Common use of Department of Agriculture Clause in Contracts

Department of Agriculture. (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (000) 000-0000. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: xxxx://xxx.xxxx.xxxx.xxx/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (000) 000-0000. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 0000 Xxxxxxxxxxxx Xxxxxx, XX Xxxxxxxxxx, X.X. 00000-0000; (2) fax: (000) 000-0000; or (3) email: xxxxxxx.xxxxxx@xxxx.xxx. This institution is an equal opportunity provider. CHILD CARE REPRESENTATIVE USE ONLY ANNUAL INCOME CONVERSION: W EEKLY X 52 – E VERY 2 WEEKS X 26 – T XXXX A MONTH X 24 – M ONTHLY X 12 S ECTION A MARK ONE OF THE BOXES BELOW TO SHOW HOW YOU ARE GOING TO DETERMINE ELIGIBILITY. SECTION B BASED ON THE INFORMATION PROVIDED, THIS APPLICATION WILL BE:  APPROVED FREE  APPROVED TIER I  APPROVED REDUCED  APPROVED TIER II  PAID  FOOD STAMP OR TANF HOUSEHOLD—THE FOOD STAMP OR TANF NUMBER MEETS THE CRITERIA FOR AN ACCEPTABLE CASE NUMBER. COMPLETE SECTION B & C OR  XXXXXX CHILD—COMPARE THE XXXXXX CHILD’S PERSONAL INCOME TO THE GUIDELINES. COMPLETE SECTION B & C OR USE THIS SPACE FOR INCOME CALCULATION.  HOUSEHOLD INCOME—COMPLETE THE INFORMATION BELOW AND COMPLETE SECTION B & C TOTAL HOUSEHOLD SIZE: _ TOTAL HOUSEHOLD INCOME $ / EXAMPLE: $100/WEEK COMPARE TOTAL HOUSEHOLD INCOME TO CURRENT USDA INCOME ELIGIBILITY GUIDELINES. WHEN THE HOUSEHOLD INCOMES ARE LISTED FOR DIFFERENT PAY PERIODS, YOU MUST CONVERT ALL INCOME TO MONTHLY OR ANNUAL INCOME. USE THE CONVERSION LISTED ABOVE.

Department of Agriculture. (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (000) 000-0000. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: xxxx://xxx.xxxx.xxxx.xxx/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (000) 000-0000. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 0000 Xxxxxxxxxxxx Xxxxxx, XX Xxxxxxxxxx, X.X. 00000-000000000‐9410; (2) fax: (000) 000-0000; or (3) email: xxxxxxx.xxxxxx@xxxx.xxx. This institution is an equal opportunity provider. CHILD CARE REPRESENTATIVE USE ONLY ANNUAL INCOME CONVERSIONChild Care Representative Use only Annual Income Conversion: W EEKLY Weekly X 52 – E VERY Every 2 WEEKS Weeks X 26 – T XXXX A MONTH Twice a Month X 24 – M ONTHLY Monthly X 12 S ECTION SECTION A MARK ONE OF THE BOXES BELOW TO SHOW HOW YOU ARE GOING Mark one of the boxes below to show how you are going TO DETERMINE ELIGIBILITY. SECTION B BASED ON THE INFORMATION PROVIDED, THIS APPLICATION WILL BE:  APPROVED FREE  APPROVED TIER 🞏 approved free 🞏 approved Tier I  APPROVED REDUCED  APPROVED TIER 🞏 approved reduced 🞏 approved Tier II  🞏 PAID  🞏 FOOD STAMP OR TANF HOUSEHOLD—THE FOOD STAMP OR TANF NUMBER MEETS THE CRITERIA FOR AN ACCEPTABLE CASE NUMBER. COMPLETE SECTION B & C OR  🞏 XXXXXX CHILD—COMPARE THE XXXXXX CHILD’S PERSONAL INCOME TO THE GUIDELINESCompare the xxxxxx child’s personal income to the guidelines. COMPLETE SECTION B & C OR USE THIS SPACE FOR INCOME CALCULATION.  🞏 HOUSEHOLD INCOME—COMPLETE THE INFORMATION BELOW AND COMPLETE SECTION Complete the information below and Complete Section B & C TOTAL HOUSEHOLD SIZETotal Household Size: _ TOTAL HOUSEHOLD INCOME Total Household Income $ / EXAMPLEExample: $100/WEEK COMPARE TOTAL HOUSEHOLD INCOME TO CURRENT week Compare total household income to current USDA INCOME ELIGIBILITY GUIDELINESIncome Eligibility Guidelines. WHEN When the household incomes are listed for different pay periods, you must convert all income to monthly or annual income. Use the conversion listed above. SECTION C Signature of Sponsor Representative Date of Approval THIS FORM EXPIRES ONE YEAR FROM THE HOUSEHOLD INCOMES ARE LISTED FOR DIFFERENT PAY PERIODS, YOU MUST CONVERT ALL INCOME TO MONTHLY OR ANNUAL INCOME. USE THE CONVERSION LISTED ABOVE.DATE IT WAS APPROVED

Department of Agriculture. (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (000) 000-0000. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: xxxx://xxx.xxxx.xxxx.xxx/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (000) 000-0000. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 0000 Xxxxxxxxxxxx Xxxxxx, XX Xxxxxxxxxx, X.X. 00000-0000; (2) fax: (000) 000-0000; or (3) email: xxxxxxx.xxxxxx@xxxx.xxx. This institution is an equal opportunity provider. CHILD CARE REPRESENTATIVE USE ONLY ANNUAL INCOME CONVERSION: W EEKLY WEEKLY X 52 – E VERY EVERY 2 WEEKS X 26 – T XXXX TWICE A MONTH X 24 – M ONTHLY MONTHLY X 12 S ECTION SECTION A MARK ONE OF THE BOXES BELOW TO SHOW HOW YOU ARE GOING TO DETERMINE ELIGIBILITY. SECTION B BASED ON THE INFORMATION PROVIDED, THIS APPLICATION WILL BE:  APPROVED FREE  APPROVED TIER I  APPROVED REDUCED  APPROVED TIER II  PAID  FOOD STAMP OR TANF HOUSEHOLD—THE FOOD STAMP OR TANF NUMBER MEETS THE CRITERIA FOR AN ACCEPTABLE CASE NUMBER. COMPLETE SECTION B & C OR  XXXXXX CHILD—COMPARE THE XXXXXX CHILD’S PERSONAL INCOME TO THE GUIDELINES. COMPLETE SECTION B & C OR USE THIS SPACE FOR INCOME CALCULATION.  HOUSEHOLD INCOME—COMPLETE THE INFORMATION BELOW AND COMPLETE SECTION B & C TOTAL HOUSEHOLD SIZE: _ TOTAL HOUSEHOLD INCOME $ / EXAMPLE: $100/WEEK COMPARE TOTAL HOUSEHOLD INCOME TO CURRENT USDA INCOME ELIGIBILITY GUIDELINES. WHEN THE HOUSEHOLD INCOMES ARE LISTED FOR DIFFERENT PAY PERIODS, YOU MUST CONVERT ALL INCOME TO MONTHLY OR ANNUAL INCOME. USE THE CONVERSION LISTED ABOVE.. SECTION C SIGNATURE OF SPONSOR REPRESENTATIVE DATE OF APPROVAL THIS FORM EXPIRES ONE YEAR FROM THE DATE IT WAS APPROVED

Department of Agriculture. (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (000) 000-0000. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: xxxx://xxx.xxxx.xxxx.xxx/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (000) 000-0000. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 0000 Xxxxxxxxxxxx Xxxxxx, XX Xxxxxxxxxx, X.X. 00000-000000000‐9410; (2) fax: (000) 000-0000; or (3) email: xxxxxxx.xxxxxx@xxxx.xxx. This institution is an equal opportunity provider. CHILD CARE REPRESENTATIVE USE ONLY ANNUAL INCOME CONVERSIONChild Care Representative Use only Annual Income Conversion: W EEKLY Weekly X 52 – E VERY Every 2 WEEKS Weeks X 26 – T XXXX A MONTH Twice a Month X 24 – M ONTHLY Monthly X 12 S ECTION SECTION A MARK ONE OF THE BOXES BELOW TO SHOW HOW YOU ARE GOING Mark one of the boxes below to show how you are going TO DETERMINE ELIGIBILITY. SECTION B BASED ON THE INFORMATION PROVIDED, THIS APPLICATION WILL BE:  APPROVED FREE  APPROVED TIER 🞏 approved free 🞏 approved Tier I  APPROVED REDUCED  APPROVED TIER 🞏 approved reduced 🞏 approved Tier II  🞏 PAID  🞏 FOOD STAMP OR TANF HOUSEHOLD—THE FOOD STAMP OR the Food Stamp or TANF NUMBER MEETS THE CRITERIA FOR AN ACCEPTABLE CASE NUMBERnumber meets the criteria for an acceptable case number. COMPLETE SECTION Complete Section B & C OR  🞏 XXXXXX CHILD—COMPARE THE XXXXXX CHILD’S PERSONAL INCOME TO THE GUIDELINESCompare the xxxxxx child’s personal income to the guidelines. COMPLETE SECTION B & C OR USE THIS SPACE FOR INCOME CALCULATION.  🞏 HOUSEHOLD INCOME—COMPLETE THE INFORMATION BELOW AND COMPLETE SECTION Complete the information below and Complete Section B & C TOTAL HOUSEHOLD SIZETotal Household Size: _ TOTAL HOUSEHOLD INCOME Total Household Income $ / EXAMPLEExample: $100/WEEK COMPARE TOTAL HOUSEHOLD INCOME TO CURRENT week Compare total household income to current USDA INCOME ELIGIBILITY GUIDELINESIncome Eligibility Guidelines. WHEN When the household incomes are listed for different pay periods, you must convert all income to monthly or annual income. Use the conversion listed above. SECTION C Signature of Sponsor Representative Date of Approval THIS FORM EXPIRES ONE YEAR FROM THE HOUSEHOLD INCOMES ARE LISTED FOR DIFFERENT PAY PERIODS, YOU MUST CONVERT ALL INCOME TO MONTHLY OR ANNUAL INCOME. USE THE CONVERSION LISTED ABOVE.DATE IT WAS APPROVED