Professional Documents
Culture Documents
NAME
51 52 53 54 55. 56. 57 58. 59 60 61 62.
NAME
s
Sales Amount
Op Chg
63
84. 85.
64.
65. 66 67 68 69.
70. 71.
Refund Data
<*
$ $ $ $
BAS Mealdays
NAME
Grade
Meal Period
$ $ $
PRIVACY ACT STATEMENT AUTHORITY: 10 U.S.C., Chapter 40; 37 U.S.C., Chapter 9, EO 9397, November 1943 PRINCIPAL PURPOSES: Used to authorize and verify the Subsistence-in-Kind entitlement, record the numbers of people subisisting, and account for cash collected. ROUTINE USES: Information maybe disclosed lo the Department of Justice, and to federal, state, local or foreign law enforcement authorities for investigating or presecuting a violation on potention violation of law DISCLOSURE: Disclosure of SSN is voluntary. However, members otherwise entitled to Subsistence-in-Kind will not be provided a meal at no cost withoul the SSN. since the SSN is used to verify the entitlement.
HEADCOUNT RECORD
ORGANIZATION OR DINING FACILITY Meal/fflght Meal Rate For Meal Periods Shown (indicate if meals were sold ala carte)
field
B/L/D/M/R/S
ALA
COLUMN A Grade Meal Period
$ $
Social Security Number
t $
Operating Charge for Meals Shown (if ala carte, enter percentage)
Op Chg
$ $
$
$
Percentage:
NAME
1
2 3 4 5. 6 7 8, 9. 10 11. 12 13 14. 15
Sales Amount
NAME
26 27. 28 29 30 31 32 33 34 35. 36 37. 38 39 40
OpChg
16.
41 42. 43 44 45 46. 47 48 49
50
* Write in B - Breakfast, L - Lunch, D - Dinner, M - Midnight, R - Brunch, S - Supper To delermine mealdays, multiply the number of meals served by the appropriate meal percentage Breakfast - 20%, Lunch-40%, Dinner40%, Midnight-20 or 40%, Brunch-45%, and Supper-55%. PRIVACY ACT STATEMENT AUTHORITY: 10 U.S.C., Chapter 40; 37 U.S.C., Chapter 9; EO 9397, November 1943 PRINCIPAL PURPOSES: Used to authorize and verify the Subsistence-in-Kind entitlement; record the numbers of people subsisting; and account for cash collected. ROUTINE USES: Information may be disclosed to the Department of Justice, and to federal, state, local or foreign law enforcement authorities for investigating or prosecuting a violation or )0tential violation of law. HSCLOSURE: Disclosure of SSN is voluntary. However, members otherwise entitled to Subsistence-in-Kind will not be provided a meal at no cost without the SSN, since the SSN is used to erify the entitlement. AF Form 79, HeadCOUnt ReCOrd (supersedes previous editions of AFform 79, 1339,463, and 2039)