(2026) SNAP Stretch Reimbursement Form: Point-of-Sale Discount Firms

(2026) SNAP Stretch Reimbursement Form: Point-of-Sale Discount Firms

Please contact WVFFC if you have questions: (304) 926-0567 or SNAPStretch@wvfoodandfarm.org
Instructions for Completing the SNAP Stretch Reimbursement Form for POS Discount Program Participants
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. Approximate Total Number of Customers (Not Just SNAP/EBT Customers) Who Shopped in the Store 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(s) (EBT Machine Only; Do Not Include SNAP Stretch or Other Incentives) During the Reporting Period in Section 2b*
Section 4: Reimbursement
4a. Total Number of Transactions (Not a Dollar Amount) in Which a 50% SNAP Stretch Discount Was Applied for Single Adults (Ages 18–59) During the Reporting Period Listed in Section 2b*
4b. Total Number of Transactions (Not a Dollar Amount) in Which a 67% SNAP Stretch Discount Was Applied for Families or Seniors (Adults with Child/Children; Adults Age 60+) During the Reporting Period Listed in Section 2b*
4c. Total Number of Transactions (Not a Dollar Amount) in Which a 75% SNAP Stretch Discount Was Applied for Senior Families (Adults Age 60+ and Child/Children) During the Reporting Period Listed in Section 2b*

4d. Fill Out the Table Below With the Dollar Amount of SNAP Stretch Discounts Applied in Each County at Each Discount Level During the Reporting Period Denoted in Section 2b*

Rows	County Where Sales Occurred	Dollar Amount of 50% Discounts Applied	Dollar Amount of 67% Discounts Applied	Dollar Amount of 75% Discounts Applied
County 1
County 2
County 3
County 4
County 5

4e. Total Dollar Amount of SNAP Stretch Redeemed (Total Amount to Be Reimbursed by WVFFC)
Section 5: Outside Funding
5a. 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
5b. If Outside-Funded SNAP Stretch or Other Non-SNAP Stretch Incentives Were Offered, Select the Applicable Option(s) Below

Double DollarsVeggie VouchersSNAP Stretch (Funded by additional grants, not The Coalition)Other
Section 6: Activities
6a. 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 7: Documentation

Please upload the following supporting documents.
7a. Time Log

Please upload time log(s) for this reporting period. 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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7b. SNAP/EBT Sales Data

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

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7c. 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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7d. 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: Point-of-Sale Discount Firms

Section 1: Contact Information

Section 2: Reporting Period

Section 3: Customer Counts and SNAP/EBT Transaction Data

Section 4: Reimbursement

Section 5: Outside Funding

Section 6: Activities

Section 7: Documentation