Fair Hearing: If you disagree with any action taken on your case, you or your representative have the have the right to request a fair hearing. You may request a fair hearing in writing. If you request a fair hearing, your case may be represented by yourself or another adult household member. To request a fair hearing, please contact STOWW’s Food Distribution Program Director at 253-589-7101 Ext. 228
Penalty Warning: If your household receives USDA foods, it must follow the rules below. Failure to comply with these rules may result in a monetary claim being filed against the household and/or suspension from STOWW’s Food Distribution Program.
Do not make false or misleading statements, misrepresent, conceal, or withhold facts regarding income, and/or household size.
Do not misuse (e.g., trade or sell) USDA foods.
Do not participate simultaneously in the Supplemental Nutrition Assistance Program (SNAP) and the Food Distribution Program.
Intentional Program Violation (IPV) Penalties: If you or any member of your household knowingly and willingly violates the rules above it is considered an Intentional Program Violation (IPV). Household members determined to have committed an IPV will be ineligible to participate in the Food Distribution Program for a period of time to be determined by STOWW’s Program Director.
Authorization: I authorize the release of any necessary information or forms to the STOWW Food Distribution Office from individuals, businesses, schools, banking institutions, Federal/State/Tribal agencies needed to determine/verify my eligibility. I understand that this information will be used only for the purpose of helping to document my eligibility for Food Distribution benefits. This authorization is good for 12 months from the date signed or until revoked by me in writing.
Certification Statement: I certify that I have read this application and that the information contained in it is true and correct to the best of my knowledge. I understand that I must comply with Program rules and provide additional documentation if required, and that falsification of information on this form may be grounds for disqualification and/or claim action. I further understand that I must report within 10 calendar days after the change becomes known the following changes: a change in household size or composition; an increase in gross monthly income or more than $100; a change in residence/address; when the household no longer incurs a shelter or utility expense; or a change in the legal obligation to pay child support.
In accordance with Federal civil rights law and U.S. 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, religious creed, disability, age, political beliefs, 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 (800) 877-8339.