FNS-790 Hunger Champions Nomination Form

Form Approved OMB No.0584-0524
Expiration Date: XX/XX/XXXX

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Hunger Champions
in administering the
Supplemental Nutrition Assistance Program
NOMINATION FORM
The Supplemental Nutrition Assistance Program (SNAP) Hunger Champion Award honors local offices
that provide exemplary service in assisting eligible clients to obtain SNAP benefits. Any individual, agency
or organization who has worked, observed or has personal experience with a local office may nominate
that office for the Hunger Champion Award.
A committee will select awards from the nominations based on three important areas of success:
outreach, access and customer service. Please provide a justification of no more than one typed page
stating why the nominated local office should be recognized as a Hunger Champion.
The justification should include how participation rates have been affected by outreach activities and
enhancements. Examples include: a) partnerships with other government or private organizations; b)
implemented processes that made accessing the program easier for working persons, immigrants and the
elderly; c) assistance provided to parents who must bring their children into the office; d) courtesy and
helpfulness of the office staff; e) attention to reasonable wait times; f) referrals to other assistance
programs; g) timely processing of SNAP applications and expedited benefits; and h) overall objective,
activity, program, process, or result that sets the office apart from other offices.

Submitter:

Name:
Title:
Phone:
E-mail:

Nominee:

Office:
Address:
City and State:
Phone number:
E-mail address:

Justification:

Fill out on-line at http://www.fns.usda.gov//snap/outreach/default.htm or
attach a one page typed justification on why the nominated assistance office
should be recognized as a SNAP Hunger Champion.

Send to:

Hunger Champions Committee
c/o USDA, Food and Nutrition Service
3101 Park Center Drive, Room 1441, Alexandria, Virginia 22302

Fax to:
Email to:

703-605-1937
[email protected]

OMB BURDEN STATEMENT: 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 0584-0524. The time required to complete this information collection is estimated to average 45 minutes per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. If you have any comments concerning the accuracy of time estimates or suggestions for improving this form, please contact: U.S.
Department of Agriculture, Food and Nutrition Service, Office of Research and Analysis, Room 1012, Alexandria, VA 22302.

Form FNS-790 (07-09) Previous Editions are Obsolete

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