Select an Online Store Application type to get started
Any firm (except for a Farmers' Market) should complete this application.
Farmers' markets are defined as "multi-stall markets at which farmer-producers sell food products
they produced (fruits, vegetables, meat, dairy, grains, etc.) directly to the general public, at a
central or fixed location."
The following application questions will be tailored towards your above selection.
Privacy Act And Paperwork Reduction Notice
Public reporting burden for this collection of information is estimated to vary from 1 to 11 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.
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.
Get Started
Before You Begin
Carefully review the following steps to complete the application process:
Note: The online application is a two-step process. Your application is not considered complete until you finish both steps AND the Food and Nutrition Service (FNS) has received all supporting documentation from you.
Step #1:
Gather the following information and documents before you start.
Date the store opened under the current ownership.
Corporate name and address if you are a private or public corporation.
Home address, social security number, and date of birth for all owners, partners, corporate officers, and in community property states, spouses.
Actual sales data from the store's your most recent IRS business tax return, if it has been open under current ownership longer than one year. If not, an estimate of the store’s annual sales.
Percentage of the store's sales from staple foods, snack or accessory foods, and all non-food items you sell.
Store hours of operation.
Copies of Photo ID, Social Security Cards for owner(s), and, in community property states, spouses.
Business license held by the store.
Answer the online application questions. Click the “Start Application” button below to begin.
Use the "Help" link in the upper right-hand corner of this page to get help on any page in the application.
Use the links on the left-hand side of each page to return to any section you already worked on.
Review your application for accuracy. Correct any mistakes before you submit your application.
View and print your application. Print an official copy of your application to keep for your records.
Submit your application online, following the instructions provided.
Step #2:
Mail your supporting documents to FNS. Instructions regarding your supporting documents are provided on-screen AFTER you submit your application and are specific to your application.
After you mail your supporting documents to FNS, you can return to www.fns.usda.gov/snap to check the status of your online application.
TIP: You can save your application and return to finish it up to 30 days after you start. FNS deletes all saved applications that are not completed within 30 days.
Do not use this form if you are applying as a restaurant. Click Contact Us to request further information.
Get Started
Acknowledgement Agreement
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.
Details:
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 the owners' 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 denial of this application;
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;
Details:
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. 55 2a(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.
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.
PRIVACY ACT AND PAPERWORK REDUCTION NOTICE
Public reporting burden for this collection of information is estimated to vary from 1 to 11 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.
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.
Store Information
Basic Information
In this section, provide basic store information and answer every question.
Use the Help feature if you have any questions.
When did or when will the store open for business under your ownership?
Store Information
Ownership Information
In this section, provide information on the type of ownership as well as the identity of each owner.
You must provide information for all officers, owners, partners, and members, if the store is owned by
one or more people or a private corporation. You must enter spousal information for each owner and
officer if your business is located in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI).
Click Help for more information about this question.
Has any officer, owner, partner, member and/or manager ever been denied, withdrawn or suspended,
or been fined for license violations (i.e. Supplemental Nutrition Assistance Program (SNAP), WIC,
business, alcohol, tobacco, lottery, or health license)?
Is 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?
Is any officer, owner, partner, and/or member currently receiving SNAP benefits?
Was any officer, owner, partner, member, and/or manager convicted of any crime after June 1, 1999?
Store Information
Sales Information
In this section, you will specify the store sales information.
Do you sell products wholesale to other businesses such as hospitals or restaurants?
Does the sale of hot and/or cold freshly prepared foods that are ready-to-eat exceed 50% of your total sales?
Total Retail Sales:
Enter the total retail sales from all products you sell at this location (both food and non-food products and services).
If your store has been open under your ownership for more than one year, enter actual total retail sales from your most recent IRS tax return
for this store, or if your store has been open under your ownership for less than one year, you must provide estimated sales. If you sell
products wholesale to other businesses, do not include those sales.
Retail sales are:
$
Example: 250,000
Round to nearest dollar, do not enter cents or dollar sign.
Store Information
Inventory Information
In this section, you will specify the types of inventory that you carry at this location.
The next question asks whether or not your store stocks a variety of food categories. A variety
is defined as at least three different types of food in each category. Milk, cheese, and yogurt
are a variety of dairy items. Whole milk, skim milk, and chocolate milk are not a variety.
Do you stock at least three different types of food items in each of the
following categories on a daily basis? Include fresh, frozen, canned, packaged.
Meat/Poultry/Fish (fresh, canned, refrigerated, frozen)
(Example: canned meats and fish, ground beef, deli meats, bacon, frozen chicken, eggs, etc.)
%
Do you stock fresh, frozen or refrigerated foods in at least two of these categories?
Do you sell "other" foods, such as snack foods, soft drinks, or condiments?
%
Do you sell non-food items or food that is hot at the time that the customer pays for it?
%
%
Store Information
Supplemental Information
In this section, you will specify your store's operational information based on this store location.
Is your store open year round?
Is your store open 7 days a week, 24 hours per day?
Has any officer, owner, partner and/or member ever been disqualified from receiving SNAP benefits as a recipient for an intentional program violation (IPV) or fraud?
Does any officer, owner, partner, and/or member currently own any other SNAP authorized stores (such as Store, Farmers' Market, etc.)?
775 / 775 characters remaining
Finalize Application
Review and Submit
You are almost finished. Before you submit your application, read and follow all the instructions below.
TIP:
You cannot make changes or corrections to your application once you click Submit Application, below.
Review your application for accuracy.
Click the "View/Print Application" below to review your application.
Acrobat Reader is required to view PDF.
If you need to make any changes or correct any mistakes, use the navigation menu on the left hand side of the screen to move from page to page.
CLICK THE BUTTON ABOVE PRIOR TO SUBMISSION TO PRINT YOUR APPLICATION FOR YOUR RECORDS.
Submit Your Application: Once you're ready to submit your application, use the Submit Application button below.
You will be allowed to submit the application only after you accept the penalty warning statement.
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.