SEBT-Card-Replacement

 

 

 

 

 

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Before you fill this out: if you complete this form, any existing cards will be deactivated.

Please correct the errors in filling the form.

Parent Name

Account Number

Primary Address

Primary Address

Address(required):

City

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Secondary Address

Secondary Address

Address:

City

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Contact phone Number

Birthdate of oldest school-aged child: *Please enter the date in the format MM/DD/YYYY

Children's names

Add Child

Thank you for your submission it will be reviewed by a member of our team. If you have any questions you may contact us at DHHS.ReplacementSNAPICC@nebraska.gov

Your submission did not go through please contact DHHS.ReplacementSNAPICC@nebraska.gov and report the date/time of failure.

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