Skip to main content

It is recommended that Attachment A be sent to all households selected for verification. The other attachments are available to be used as needed.

Attachment A

Attachment A page 1 of 4- “Letter to Households- Notification of Selection for Verification of Eligibility”

Attachment A page 2 of 4- USDA Nondiscrimination Statement

Attachment A page 3 of 4- “Adult Household Members”

Attachment A page 4 of 4- “Verification Information for Free and Reduced Price Meals”

Attachment B

Attachment B page 1 of 2- “Letter to the SNAP/TANF/FDPIR Office from the LEA”

Attachment B page 2 of 2- “Verification Form- SNAP/TANF/FDPIR Recipients (Multiple Applicants)”

Attachment C

Attachment C page 1 of 2- “Letter of Verification Results and Change in Eligibility”

Attachment C page 2 of 2- USDA Nondiscrimination Statement

Attachment D

Attachment D page 1 of 2- “Letter of Change in Eligibility for SNAP/TANF/FDPIR Households”

Attachment D page 2 of 2- USDA Nondiscrimination Statement

Attachment E

Attachment E- “Notification of Continuation of Benefits as a Result of Verification”

Attachment F

Attachment F- “Verification Summary/Recordkeeping”

Attachment G

Attachment G - “School Food Authority (SFA) Verification Collection Report”

Last updated
February 22, 2021

USDA Nondiscrimination Statement

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-0508-0002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:

  1. mail:
    U.S. Department of Agriculture
    Office of the Assistant Secretary for Civil Rights
    1400 Independence Avenue, SW
    Washington, D.C. 20250-9410; or
  2. fax:
    (833) 256-1665 or (202) 690-7442; or
  3. email:
    program.intake@usda.gov

 

This institution is an equal opportunity provider.

Click here for Nondiscrimination Statement translations.

Top