“So I'm on the production floor looking at one of our HP printing presses and it takes a roll of paper that starts out at a thousand pounds, and then it goes through the machine, gets printed, and then gets trimmed to size," Ellington said, adding that the machine can print about 20,000 ballots an hour.
Standing near the printer are stacks of massive rolls of white paper that will eventually become ballots for millions of American voters. On this day, the company is producing mailings for Iowa, Nevada, Arizona and Georgia. The latter's ballots need to be delivered quickly for Georgia's June 9 primary, which was delayed from March due to the pandemic.
They issue them but don’t do the physical printing:
https://www.npr.org/2020/05/03/848347895/ballot-printers-increase-capacity-to-prepare-for-mail-voting-surge
Then they must issue the official paper the ballot will be printed on.