How to Complete Form FNS-252-2

RMP_124x124
Restaurant Meals Program
Recipient Information
Recipient FAQs
Restaurant Owner Information
Restaurant Owner FAQs
How to Complete Form FNS-252-2
CalFresh
EBT


 

Click here for FNS-252-2 PDF

 

Part 1 – Meal Service Types

  • RMP Restaurant* applicants will select Private For-Profit Restaurant and indicate whether or not it is a franchise.

*Restaurant is defined as a private for-profit establishment where meals are sold and served to customers, including in store deli’s and food trucks.

 

Part 2 – Sponsoring Organization or Business

  • Enter store information (also included as Site #1 in Part 3), or
  • Enter corporate information if the restaurant is owned by a corporation.

 

Part 3 – Specific Site Information

  • Must be filled out completely for each location including the telephone number.  This telephone number will print on the bottom of EBT receipts.
  • Include store number of franchise under Site Name.  (E.g.: Taco Bell #4217)
  • If there are more than three sites, the applicant may make additional copies of page two to report all restaurants or they can create a Word or Excel file that contains all the required information for each location.
  • Manager information would be entered in this section for large chains.
  • Group Living Arrangement does not apply to the RMP.

 

Part 4 – Ownership Information

  • Include all owners/officers and their spouses.
  • Home addresses are required.
  • A photo ID and verification of Social Security Number are required for all owners/officers and their spouses.

Note: Elements of Part 4 including restaurant name, location, days of operation, and meals served, will be gathered for use in an informational listing.  This listing will be distributed to recipients and posted on-line.

 

Part 5 – Agreement and Signature Block

  • An original signature of one of the owners/officers is required.  (All owners are NOT required to sign.)

 

Section A – Private For-Profit Restaurant

  • Details all Required Documentation including:
    • Copy of a government issued photo identification card and a copy of a Social Security card, or other verification of a Social Security Number (e.g.: tax form) for:
      • all owners/partners
      • all officer(s) of private corporations
      • also provide for spouses of owners/officers

Note: Above documentation is not required for publicly-owned corporations.

    • Copy of a valid business license.  (A health permit or business license is required for each location.  It should be current and have the correct address of the location and correct ownership.)