RIGHT TO NONDISCRIMINATION
Pike County does not discriminate in any of its programs on the basis of race, color, religion, sex, age, national origin, ancestry, familial status, disability, or use of guide or support animals because of the blindness, deafness, or physical handicap of the user or because the user is a handler or trainer of support or guide animals.
If you are a person with a disability or limited English proficiency and require an auxiliary aid, service, or accommodations to participate, please contact Robert Ruiz, Executive Director of Human Development, at (570) 296-3434 or email@example.com, to discuss how to best accommodate your needs.
Robert Ruiz is designated as Fair Housing Officer for Pike County and that any resident that believes they have been discriminated against may file a complaint with the Fair Housing Officer at the following address:
Executive Director, Human Development
506 Broad Street
Milford, PA 18337
Any complaints, grievances, or comments regarding any components of the program should be written and submitted to Robert Ruiz, Executive Director of Human Development, at firstname.lastname@example.org or 506 Broad Street, Milford, PA 18337. Written responses will be addressed within 15 working days when practicable.
RIGHT TO CONFIDENTIALITY
We will keep your information private. It will only be used to decide which programs you may be eligible for. Any person knowingly violating any of the rules and regulations of this department shall be guilty of a misdemeanor and, upon conviction shall be sentenced to pay a fine, not exceeding one hundred ($100) dollars, or to undergo imprisonment, not exceeding six months, or both (62 P.S. section 483).
RESPONSIBILITY TO PROVIDE INFORMATION
You must give true, correct and complete information. You must help in proving the information, you give. Benefits may be denied if you fail to provide certain proof. If you are contacted by a representative from the county, state, or federal government, you must fully cooperate with those persons or investigators.
PRIVACY ACT STATEMENT
The collection of this information, including the Social Security number (SSN) of each household member, is authorized under 42 U.S.C. § 405(c)(2)(C)(i-iv) and 62 P.S. § 432.2(b)(3).
The information will be used to determine whether your household is eligible or continues to be eligible to participate in this program. We will verify this information through computer matching programs. This information will also be used to monitor compliance with program regulations and for program management.
This information may be disclosed to other federal and state agencies for official examination, and to law enforcement officials for the purpose of apprehending persons fleeing to avoid the law. Failure to provide an SSN may result in the denial of assistance to each individual failing to provide an SSN. Any SSNs provided will be used and disclosed in the same manner as SSNs of eligible household members. If someone wants help getting an SSN:
(1) call: 1-800-772-1213 or 1-800-325-0778 (TTY); or
(2) visit: www.ssa.gov.
The grievance procedure for any person who believes that they has been discriminated against or denied equal opportunity or access to programs or services may file a complaint, which shall be referred to as a grievance, with the following:
Gary Orben, Chief Clerk, Pike County, 506 Broad Street, Milford, PA 18337, email@example.com, (570) 296-7613 OR EQUAL HOUSING OPPORTUNITY, U.S. Department of Housing and Urban Development, FHEO/Regional III Office Mid-Atlantic Office, 100 Penn Square East, 12th Floor, Philadelphia, PA 19107, (215) 861-7643, Fax: (215) 656-3449 TTY: (800) 927-9275
Grievance procedures and complaint forms may be requested from the offices of Pike County in the following manner: Contact Gary Orben at firstname.lastname@example.org or (570) 296-7613.