FNS 252-R Supplemental Nutrition Assistance Program Application fo

Form FNS-252-R
US Department of Agriculture
Food and Nutrition Service

SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM
REAUTHORIZATION APPLICATION FOR STORES

Reauthorization Customer Number:

2 Doing business as (if different
from store name):

1 Store Name:

OMB APPROVED NO. 0584-0008
Expiration Date: 01/31/2021

3 Is this store still open for business?
Yes

No

Yes

No

4 Store Operations: [Store Address]
4a Is this the current store location? If No, enter current store location address.
Store Location Address (do not enter P.O. Box here):
Street Number: Street Name:

Additional Address (Bldg #, Unit #, Stall #, etc.):

City:

State:

Zip Code:

4b Owner or Store Email Address:
4c Enter the current store telephone number:

(

)

5 Store Hours and Days of Operation:
Is this store open 7 days a week, 24 hours per day?
If No, indicate operating hours:
Opening Time
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:

Select AM or PM

6 How many cash registers are at this store?

4d Alternate telephone number:

–
Yes

(

)

–

No
Closing Time

Select AM or PM

7 Are optical scanners used at this store?

8 Do you have or are you applying for a restaurant license for your store?

Yes

Yes

No

No

9 Answer 9 a, b, c, and d regarding staple food varieties that you have currently and on a continuous basis in your store. Enter the number of varieties
for each staple food category if less than 10. Check "10+" if the number of varieties for each staple food category is equal to or greater than 10.
9a Indicate the number of varieties in the Breads and/or Cereals staple food category (Examples: rice, pasta, flour, pita, tortilla,
10+
OR
etc.) that you have currently and on a continuous basis in your store:
9b Indicate the number of varieties in the Dairy products staple food category (Examples: soymilk, butter, yogurt, infant
10+
OR
formula, etc.) that you have currently and on a continuous basis in your store:
9c Indicate the number of varieties in the Meat, Poultry, and/or Fish staple food category (Examples: beef, pork, eggs, tuna,
10+
OR
etc.) that you have currently and on a continuous basis in your store:
9d Indicate the number of varieties in the Vegetables and/or Fruits staple food category (Examples: apple, tomato, peach,
10+
OR
carrot, etc.) that you have currently and on a continuous basis in your store:
10 Answer the following questions regarding stocking units of staple food varieties that you have currently and on a continuous basis in your store:
10a Do you have at least three stocking units of each variety in the Breads and/or Cereals category (Examples: 3 bags of rice,
3 boxes of pasta, etc.)?
10b Do you have at least three stocking units of each variety in the Dairy products category (Examples: 3 cartons of soymilk, 3
cans of infant formula, etc.)?
10c Do you have at least three stocking units of each variety in the Meat, Poultry, and/or Fish category (Examples: 3 cans of
tuna, 3 cartons of eggs, etc.)?
10d Do you have at least three stocking units of each variety in the Vegetables and/or Fruits category (Examples: 3 apples, 3
cans of peaches, etc.)?

Yes

No

Yes

No

Yes

No

Yes

No

Yes
Yes

No
No

Yes

No

Yes

No

11 Answer the following questions regarding perishable foods that you have currently and on a continuous basis in your store:
11a Do you have at least one variety of perishable foods in the Breads and/or Cereals category (Examples: bread, pita, etc.)?
11b Do you have at least one variety of perishable foods in the Dairy products category (Examples: refrigerated cow’s milk,
refrigerated butter, etc.)?
11c Do you have at least one variety of perishable foods in the Meat, Poultry, and/or Fish category (Examples: fresh eggs,
frozen chicken, etc.)?
11d Do you have at least one variety of perishable foods in the Vegetables and/or Fruits category (Examples: fresh apples,
frozen broccoli, etc.)?

FNS-252-R (10-17) Previous Edition Obsolete

SBU
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Electronic Form Version Designed in Adobe 10.0 Version

12 Enter your total retail sales for a one year period in the following table and indicate the tax year corresponding to your sales figures. If you do not sell
a particular category of products place a "0" in the appropriate sales column cell.
Entered sales figures correspond to tax year 20
Sales Category
Gasoline

Sales
$

Lottery
Tobacco (Examples: cigarettes, cigars, chewing tobacco, etc.)
Alcohol (Examples: wine, beer, liquor, etc.)

$

Other Nonfood (Examples: soap, paper, pet food, etc.)
Hot Foods (Examples: hot coffee, hot soup, hot pizza, etc.)
Cold Prepared Foods (Examples: sandwiches, salads, etc.)

$

Accessory Foods (Examples: ice cream, potato chips, soda pop, doughnuts, etc.)
Staple Foods (Examples: rice, milk, beef, apples, etc.)
Total Sales

$

$
$
$
$
$
$

13 Owners/Officers. FNS records show the following persons are primary owners or officers of a private corporation that owns the store. In
community property states, the spouse of an owner or officer is also listed. (Community property states are AZ, CA, ID, LA, NM, NV, TX, WA, WI).
Is each person listed still an owner/officer/spouse? Check Yes or No for each person.
Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

13a Are there any primary owners/officers, or their spouses (in community property states), that are not listed here?
If Yes, go to 13b to enter information about these persons. See instructions for more information about this question.

13b If you answered Yes to question 13a, enter information for up to two additional owners/officers/spouses here. Make a copy of this page if you need
to enter additional owner/officer/spouse information, and attach it to this application. Do not enter any information if your store is owned by a
publicly-held corporation or government agency. Do not enter information for persons listed above.
(1) Print name exactly as it appears on the social security card:
First Name:
Middle Name:
Street Number:

Last Name:

Street Name:

Additional Address (Bldg #, Unit #, Stall #, etc.):

City:

State:

Social Security Number:

Date of Birth: (MM/DD/YYYY)

Social Security Number:

Additional Address (Bldg #, Unit #, Stall #, etc.):
State:

Date of Birth: (MM/DD/YYYY)

Email Address:

Last Name:

Street Name:

City:

If foreign address, add Country:

Business Title (i.e. owner, partner, spouse, etc.):

(2) Print name exactly as it appears on the social security card:
Middle Name:
First Name:
Street Number:

Zip Code:

Zip Code:

If foreign address, add Country:

Business Title (i.e. owner, partner, spouse, etc.):

Email Address:

14 Answer the questions for all officers, owners, partners, members, and/or managers.
14a Has any officer, owner, partner, member and/or manager ever been denied, withdrawn, disqualified, suspended, or
been fined for Supplemental Nutrition Assistance Program (SNAP), WIC, business, alcohol, tobacco, lottery, and/or
health violations?

Yes

No

Yes

No

14b If Yes, provide an explanation:

14c Has any officer, owner, partner, member, and/or manager currently or ever been suspended or debarred from
conducting business with or participating in any program administered by the Federal Government?
14d If Yes, provide an explanation:

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14e Is any officer, owner, partner, and/or member currently receiving assistance through the Supplemental
Nutrition Assistance Program?

Yes

No

14f If Yes, has the owner, partner, and/or member reported this store ownership to their SNAP caseworker?

Yes

No

Yes

No

Yes

No

Yes

No

14g If No, provide an explanation:

14h Has any officer, owner, partner and/or member ever been disqualified from receiving assistance through the
Supplemental Nutrition Assistance Program for an intentional program violation (IPV) or fraud?
14i If Yes, provide an explanation:

14j Does any officer, owner, partner, and/or member currently own any other SNAP authorized stores?
14k If Yes, how many currently authorized SNAP stores do you own?
15 Was any officer, owner, partner, member, and/or manager convicted of any crime after June 1, 1999?
15a If Yes, provide an explanation:

16 What is the name, phone number, and address of the company that provides your EBT equipment and services?
Equipment Provider Name:
Equipment Provider Phone Number:
Equipment Provider Mailing Address:
Street Number:

Street Name:

Additional Address (Bldg #, Unit #, Stall #, etc.):

City:

State:

Zip Code:

If foreign address, add Country:

17 Provide the name and address of the financial institution (bank) that you use for SNAP payment deposits:
Financial Institution Name:
Financial Institution Mailing Address:
Street Number:

Street Name:

Additional Address (Bldg #, Unit #, Stall #, etc.):

City:

State:

Zip Code:

If foreign address, add Country:

18 Do you have a website for your store? If yes, provide website address:
19 If you have additional information or comments you would like to provide to FNS (such as any Store name change, updated mailing address, new
or updated email address for each owner or officer listed in question 13, or any special circumstances that FNS should know, etc.) please provide
the information here:

PENALTY WARNING STATEMENT - The Food and Nutrition Service can deny or withdraw your approval to accept Supplemental Nutrition
Assistance Program benefits if you provide false information or try to hide information we ask you to give us. In addition, if false information is
provided or information is hidden from the Food and Nutrition Service, the owners of the firm may be liable for a $10,000 fine or imprisoned for as
long as five years, or both (7 U.S.C. 2024(f) and 18 U.S.C. 1001).
I have read, understand and agree with the conditions of participation outlined in the Privacy Act, Use and Disclosure, Penalty Warning and
Certification Statements, and agree to comply with all statutory and regulatory requirements associated with participation in the
Supplemental Nutrition Assistance Program. I am an owner/officer or authorized to complete the application for the store.
Print name:

Signature:

First Name

Business title:

Last Name

Middle Name

Date:

(

)

(owner, officer, manager, etc.)

–

Phone number where you can be reached

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KEEP THIS PAGE FOR YOUR RECORDS
PRIVACY ACT STATEMENT - Authority: Section 9 of the Food and Nutrition Act of 2008, as amended, (7 U.S.C. 2018); section 205(c)(2)(C) of the
Social Security Act (42 U.S.C. 405(c)(2)(C)); and section 6109(f) of the Internal Revenue Code of 1986 (26 U.S.C. 6109(f)), authorizes collection of the
information on this application.
• Information is collected primarily for use by the Food and Nutrition Service in the administration of the Supplemental Nutrition Assistance
Program;
• Additional disclosure of this information may be made to other Food and Nutrition Service programs and to other Federal, State or local agencies
and investigative authorities when the Supplemental Nutrition Assistance Program becomes aware of a violation or possible violation of the Food
and Nutrition Act of 2008, as explained in the next section called "Use and Disclosure";
• Section 278.1(b) of the Supplemental Nutrition Assistance Program regulations provides for the collection of each owner's Social Security
Number (SSN), Employee Identification Number (EIN) and tax information;
• The use and disclosure of SSNs and EINs obtained by applicants is covered in the Social Security Act and the Internal Revenue Code. In
accordance with the Social Security Act and the Internal Revenue Code, applicant social security numbers and employer identification numbers
may be disclosed only to other Federal agencies authorized to have access to social security numbers and employer identification numbers and
maintain these numbers in their files, and only when the Secretary of Agriculture determines that disclosure would assist in verifying and
matching such information against information maintained by such other agency [42 U.S.C. 405(c)(2)(C)(iii); 26 U.S.C. 6109(f)];
• Furnishing the information on this form, including your SSN and EIN, is voluntary but failure to do so will result in withdrawal of store
authorization to accept SNAP benefits;
• The Food and Nutrition Service may provide you with an additional statement reflecting any additional uses of the information furnished on this
form.
USE AND DISCLOSURE - Routine Uses: We may use the information you give us in the following ways:
• We may disclose information to the Department of Justice (DOJ), a court or other tribunal, or another party before such tribunal when the USDA
is involved in a lawsuit or has an interest in litigation and it has been determined that the use of such information is relevant and necessary and
the disclosure is compatible with the purpose for which the information was collected;
• In the event that the information in our system indicates a violation of the Food and Nutrition Act or any other Federal or State law whether civil
or criminal or regulatory in nature, and whether arising by general statute, or by regulation, rule, or order issued pursuant thereto, we may
disclose the information you give us to the appropriate agency, whether Federal or State, charged with the responsibility of investigating or
prosecuting such violation or charged with enforcing or implementing the statute, or rule, regulation or order issued pursuant thereto;
• We may use your information, including SSNs and EINs, to collect and report on delinquent debt and may disclose the information to other
Federal and State agencies, as well as private collection agencies, for purposes of claims collection actions including, but not limited to, the
Treasury Department for administrative or tax offset and referral to the Department of Justice for litigation. (Note: SSNs and EINs will only be
disclosed to Federal agencies authorized to possess such information);
• We may disclose information to other Federal and State agencies to verify the information reported by applicants and participating firms, and to
assist in the administration and enforcement of the Food and Nutrition Act, as well as other Federal and State laws. (Note: SSNs and EINs will
only be disclosed to Federal agencies authorized to possess such information);
• We may disclose information to other Federal and State agencies to respond to specific requests from such Federal and State agencies for the
purpose of administering the Food and Nutrition Act as well as other Federal and State laws;
• We may disclose information to other Federal and State agencies for the purpose of conducting computer matching programs;
• We may disclose information (excluding EINs and SSNs) to private entities having contractual agreements with us for designing, developing, and
operating our systems, and for verification and computer matching purposes;
• We may disclose information to the Internal Revenue Service for the purpose of reporting delinquent retailer and wholesaler monetary penalties
of $600 or more for violations committed under the SNAP. We will report each delinquent debt to the Internal Revenue Service on Form 1099-C
(Cancellation of Debt). We will report these debts to the Internal Revenue Service under the authority of the Income Tax Regulations (26 CFR
Parts 1 and 602) under section 6050P of the Internal Revenue Code (26 U.S.C. 6050P);
• We may disclose information to State agencies that administer the Special Supplemental Nutrition Program for Women, Infants, and Children
(WIC), authorized under Section 17 of the Child Nutrition Act of 1966 (CNA) (42 U.S.C. 1786), for purposes of administering that Act and the
regulations issued under that Act;
• Disclosures pursuant to 5 U.S.C. 552(a)(b)(12). We may disclose information to “consumer reporting agencies” as defined in the Fair Credit
Reporting Act (15 U.S.C. 1681a(f)) or the Debt Collection Act of 1982 (31 U.S.C. 3711(d)(4));
• We may disclose information to the public when a retailer has been disqualified or otherwise sanctioned for violations of the Program after the
time for administrative and judicial appeals has expired. This information is limited to the name and address of the store, the owner(s) name(s)
and information about the sanction itself. The purpose of such disclosure is to assist in the administration and enforcement of the Food and
Nutrition Act and Supplemental Nutrition Assistance Program regulations.

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KEEP THIS PAGE FOR YOUR RECORDS
CERTIFICATION AND SIGNATURE - By signing the application for reauthorization you are confirming your understanding of and agreement with the
following:
• I am an owner of this firm; or am authorized to represent the firm regarding this reauthorization.
• I have provided truthful and complete information on this form and on any documents provided to the Food and Nutrition Service;
• If I provide false information, my authorization to accept Supplemental Nutrition Assistance Program (SNAP) benefits may be withdrawn;
• Any information I have provided or will provide may be verified and shared by the USDA as described in the Privacy Act and Use and Disclosure
statement.
• SNAP training materials are available on request from the Food and Nutrition Service. Owners/Officers must ensure that the training materials are
reviewed by all firm's owners and all employees (whether paid or unpaid, new, full-time or part-time), and that all employees will follow SNAP
regulations.
• Violations of program rules can result in administrative actions such as fines, sanctions, withdrawal or disqualification from the Supplemental
Nutrition Assistance Program; Violations of the Supplemental Nutrition Assistance Program rules can also result in Federal, State and/or local
criminal prosecution and sanctions.
• Owners/Officers are responsible for violations of the Supplemental Nutrition Assistance Program regulations, including those committed by any of
the firm's employees, paid or unpaid, new, full-time or part-time. These include violations such as, but not limited to:
○ Trading cash for Supplemental Nutrition Assistance Program benefits (i.e., trafficking);
○ Accepting Supplemental Nutrition Assistance Program benefits as payment for ineligible items;
○ Accepting Supplemental Nutrition Assistance Program benefits as payment on credit accounts or loans;
○ Knowingly accepting Supplemental Nutrition Assistance Program benefits from people not authorized to use them;
• Disqualification from the WIC Program may result in Supplemental Nutrition Assistance Program disqualification, and a disqualification from the
Supplemental Nutrition Assistance Program may result in WIC Program disqualification;
• In accordance with Federal law and U.S. Department of Agriculture policy, no customer may be discriminated against on the grounds of race,
color, national origin, sex, age, religion, political beliefs, or disability. Supplemental Nutrition Assistance Program customers must be treated in the
same manner as non-Supplemental Nutrition Assistance Program customers;
• Participation can be withdrawn if the firm violates any laws or regulations issued by Federal, State or local agencies, including civil rights laws and
their implementing regulations;
• Changes in the firm's ownership, address, type of business and operation must be reported to the Food and Nutrition Service.
Supplemental Nutrition Assistance Program authorization may not be transferred to new owners, partners, or corporations. An unauthorized individual or
firm accepting or redeeming Supplemental Nutrition Assistance Program benefits is subject to substantial fines and administrative sanctions.

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Instructions for Form FNS-252-R
Supplemental Nutrition Assistance Program
Reauthorization Application for Stores
General Instructions

United States Department of Agriculture

Food and Nutrition Service
Question 3 - Store Still in Business: Check Yes or
No. If No, skip questions 4 through 18. Sign, date, and mail
Form FNS-252-R. Stores not in business will be withdrawn
from the program.

Filing Requirements: The Supplemental Nutrition Assistance
Program (SNAP) regulations require the Food and Nutrition
Service (FNS) to periodically reauthorize stores for continued
eligibility. Failure to cooperate may result in the withdrawal of
your store. The information you provide on the FNS-252-R
will be used by FNS to update our records and determine your
store's continued eligibility to accept SNAP benefits. FNS
may contact you for additional information or visit your store
as part of this review.

TIP

If the name of the store has changed, make a pen-andink correction.

Question 4 - Store Operations:

Question 4a - Store Address: Check Yes or No whether the
store address is correct. If No, enter the new address for the
store. If you notice a minor error in the current address, check
Yes, but make a pen-and-ink correction.

How to Apply?

Apply Online: If you've been notified to apply online for
reauthorization, follow the instructions on the letter you
received.

Question 4b - Email Address: Enter the owner or store email
address where you want to receive Supplemental Nutrition
Assistance Program official correspondence.

Apply by Mail: You must complete the reauthorization
application, Form FNS-252-R and attach any required
documents requested by FNS to the application. Form
FNS-252-R is not considered a valid application unless you
sign and date it.

Question 4c - Store Telephone Number: Enter the current
store telephone number.
Question 4d - Alternate Telephone Number: Enter an
alternate telephone number, such as a cellular number,
including area code. We may use the alternate telephone
number to contact you during a disaster situation. The
alternate telephone number cannot be the same as the store
telephone number.

Where to Mail Form FNS-252-R? You must send Form
FNS-252-R to the FNS mailing address listed on the cover
letter included with the paper reauthorization application.

Question 5 - Store Hours and Days of Operation:

Reminders

Check the box to indicate if your store is open 7 days a week,
24 hours per day. If No, enter the opening and closing time for
each day your store is open for business and indicate AM or
PM.

You must answer all of the questions on Form FNS-252-R,
with the following exceptions:
• Question 2;
• If the store is no longer in business, skip questions
4 through 18;
• If store is owned by a publicly-held corporation or
government agency, skip question 13.

Question 6 - Number of Cash Registers: Enter the
current number of cash registers at this store used for
accepting payment for retail purchases.

Specific Instructions. This reauthorization application is

Question 7 - Optical Scanners: Select "Yes" or "No"

pre-printed with information about your store currently on file
with FNS. Review the preprinted information and check either
Yes or No if the information we have on file is still correct.
You will also be required to give answers about current store
operations. Enter new or changed information in the spaces
provided. Print or type your answers so they are clear and
legible.

to indicate if optical scanners are used at your store.

Question 8 - Restaurant license: Select "Yes" or "No"

to indicate if you have or are applying for a restaurant license
for your store.

Question 9-11: Staple Food Varieties & Depth of
Stock: Please answer the questions regarding staple food

Question 1 - Store Name: Review the name of your

varieties and the depth of stock that you have currently and on
a continuous basis in your store. Additional information
related to staple food varieties and minimum stocking
requirements can be found online at: https://www.fns.

store as it appears in FNS records.

Question 2 - Doing Business As: If you are doing

business under a name that is different from the store name
you entered, please provide this name in question 3.

usda.gov/snap/retailers-store-traininginformation.
For each question, check only Yes or No.

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CONTINUATION PAGE
Question 13b - New Owner, Partner, Officer, Member,
Information: Enter the first name, middle name, and last
name of each added person exactly as it appears on their social
security card. Enter the home address, social security number,
date of birth, and business title for each added person. In
community property states (AZ, CA, ID, LA, NM, NV, TX,
WA, and WI) spousal information must be entered for each
person listed. Do not enter any information or return this page
to FNS if the store is owned by a publicly-held corporation or
government agency.

Staple Foods: Staple food means those food items intended
for home preparation and consumption in each of the
following food categories: meat, poultry, or fish; bread or
cereals; vegetables or fruits; and dairy products. A list of
examples of staple foods can be found online at: https://www.
fns.usda.gov/snap/retailers-store-training-information.
Variety: Variety means different kinds of products in each of
the four staple food categories. A list of examples of
acceptable varieties in each of the staple food categories can
be found online at: https://www.fns.usda.gov/snap/retailersstore-training-information.

Email Address: Enter the email address for all owners/
officers here (optional).

Stocking Unit: A stocking unit is a can, bunch, box, bag, or
package for the product as typically sold. A list of examples of
stocking units can be found online at: https://www.fns.usda.
gov/snap/retailers-store-training-information.

Questions 14 and 15 - Ownership Questions:
For each question, check only one box.

Question 14b, 14d or 15a: If you answer "Yes" to either
question 14a, 14c or 15, provide an explanation.

Perishable Foods: Perishable foods are items which are either
frozen staple food items or fresh, unrefrigerated or refrigerated
staple food items that will spoil or suffer significant
deterioration in quality within 2-3 weeks.

Question 14g: If you answer "No" to question 14f, provide an
explanation.
Question 14i: If you answer "Yes" to question 14h, provide
an explanation.

Question 12 - Retail Sales: Enter the total retail sales
for each kind of product you sell at this store location (e.g., if
the store sells gasoline, enter gasoline sales where indicated)
as reported to the Internal Revenue Service in the most recent
tax year. Enter the tax year for these sales. If you do not sell
items in a category, enter "0" (e.g., if the store does not sell
alcohol, enter 0).

Question 14k: If you answer "Yes" to question 14j, enter the
number of currently authorized SNAP stores under your
ownership.

Question 13 - Owner/Officer Information: All

Question 17 - Financial Institution Name and
Address: Provide the name and address of the financial

Question 16 - EBT Provider Information: Enter
the Name, Phone Number and Address of the company that
provides your EBT equipment and services.

persons currently in FNS files as the primary owners/officers
are listed. Check No, for each person who is not currently an
owner/officer.

institution that you use for SNAP payment deposits (i.e. what
is your bank?).

The term owner/officer includes owners, officers, members,
partners, and primary shareholders. If this store is owned by a
non-profit organization, enter information for the primary
officers. In community property states it includes spouses. If
the store is owned by a publicly-held corporation or
government agency, skip question 13.

Question 18 - Store Website: If you have a public
website for your store, please enter the full website address.
Question 19 - Additional Information or
Comments: Enter any additional information or comments

Question 13a - Additional Persons: Are there persons not
listed who are owners/officers, or in community property
states, spouses? If Yes, go to question 13b to enter additional
persons who are owners/officers or their spouses.

you would like to provide to FNS, such as Store name change,
updated mailing address, new or updated email address for
each owner or officer listed in question 13, or any special
circumstances that FNS should know.

If there are more than two new primary owners/officers to
report, make blank copies of question 13b and enter the
additional person(s) information, and attach it to this
application.

Name and Signature - Before you sign Form FNS-252-

R, read the attached Privacy Act Statement, Use and
Disclosure Statement, Penalty Warning Statement, and
Certification and Signature Acknowledgment.
Print your full name and business title. Sign and date in the
space provided. Provide a phone number where we can call
you if we have questions about the information you provided.
Mail the form in accordance with Where to Mail Form
FNS-252-R section in the General Instructions.

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Privacy Act and Paperwork Reduction Notice
Public reporting burden for this collection of information is
estimated to vary from 1 to 19 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. An
agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it
displays a currently valid OMB control number. 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, Room
1014, 3101 Park Center Drive, Alexandria, VA 22302, ATTN:
PRA (0584-0008). Do not return the completed form to this
address. Instead, see Where to Mail Form FNS-252-R section
of these instructions.
To file a complaint of Discrimination, write to the USDA,
Director, Office of Adjudication, 1400 Independence Ave,
SW, Washington, DC 20250-9410. Do not send the completed
application form to this address.

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