Supplemental Nutrition Assistance Program - Supplemental Nutrition Assistance for Victim of Disasters

OMB CONTROL NUMBER: 0584-0336

EXPIRATION DATE: XX/XX/XXXX

WAIVER REQUEST REVIEW SHEET

(TEMPLATE0 DISASTER SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM

Type of request: Initial, Extension, Expansion, or Modification

State: Click here to enter text.

Region: Click here to enter text.

Disaster Information

• Type of disaster:

• Date of disaster or mandatory evacuation order:

• Areas Included in Disaster Declaration:

• Any differences between request/FEMA regarding date and/or disaster area

Disaster Impact

• Number of Households/Businesses impacted:

• Are commercial channels of food distribution up and running?

Benefit Period

• Start/end dates:

Application Period

• Site locations:

• Dates of operation:

• Hours of operation

• Will sites be open on weekends/holidays?

Eligibility Criteria

• Open to households that lived or lived/worked in disaster area?

• Is food loss alone a qualifying factor?

• Is State using the DSED?

Ongoing Households

• Will supplements be issued automatically or by affidavit?

  • What is the process/who is eligible?

Anticipated Issuance:

• Estimated number of new D-SNAP applicants

• Estimated number of ongoing households to receive supplements

  • How were estimates derived?

EBT

• Number of EBT cards on hand/ordered:

• Issuance procedures:

• Card vendor:

Duplicate Participation

• How/when checks will be conducted

Program Integrity

• Appropriate fraud prevention/security measures in place

Logistics

• Request addresses plans for publicity, security, and plans for serving persons with disabilities, the elderly, and other vulnerable populations, as appropriate.

Staffing

• Number of staff/supervisors available for D-SNAP

• Plans for sharing staff

Employee Applications

• Procedure for handling State agency employee applications

Attachments

• Draft press releases, D-SNAP application, PDAs, FEMA declaration, map of disaster area are included?

1