This government document is issued by Department of Agriculture for use in Pennsylvania
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https://www.google.com/url?client=internal-element-cse&cx=007572080359491747877:qqxrx9mf39e&q=https://www.agriculture.pa.gov/Food/food_assistance/The%2520Emergency%2520Food%2520Assistance%2520Program/Documents/2022-2023%2520Declaration%2520of%2520Need%2520Form(English).pdf&sa=U&ved=2ahUKEwj8j5mH8tL8AhWjUKQEHWRCAm04ChAWegQIAxAB&usg=AOvVaw1zU67_yDb73ik7WOAnF47J