Form H4529: Authorization to Transfer USDA Foods

1. Transferring CE Information
Page Instructions:
- Transferring CEs: Complete all fields.
- Receiving CEs/NSLP Warehouse: Review all selections.
Transferring CE Lookup
1.1 Transferring CE ID*
1.2 Transferring CE Name*
1.3 Transferring CE - Authorized Representative Name*
1.4 Transferring CE - Authorized Representative Email*
example@example.com

2. Receiving CE Information
Page Instructions:
- Transferring CEs: Complete all fields using the Receiving CE Lookup. Enter the Receiving CE ID into field 2.1 and autofill Receiving CE contact information. Copy this information into the Authorized Representative fields or complete the Authorized Representative fields with another Receiving CE contact.
- Receiving CEs/NSLP Warehouse: Review all selections.
Receiving CE Lookup
2.1 Enter the 5-digit CE ID without the # sign. Click the button below to complete the fields. *
2.3 Receiving CE Food Service Director
2.4 Receiving CE Food Service Director Email
example@example.com
*Only the Authorized Representative will be notified of this transfer.
2.2 Receiving CE Name*
2.5 Receiving CE Authorized Representative*
2.6 Receiving CE Authorized Representative Email:*
example@example.com

4. NSLP Warehouse Certification

State-contracted Warehouse Use Only - Transferring/Receiving CEs click Next.
Page Instructions: Complete all fields. Comment field (4.3) will notify TDA only of why a transfer is not approved (inventory shortages, etc). *Only the Warehouse Representative designated on this page will be notified of the transfer's final approval status.

4.2 Please Confirm Approval Status:*

I have reviewed the information on this form and APPROVE this transfer.I have reviewed the information on this form and DO NOT approve this transfer.
4.3 If Not Approved, please explain:
4.4 Warehouse Representative Name*
4.6 Warehouse Representative Email:*
example@example.com

5. TDA Approval

TDA Use Only
TDA Access Code
5.1 Transfer Approval Status

The transfer is approved.The transfer is not approved.
5.2 If Not Approved or adjustments were made, please explain:
5.3 Allocation Name:
5.4 TDA Representative

First Name Last Name
5.5 TDA Representative Email
example@example.com
5.6 Confirm the date:

MonthDay Year
Date

Thank you for completing Form H4529. You will receive a confirmation email when the transfer is finalized.
Should be Empty:

	Yes	No
I certify that each of the listed products are in good condition and on hand.
The transferring CE has verified the transfer.
The receiving CE has verified the transfer

Authorization to Transfer USDA Foods

	Texas Department of Agriculture
	USDA Foods
	Last Updated: 10/26/2021