Texas Department of
Agriculture
Form H1620
July 2008
Month/Year
Special Milk Program Worksheet
School Food Authority
Program No.
School/Child Institution/Facility
TX PRICING WITH FREE OPTION
DATE
Number of 1/2 pints of milk served to children
Paid
Free*
PRICING WITHOUT
FREE OPTION
(Number of 1/2 pints of
milk served to children)
NON-PRICING
NON-ELIGIBLE
PROGRAM OPTION
MILK (1/2 pints
(Number of 1/2 pints of milk consumedmilk served to children) ALL ADULTS)
MILK PURCHASES
Vendor
Quantity
Number of
1/2 pints**
Cost
10.
9.
E
IV
H
C
R
A
6b.
6a.
7.
8.
These numbers correspond to item numbers in the Special Milk Program section on Form 1532, Claim for
Reimbursement – Food and Nutrition Division.
*For programs which charge separately and choose to serve free milk to eligible children.