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EXHIBIT 10

ICR 201702-0584-002 · OMB 0584-0631 · Object 76108301.

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EXHIBIT 10
Smryczko
Writer
2017-08-15
2026-09-12
complete

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OMB Number.: XXXX-XXXX
 Expire Date: XX/XX/20XX

APPENDIX V: STATE AGENCY ADMINISTRATIVE CASE RECORD DATA


Dear [State agency],

As we have previously discussed, we are writing to request SNAP data for the Assessment of the Barriers That Constrain the Adequacy of SNAP Allotments. At your earliest convenience, please send us a data file including the following elements for SNAP Participants RECEIVING SNAP AS OF [date]:
    • Name
    • Address
    • Phone Number
    • Household Size
    • Presence of children (yes/no)
    • Date benefit started
    • Amount of monthly benefit


Thank you for your time,
Sincerely,


Maeve E. Gearing
Project Director
Westat