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SNAP Incentive Waiver Request

This information is being collected to assist the Food and Nutrition Service to streamline the request process for an incentive waiver.  This is a voluntary collection and FNS will use the information to assess the eligibility of entities to offer incentives to SNAP households to increase their overall purchasing power for the purchase of healthy foods. This collection does not request any personally identifiable information under the Privacy Act of 1974.  

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0584-0695, which will expire on 04/30/2027.  

The time required to complete this information collection is estimated to average 2:00 hours per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 1320 Braddock Place, 5th Floor, Alexandria, VA 22306 ATTN: PRA (0584-NEW). Do not return the completed form to this address.

Your store must apply for a waiver of the SNAP equal treatment rule provisions (7 CFR 274.7(f) and 7 CFR 278.2(b)). The SNAP equal treatment provisions require that you treat SNAP recipients as you do your other customers. These provisions prohibit both negative treatment (such as discriminatory practices) and preferential treatment (such as incentive projects).

Requestor Information

Funding Source (select all that apply)
If no, which other groups will be eligible for the incentive?

Dates of Operation


Retailer Locations

(If multiple retailer banners will be participating, please indicate the number of retailer locations participating under each retailer banner; e.g. store banner A- 2 locations, store banner B- 5 locations)

Foods being Incentivized

Food categories project will incentivize

In accordance with "What foods can be incentivized?", please select all the food categories your program will incentivize: *

I confirm that the incentivized foods will meet the criteria outlined on "What foods can be incentivized?". *
Please indicate if you plan to apply additional criteria to the qualifying incentive foods for your incentive program. (e.g., must be fresh fruits and vegetables, locally-grown produce, etc.).

Incentive Model

Please indicate the incentive model for this program.
At the point of purchase, how will the incentive be triggered?

At the point of purchase, how will the incentive be triggered?

At the point of purchase, how will the incentive be delivered?

At the point of purchase, how will the incentive be delivered?

If yes, when is the maximum applied?
Which food items can the earned incentives buy?


Other Information

If you have any questions or concerns on retailer incentive programs, please email FNS at