Fair Food Pricing Interest Form

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The option to purchase discounted local farm-fresh food is part of AdkAction’s new “Fair Food Pricing” incentive. The incentive will reduce the price of local food by 30% for qualifying families in the Adirondack Region. You do not have to be on SNAP to be eligible for Fair Food Pricing. Eligibility thresholds are as follows:

Single Adult - $22,944
Two Adults - $35,676
Single Adult, One or more children in care - $50,340
Single Adult, One or more school-aged children - $44,064
Two Adults, Two or more School-aged Children - $56,796
Two Adults, One or more in child care and one or more school-aged children - $63,072
Two Adults, Two or more in Child Care - $69,348
Single Senior - $26,076
Two Seniors - $41,088
Additional adult in the household - add $12,732

The Hub on the Hill, in Essex, New York, is the first local food vendor that will accept Fair Food pricing.

In addition to the 30% Fair Food Pricing Discount, SNAP recipients will have the opportunity to sign up for another program called “Double Up Food Bucks.” Together, the two programs can reduce the price of local food by up to 65% for SNAP recipients.

*Special thanks to Adirondack Foundation, Mother Cabrini Health Foundation, and New York State Health Foundation (NYSHealth) for funding this program.

Email *

Name *

Phone number *

Home address *

Zip Code *

Eligibility Guidelines

Single Adult - $22,944
Two Adults - $35,676
Single Adult, One or more children in care - $50,340
Single Adult, One or more school-aged children - $44,064
Two Adults, Two or more School-aged Children - $56,796
Two Adults, One or more in child care and one or more school-aged children - $63,072
Two Adults, Two or more in Child Care - $69,348
Single Senior - $26,076
Two Seniors - $41,088
Additional adult in the household - add $12,732

Please check the option that describes your household: *

Single adult, household income less than $22,944

Single Adult, One or more children in care - $50,340

Single Adult, One or more school-aged children - $44,064

Two adults, household income less than $35,676

Two adults with two or more school-aged children, household income less than $56,796

Two adults with one or more children in child care and one or more school-aged children, household income less than $63,072

Two adults with two or more children in child care, household income less than $69,348

Single senior, household income less than $26,076

Two seniors, household income less than $41,088

None of these apply, my household does not meet eligibility guidelines

Other:

Are you currently on SNAP? *

Yes

Would you like help signing up for Double Up Food Bucks (must be on SNAP)? *

*We will contact you and help you qualify for Fair Food and Double Up if you select “yes”.*

Yes

I would like voluntarily to be enrolled in AdkAction’s Fair Food Pricing discount program and I certify that the information I have presented on this form is true and accurate. *

Yes, I agree.

No, I do not agree.

Questions/Comments

A copy of your responses will be emailed to the address you provided.

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