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STATE OF HAWAII DEPARTMENT OF HUMAN SERVICES BENEFIT, EMPLOYMENT, AND SUPPORT SERVICES DIVISION IMPORTANT INFORMATION WHEN APPLYING FOR FINANCIAL ASSISTANCE AND SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) Information provided by the applicant in connection with the application will be subject to verification by Federal, State or local officials to determine if the information is factual; that if any information is incorrect, SNAP may be denied and the applicant may be subject to criminal prosecution for knowingly providing incorrect information. If any member of your household receives SNAP or Temporary Assistance for Needy Families (TANF) benefits, then all children in your household are eligible for free school meals if their school participates in the United States Department of Agriculture (USDA) meal program. Please call your child’s school if you have questions regarding the School Breakfast and Lunch Program. They will be able to provide you information when: • You think your child should get free meals but does not receive them, • You do not want your child to get free school meals, or • You have questions about the USDA meal programs. Information about TANF and other programs available under the Department of Human Services can be found at the following website: http://humanservices.hawaii.gov/bessd/ 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), religious creed, disability, age, political beliefs, 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 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 (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/ad-3027.pdf, from any USDA office, by calling (833) 620-1071, 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: Mail: Food and Nutrition Service, USDA 1320 Braddock Place Room 334 Alexandria, VA 22314 Fax: (833) 256-1665 or (202) 690-7442 Email: FNSCIVILRIGHTSCOMPLAINTS@USDA.GOV This institution is an equal opportunity provider. Apply faster online at: https://pais-benefits.dhs.hawaii.gov Attachment A-2, Page 1 of 18