BRAG Central Intake Application

Bear River Association of Governments Applicant,

This application is intended to help Individuals within the Cache, Box Elder and Rich counties utilize BRAG services and navigate through the required verifications for each program.

Once your application has been received, we will reach out to you with the next steps. To speed the process up please make sure to provide as many of the following verifications as soon as possible.

Please submit the following documents with your application:

• BRAG Intake Packet
• Social Security Cards/Permanent Resident Cards – all household members
• Picture ID – all household members over 18 years of age
• Birth Certificate – all household members
• Proof of Income – For the last 60-days

Department of Health and Human Services

2025 National Poverty Guidelines

Gross Monthly Income

BRAG uses the above poverty guidelines to determine eligibility for our programs. The amounts listed above are based on gross monthly income.

According to Community Action Program Legal Services (CAPLAW), the income of all members of each individual family unit must be included in determining the income eligibility.

Each funding source utilizes different percentages of poverty to qualify households’ income. All eligible funds will be looked at to assist applicants.

Please Note: In order to maintain a safe and productive environment, the following behaviors will not be tolerated:

1. Verbal Abuse-including use of profanity or aggressive words, making threats, and being disrespectful toward BRAG staff or clients
2. Physical abuse-including inflicting harm or intent to harm.
3. Emotional abuse-including name calling and belittling. 
4. Sexual abuse-including elicitation or solicitation of a sexual nature or making sexual overtures/innuendos.
5. Possession of illegal substances and/or drug paraphernalia, presenting under the influence and/or in an altered state. 
6. Possession of handgun or any other lethal weapon.
7. Behaviors that promote a negative atmosphere-including unnecessary or excessive phone calls, emails, and other forms of negative communication.

If someone engages in behavior that endangers the safety or wellbeing of others, staff may take immediate steps to protect the safety of individuals and the office, including asking the client to leave the premises, contacting law enforcement, or terminating services.

By signing below, I verify that the information I have provided is true and accurate to my knowledge. I understand that providing misleading or false information will result in termination of assistance. I was informed about and offered a copy of the BRAG anti-discrimination policy and notified of my rights to fair housing.

WARNING: Title 18, section 1001 of the United States Code, states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department or agency of the United States. Income for all household members must be disclosed or the application will be denied.

I hereby authorize Bear River Association of Governments (BRAG) to share information regarding services my household and I have received or will receive with organizations relevant to my case. This may include but not limited to the following organizations: Department of Workforce Service (DWS) utility company, my landlord, Bear River Mental Health, Citizens Against Physical & Sexual Abuse (CAPSA), Cache Valley Veterans Association (CVVA), Utah Families Feeding Families, 4 Helping Hearts, and Division of Child and Family Services (DCFS).

I understand that the information will remain confidential and is protected by state and federal law, and will only be used for my benefit or to benefit other members of my household.

Information to be Released: All information concerning my care. Non-identifying information may also be used for the purposes of research to ensure program success and current and potential funding sources.

Purpose of Release: The purpose of sharing this information is to improve the coordination of services to better promote overall stability.

1) To provide coordinated housing, medical, social, psychological, and other services

2) To evaluate outcomes related to service delivery

3) To improve coordination of services to assist in becoming stably housed or employed depending on personal needs

Not Required for Services: I understand that authorization is voluntary and that I may refuse to sign this authorization. I also understand that refusal to share information with certain organizations may prevent me from receiving specific services from certain programs.

Right to Revoke: I understand that my consent will last one year from today’s date unless I revoke my authorization in writing before that time.

Bear River Association of Governments assists those who currently are staying or residing within Cache, Box Elder and Rich counties. Please refer to the link below to find the Community Action program in your county.

Community Action Network Providers

If you have any questions please speak with our Central Intake Specialist.

Thank you

Grievance Procedure

This Grievance Procedure is to be followed by program consumers who are dissatisfied with or are denied services under programs funded by Community Service Block Grant (CSBG), Social Service Block Grant (SSBG), and any other grant or program overseen by the Bear River Human Services Council. Attempts will be made to resolve grievances as quickly as possible.

Informal: Consumer will bring the issue to attention of the local program provider. If not resolved to consumer’s satisfaction, the consumer has the option of pursuing the grievance by issuing a formal complaint.

Formal Complaint

1. Consumers will submit written grievances to local program providers within five (5) working days of the incident or of
2. knowledge of the incident. The local Program Provider will respond in writing within ten (10) working days. If not resolved to the consumer's satisfaction, they have the option to proceed.
3. If the issue is still not resolved to consumer’s satisfaction, consumers may submit a written grievance within ten (10)
4. working days to the Director of Community Action, Bear River Association of Governments, 170 North Main Street, Logan, Utah 84321. The Director of Community Action will respond in writing within ten (10) working days. If not resolved to consumer’s satisfaction they have the option to proceed.
5. If the issue is still not resolved to consumer’s satisfaction, consumers may submit a written grievance within ten (10)
6. working days to the Executive Director of Bear River Association of Governments, 170 North Main Street, Logan, Utah 84321. The Executive Director will utilize support staff or Human Services Council support as deemed necessary to investigate information and render a decision regarding the grievance. The Executive Director will respond in writing within ten (10) working days. If not resolved to the consumer's satisfaction, they have the option to proceed.
7. If the issue is still not resolved to consumer’s satisfaction, consumers will be provided with address and telephone
8. number(s) for the Chairperson of both the Bear River Human Services Council and Bear River Association of Governments Steering Committee. A hearing before the Human Services Council will offer the next level of grievance and help remedy appropriate action(s) regarding the complaint. The nature of the complaint and the investigation shall be properly documented. The response to the consumer will address the complaint received and relevant action taken. If any member of the Human Services Council is involved in the grievance, those members shall exclude themselves from the grievance procedure.
9. If the decision is not to the satisfaction of the consumer, the consumer shall be referred to the appropriate state
10. agency’s grievance procedure. In most instances, this will be the Utah Department of Workforce Services or the Utah Department of Human Services.

I understand the BRAG Grievance Procedures Policy and if I have a complaint related to the completion of services that I have received from BRAG, I have the right to file an appeal. This appeal must be made within five (5) days from the incident or knowledge of the incident.

Please make appeal to Lucas Martin, Human Services Director, lucasm@brag.utah.gov

You have chosen to apply or receive more information about the below programs. Please note that your applications for these programs are not finalized at this point. Please get with your Central Intake specialist to review your next steps.

Cache/Rich County - 435-713-1445

Box Elder County - 435-723-1111

Thank you