Retail Waiver Request Form

Supplemental Nutrition Assistance Program (SNAP)—Waiver Requests to Offer Incentives to SNAP Recipients at SNAP Authorized Stores.

Documents and Forms

Document Name Document Type
Appendix F. FNS Incentive Waiver Request -1.pdf Other-Incentive Waiver Request
Appendix F. FNS Incentive Waiver Request -1.pdf Other-Incentive Waiver Request

Information Collection (IC) Details

IC Title:	Retail Waiver Request Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Incentive Waiver Request			Appendix F. FNS Incentive Waiver Request -1.pdf		Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.