2025 SNAP Reimbursement Form
NYS Wireless EBT Program
New York State, in partnership with the Farmers Market Federation of New York, supports farmers and farmers’ markets accepting Supplemental Nutrition Assistance Program (SNAP) benefits by providing equipment and program cost reimbursements. Farmers and farmers markets can receive reimbursement for mobile app technology, associated EBT fees, and Bluetooth card readers. Use this form to request reimbursements by submitting payee information and proof of your expenses.
Requirements
Complete a separate form for each FNS account number.
Eligibility
Farmers Markets and Farmers who direct market at NYS farmers markets or farm stands, or any other means of direct-to-consumer sales EXCEPT online markets.
Select one of the following that best describes your business/organization:
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Farmer selling my own farm products
Non-profit facilitating the sale of local farm products
For-profit facilitating the sale of local farm products
Other
What percentage of your total retail sales is from products grown or raised by your farm?
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What best describe the manner of your non-profit's work:
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Managing a farmers market where multiple vendors sell their farm products directly to the public
Managing a farm stand where a farm sells their farm products directly to the public
Managing a farm stand where our organization buys farms products for resale to the public
Other
What best describes the manner of your business' work:
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Managing a farmers market where multiple vendors sell their farm products directly to the public
Managing a farm stand where a farm sells their farm products directly to the public
Managing a farm stand where our business buys farms products for resale to the public
Managing a brick and mortar where our business buys farm products for resale to the public
Other
Is there any additional information about your Farmers Market, Farm Stand, or Farm that you want to share?
Today's Date
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Month
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Day
Year
Date
Name
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First Name
Last Name
Farm/Organization Name
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FNS Number
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Payee Name
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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E-mail
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Your E-mail Address
SNAP Expenses
Yearly or Monthly Fees and Equipment incurred from January 1st, 2025 to December 31st, 2025
Expenses List
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Purchase Date
Product/Service Description
Cost
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Total Cost ($)
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Upload Proof of Payment
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I certify
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I certify that all information entered above is valid and true.
Reimbursement Timeline
Submit 2025 SNAP related fees between January 1st, 2026 and June 1st, 2026 for reimbursement in June 2026 via a check in the mail.
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