FNS Form-674
The FNS-674 form needs to have certain data in boxes 14 – 20.
- All Users
- Box 14 System Name: Food Delivery Portal (FDP)
- Box 15 Type of Access/Role
- State Agency: FDP SA User
- Regional Office: FDP RO User
- Headquarters: FDP National Office (HQ) User
- Box 16 Action Requested: Add
- Boxes 17 and 18: Leave blank.
- Box 21 - Provide your signature, printed name and date.
- State Agency Users
- Box 19 State/Locality Codes: 2-digit state/state agency code (e.g., AZ, MP, NN).
- Please see the list of state agency abbreviation codes.
- Box 20 : copy and paste the text below, then change the state agency reference to be appropriate
- “FNCS Org (Salesforce) Environment(s): Production; Role: System generated after a State agency contact is created; License Type: Partner Community; Profile: FNSWIC_State Agency User Profile; Public Groups: FNS WIC Portal Users”
- Print out the form.
- Box 22a: Obtain your supervisor's information and ink signature.
- Scan the completed form as a PDF (or take a clear picture).
- Save the completed FNS-674 as a .PDF using the following filename format: State Abbreviation_LastName_FirstName_FNS674 (ex: MA_John_Doe_FNS674)
- Box 19 State/Locality Codes: 2-digit state/state agency code (e.g., AZ, MP, NN).
- FNS Users
- Box 20: copy and paste the text below, then add or remove the region reference (as appropriate), and add your email address as the User name:
- “FNCS Org (Salesforce) Environment(s): Production, FDP-UAT (fncs-- uat.my.salesforce.com without enhanced domains); Role: FNS WIC FDP User; License Type: Salesforce; Profile: FNSWIC_FDP Standard User; Public Groups: FNS WIC Portal Users; Permission Sets: FNSWIC FDP Community Access, Salesforce Classic Permissions; Region represented: _____; User name (email address): ____”
- Box 22a: Obtain your supervisor's digital signature.
- Save the completed FNS-674 as a .PDF using the following filename format: Region or Group Abbreviation_LastName_FirstName_FNS674 (ex: SWRO_John_Doe_FNS674, V&T Jane Doe FNS674)
- Box 20: copy and paste the text below, then add or remove the region reference (as appropriate), and add your email address as the User name:
Complete the STARS Confidentiality Form
All FDP users will need to complete a STARS confidentiality form as information on STARS retailers appears within FDP. This form is available from your state agency management, regional office, or the FDP Helpdesk at SM.fn.FDPHelp@usda.gov.
Turn in Completed Package
- Email the completed FNS-674 form and STARS confidentiality form to the FDP Helpdesk. The FDP Helpdesk will forward your account request package to the system’s FNS authorizing official.
- You will receive an email when your user account is ready to use.