reports must be mailed or e-mailed by the close of business on dates listed above. 


Mail reports to:

Mountaineer Food Bank

484 Enterprise Dr. Gassaway, WV 26624 or

Email reports to:

in the subject line type 'Your Pantry Quarterly Report'

TEFAP Food Pantry Means Test

TEFAP 2020-2021 Food Pantry Recipient Application

Additional Food Pantry Recipient Application


Nondiscrimination Statement for TEFAP Documentation 


USDA Civil Rights Compliance in the Food Distribution Programs 


Civil Rights Discrimination Complaint Form


Civil Rights Discrimination Complaint Form Instructions


Civil Rights Discrimination Complaint Form SPANISH 


Civil Rights Discrimination Complaint Form Instructions SPANISH


USDA TEFAP Civil Rights-Media Release

USDA TEFAP CSFP Beneficiary Referral Request

USDA CSFP Beneficiary Notice of Beneficiary Rights

USDA TEFAP Beneficiary Notice of Beneficiary Rights

Food Distribution National Policy Memorandum

TEFAP Recall Control   |  484 Enterprise Drive, Gassaway, WV 26624

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