Authorization Number : 440-0049
Agency Series No. : 44.01
Status : Active
Agency Web Link :
Agency : DOH
Confidential Description :
Division :
Vital Description : N/A-Load
Section :
Record Title : PROCESSED FOOD INSTRUMENTS
Revision : 0
Record Description : These forms (Coupon and Delivery Verification Receipt) contain information which allows a program participant to purchase designated food items. Each form includes the following information: Participant's name, address and signature; Vendor's name, address, and tax identification number; amount of sale; authorized food items, quantity; and redeemable dates.