If you are a new recipient of Summer EBT and have received a notice of the benefit, but not the card, please wait 7-10 business days for the card to arrive. If at that time you have not received a card, please contact support.

Sun Bucks

Submit an AG Misfortune for a Loss of Food Event

If food purchased with Summer EBT funds was lost, destroyed, or damaged due to misfortune event, submit this form to request a reimbursement of funds. Examples of misfortune events include, but are not limited to, fire, flood, tornado, prolonged electrical outage, etc.
AG Misfortune Form

Step 1: Information About the Student

The following student information is required to submit a claim.

Student Information

MM/DD/YYYY format

Residential Address

Mailing Address

Step 2: Loss/Replacement Information

Please provide information about the value of items lost and date the loss occurred. Note: You may be required to provide verification of the disaster or misfortune.

$
worth of food purchased with Summer EBT (SunBucks) Benefits that was destroyed in a disaster or misfortune (Amount cannot exceed the annual disbursement of $120.00).
MM/DD/YYYY format

Step 3: Please Explain What Happened

Please use the space below to explain how the loss occurred and remember to attach your proof.

 Be certain to redact sensitive information such as social security numbers and tax payer ids prior to uploading.

Drag and drop files here
(Allowed file types: pdf, jpg, jpeg, png, gif)

Attached Files

No files uploaded

Step 4: Please Review and Sign

I acknowledge that if this statement is not signed and returned to the Summer EBT support within 10 days of the Food Loss date reported above, benefits will not be replaced. I certify that I am aware of the penalties for intentional misrepresentation of facts, including but not limited to perjury for a false claim. I understand that the Summer EBT support has 10 days from the date this form is submitted to verify the misfortune. If verified, benefits will be distributed during the next benefit month.

(000) 000-0000 format
Non-Discrimination Statement

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), religious creed, disability, age, political beliefs, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the agency (state or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at 800-877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, from any USDA office, by calling 833-620-1071, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to:

  1. Mail:
    Food and Nutrition Service, USDA 1320
    Office of the Assistant Secretary for Civil Rights
    Braddock Place, Room 334
    Alexandria, VA 22314; or
  2. Fax:
    (833) 256-1665 or (202) 690-7442; or
  3. Email:
    FNSCivilRightsComplaints@usda.gov

This institution is an equal opportunity provider.

Please do not send information, such as applications or verifications, to the United States Department of Agriculture (USDA) address listed above. This address is for civil rights complaints only. Please send application materials or verifications to your local county JFS office.