(2026) SNAP Stretch Reimbursement Form: Voucher Distribution Firms

(2026) SNAP Stretch Reimbursement Form: Voucher Distribution Firms

Please contact WVFFC if you have questions: (304) 926-0567 or SNAPStretch@wvfoodandfarm.org
Instructions for Completing the SNAP Stretch Reimbursement Form for Voucher Program Participation
Section 1: Contact Information
1a. Legal Market Name Registered with USDA FNS*
1b. Payee Entity (if different)
1c. Name of the Person Submitting This Form*

First NameLast Name
1d. Email*
example@example.com
Section 2: Reporting Period
2a. Month Being Reported*
2b. Dates Being Reported (Reporting Period)*
Section 3: Customer Counts and SNAP/EBT Transaction Data
3a. Total Number of Market Customers (All Customers, Not Just SNAP/EBT) During the Reporting Period in Section 2b*
3b. Total Number of SNAP/EBT Transactions (Do Not Report Dollar Amount) During the Reporting Period in Section 2b*
3c. Total Dollar Amount of SNAP/EBT Transactions Processed on the EBT Point-of-Sale Device (EBT Machine Only; Do Not Include SNAP Stretch or Other Incentives) During the Reporting Period in Section 2b*
Section 4: SNAP Stretch Distributed

Report the total dollar amount of SNAP Stretch vouchers distributed during the reporting period in Section 2b for each of the four categories below. PLEASE NOTE: This section is for SNAP Stretch distributions ONLY. Do not enter SNAP/EBT dollar distributions.
4a. Single Adult (Age 18–59): Total Dollar Amount of SNAP Stretch Incentives Distributed to Single Adults (1:1 Match) *
4b. Family (Adult + Child/Children): Total Dollar Amount of SNAP Stretch Incentives Distributed to Families (1:2 Match)*
4c. Senior Adult (Age 60+, No Children): Total Dollar Amount of SNAP Stretch Incentives Distributed to Senior Adults (1:2 Match)*
4d. Senior Family (Age 60+ with Child(ren)): Total Dollar Amount of SNAP Stretch Incentives Distributed to Senior Families (1:3 Match)*
4e. Total Dollar Amount of SNAP Stretch Incentives Distributed: This Amount Should Be the Sum of the Four Categories Above (Calculated Automatically)
Section 5: SNAP Stretch Redeemed

Report the total dollar amount of SNAP Stretch vouchers redeemed in each county during the reporting period in Section 2b. Do not include SNAP/EBT dollars. (For example, if using WVFFC SNAP Stretch vouchers, report only red and purple vouchers redeemed.)
5a. First County Where SNAP Stretch Dollars Were Redeemed *
5b. Total Dollar Amount of SNAP Stretch Redeemed in County 5a*
5c. Second County Where SNAP Stretch Dollars Were Redeemed (Leave Blank if Not Applicable)
5d. Total dollar amount of SNAP Stretch redeemed in county 5c
5e. Third County Where SNAP Stretch Dollars Were Redeemed (Leave Blank if Not Applicable)
5f. Total Dollar Amount of SNAP Stretch Redeemed in County 5e
5g. Fourth County Where SNAP Stretch Dollars Were Redeemed (Leave Blank if Not Applicable)
5h. Total Dollar Amount of SNAP Stretch Redeemed in County 5g
5i. Fifth County Where SNAP Stretch Dollars Were Redeemed (Leave Blank if Not Applicable)
5j. Total Dollar Amount of SNAP Stretch Redeemed in County 5i
5k. Total SNAP Stretch Redeemed (Total Amount to Be Reimbursed by WVFFC)
Section 6: Outside Funding
6a. If Additional (Non-WVFFC) Funds Were Used for SNAP Stretch or Other Non-SNAP Stretch Incentives (e.g., Double Dollars or Veggie Vouchers), Indicate the Total Amount Redeemed During the Reporting Period in Section 2b
6b. If Outside-Funded SNAP Stretch or Other Non-SNAP Stretch Incentives Were Offered, Select the Applicable Option(s) Below

Double DollarsVeggie VouchersSNAP Stretch (Funded not through WVFFC)Double Up BucksOther
Section 7: Activities
7a. Did the Market Have Any of the Following Activities During the Reporting Period in Section 2b?

Live MusicSNAP OutreachWVU Extension OutreachCooking DemoGardening InstructionWIC/Senior Voucher OutreachContest/Taste Testing/Kids ActivitiesHealth FairOther
Section 8: Documentation

Please upload the following supporting documents.
8a. Time Log

Please upload time log(s) for the reporting period in Section 2b. This should include time spent planning and promoting events, conducting customer outreach and engagement, operating SNAP Stretch at the market, and completing reporting requirements.

If any of this work was performed as paid labor (not volunteer time), please include those hours and the hourly rate paid.

Template is found here: Time Log
File Upload*

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8b. SNAP/EBT Sales Data

Please upload a SNAP/EBT sales report generated from the EBT point-of-sale device that includes the full range of dates during the reporting period in Section 2b. The report should include the total amount of SNAP/EBT processed on the device. Please ensure that this total matches the total reported in section 3c.
File Upload*

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8c. Market Photos

REMINDER: We ask that at least twice a year markets share pictures with WVFFC so that we may share your successes with donors and the community at large, please include captions or context in the Success/Challenges box below.
File Upload

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8d. Please include captions for photos uploaded in 8c and SNAP Stretch impact stories below. If there are any questions for WVFFC or additional follow up needed, please also note these below.
Should be Empty:

(2026) SNAP Stretch Reimbursement Form: Voucher Distribution Firms

Section 1: Contact Information

Section 2: Reporting Period

Section 3: Customer Counts and SNAP/EBT Transaction Data

Section 4: SNAP Stretch Distributed

Section 5: SNAP Stretch Redeemed

Section 6: Outside Funding

Section 7: Activities

Section 8: Documentation