Exhibit E - AF-79 Headcount Record.pdf
PDF 60 KB Posted
- Solicitation number
- RFP 511 180000000894 1
- Issued by
- Ingham County, Michigan
About this file
This is an AF Form 79 Headcount Record, a United States Air Force document used to account for meals sold in dining facilities, flight kitchens, or field feeding operations. The form serves as the official record for tracking meal transactions and subsistence entitlements across military dining operations. The document is structured to record individual meal transactions across four columns (A, B, C, and D), with capacity for up to 92 individual entries per page. Each entry requires recording the meal recipient's name, grade, meal period, Social Security number, sales amount, and operating charge. The form includes designated sections for calculating totals across each column and combined columns, tracking both Subsistence-in-Kind (SIK) meals and cash meal transactions with their associated operating charges.
The headcount record functions as both an accountability and financial document, enabling facilities to verify subsistence entitlements, document the number of people subsisting, and account for cash collected. The form includes sections for recording refund data, cash overages or shortages, and net cash available for turn-in. It requires certification by both the facility supervisor and the person responsible for cash collection through signature and grade designation. The Privacy Act statement authorizes the collection of Social Security numbers under 10 U.S.C. Chapter 40 and 37 U.S.C. Chapter 9, with disclosure authorized to the Department of Justice and law enforcement authorities for investigating potential violations. The Social Security number disclosure is technically voluntary, though members entitled to no-cost meals cannot receive them without providing this identifying information for entitlement verification purposes.
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| Exhibit D Air Force Instruction 48-116.pdf | ||
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| Exhibit F AFI 34-239 sup (1).pdf |
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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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