P-EBT Application

The American Samoa P-EBT Program provides food assistance for children who lost access to free meals at school from the National School Lunch Program (NSLP) due to closure or reduced attendance or hours of their schools during School Year (SY) 2020-2021, and for children who were eligible to receive free meals from the NSLP as of the end of SY 2020-2021. Students from schools that had virtual days earlier in the school year and students who were in school at the end of the school year qualify for P-EBT benefits. To qualify, DHSS will verify whether the names of the children applying for P-EBT benefits are included in the official student enrollment lists for SY 2020-21 from the American Samoa Department of Education (ASDOE) and private schools. To qualify as an Authorized Representative to pick up and redeem P-EBT benefits for the children, DHSS will verify whether the names of the parents/legal guardians are included in the official student enrollment lists from the ASDOE or private schools.

Parents/ legal guardians who registered their children for SY 2020-2021 with ASDOE or a private school must fill out the application for their children. Parents/ legal guardians with more than one child in their household must complete one application for their children. Each application must only include names of children who reside in the same house and who were registered by the applicant. Parents/ legal guardians of current ASNAP school-age recipients must fill out a separate application.

Parent/ legal guardian Demographic Information
Demographics Information for Child #1
Type "none" if you don't have an SSN.