Exhibit E - AF-79 Headcount Record.pdf
PDF 60 KB Posted
- Solicitation number
- RFP-511-180000000894-1
- Issued by
- Allegan County, Michigan
About this file
This document is Air Force Form 79, a Headcount Record form used to account for meals sold in dining facilities, flight kitchens, or field feeding operations within the U.S. Air Force. The form is designed to track meals served under Subsistence-in-Kind (SIK) entitlements and cash sales, recording details such as grade, meal period (breakfast/lunch/dinner/midnight), social security numbers, sales amounts, and operating charges across four columns (A-D) accommodating up to 92 entries.
The form includes sections for calculating totals of SIK meals, sales amounts, and operating charges from each column, as well as cumulative totals. A refund data section allows for recording meal refunds and their explanations. The bottom portion contains fields for total cash collected, refunds, overages/shortages, net cash for turn-in, total SIK meals, total cash meals, total discount rate collected, and total operating charge. The form requires signatures from both the facility supervisor and the person making collections, operating under the authority of 10 U.S.C., Chapter 40 and 37 U.S.C., Chapter 9.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit I AF-0148.pdf | ||
| Exhibit F AFI 34-239 sup (1).pdf | ||
| Alpena CRTC Food Services Proposal Instructions and Vendor Questions Worksheet and Schedule A - Schedule B.docx | DOCX document | |
| Standard Contract Terms.docx | DOCX document | |
| Exhibit F AFI 34-239.pdf | ||
| Exhibit D Air Force Instruction 48-116.pdf | ||
| Exhibit G AFMAN 34-240 Food Service Program Management.pdf | ||
| Exhibit H New menu.xlsx | XLSX spreadsheet |
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Text version
HEADCOUNT RECORD Accounts for meals sold in a dining facility, flight kitchen or field feeding
Serial No.
ORGANIZATION OR DINING FACILITY:
DATE:
Meal/Flight Meal Rate For Meal Periods Shown
B/L/D/M Operating Charge for Meals Shown
COLUMN A COLUMN B
NAME Grade Meal Period
Social Security Number
Sales Amount
Op Chg
NAME Grade Meal Period
Social Security Number
Sales Amount
Op Chg
1.
26.
2.
27.
3.
28.
29.
5.
30.
6.
31.
7.
32.
8.
33.
9.
34.
10.
35.
11.
36.
12.
37.
13.
38.
14.
39.
15.
40.
16.
41.
17.
42.
18.
43.
19.
44.
20.
45.
21.
46.
22.
47.
23.
48.
24.
49.
25.
50.
# of SIK Meals from Column
B
Sales Amount from Column
B
$ Operating Charge from
Column B
# of SIK Meals from
Column A
Sales Amount from
Column A
$ Operating Charge from
Column A
$ # of SIK Meals from Column
A & B
Sales Amount from Column
A & B
$ Operating Charge from
Column A & B
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 potential 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 without the SSN, since the SSN is used to verify the entitlement.
AF Form 79, Headcount Record (supersedes previous editions of AF form 79, 1339,463, and 2039)
COLUMN C COLUMN D
from
Column A & B
Sales Amount from Column A & B
$ Operating Charge from
Column A & B
$ # of SIK Meals From Column
A, B, & C
Sales Amount From Column
A, B, & C
Operating Charge From Col A, B, & C
NAME Grade Meal Period
Social Security Number
Sales Amount
Op Chg
NAME Grade Meal Period
Social Security Number
Sales Amount
Op Chg
51.
72.
52.
73.
53.
74.
54.
75.
55.
76.
56.
77.
57.
78.
58.
79.
59.
80.
60.
81.
61.
82.
62.
83.
63.
84.
64.
85.
65.
86.
66.
87.
67.
88.
68.
89.
69.
90.
70.
91.
71.
92.
from Column
C
Sales Amount from Column
C
$ Operating Charge from Column
C
$ # of SIK Meals from Column
D
Sales Amount from Column
D
$ Operating Charge from
Column D
Refund Data Total All Cash Collected $
NAME Grade Meal Period
Meal Type*
Amount Refunded
Less Refunds $ a.
$ Cash Overages/Shortages $ b.
$ Net Cash for Turn-In $ c.
$ Total All
SIK
Meals
Total # of Cash Meals
Total Discount
Rate Collected
Total Operating
Charge
Explanation for Refunds:
Explanation of overages/shortages
Signature and Grade of Facility Supervisor
Signature and Grade of Person Making Collection
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 persecuting a violation on potential 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 without the SSN, since the SSN is used to verify the entitlement.
| Number |
| Number |
| B |
| B |
| A & B |
| Sales |
| From Column |
| Grade |
| Security Number |
| D |
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