Request for Administrative Review

OMB 0584-0520

Retailers submit a letter to request an Administrative Review of a Food Stamp Program determination concerning a retail food store's participation in the program.

The latest form for Request for Administrative Review expires 2021-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Attachment A Legal Authority.pdf Supplementary Document
Supporting Statement - July 3 2018.docx Supporting Statement A
Request for Administrative Review Business & Farms

All Historical Document Collections

201806-0584-002 Approved without change	Extension without change of a currently approved collection	2018-07-31
201503-0584-001 Approved without change	Revision of a currently approved collection	2015-07-27
201201-0584-019 Approved without change	Revision of a currently approved collection	2012-08-13
200905-0584-004 Approved without change	Revision of a currently approved collection	2009-07-21
200604-0584-001 Approved without change	Revision of a currently approved collection	2006-04-20
200301-0584-003 Approved with change	New collection (Request for a new OMB Control Number)	2003-01-23