[Code of Federal Regulations]

[Title 7, Volume 4]

[Revised as of January 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 7CFR247.8]



[Page 406-407]

 

                          TITLE 7--AGRICULTURE

 

    CHAPTER II--FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE

 

PART 247_COMMODITY SUPPLEMENTAL FOOD PROGRAM--Table of Contents

 

Sec. 247.8  Individuals applying to participate in CSFP.



    (a) What information must individuals applying to participate in 

CSFP provide? To apply for CSFP benefits, the applicant, or the adult 

parent or caretaker



[[Page 407]]



of the applicant, must provide the following information on the 

application:

    (1) Name and address, including some form of identification for each 

applicant;

    (2) Household income, except where the applicant is determined to be 

automatically eligible under Sec. 247.9(b)(1)(i) and (b)(1)(ii);

    (3) Household size, except where the applicant is determined to be 

automatically eligible under Sec. 247.9(b)(1)(i) and (b)(1)(ii); and

    (4) Other information related to eligibility, such as age or 

pregnancy, as applicable.

    (b) What else is required on the application form? The application 

form must include a nondiscrimination statement that informs the 

applicant that program standards are applied without discrimination by 

race, color, national origin, age, sex, or disability. After informing 

the applicant (or adult parent or caretaker) of his or her rights and 

responsibilities, in accordance with Sec. 247.12, the local agency must 

ensure that the applicant, or the adult parent or caretaker of the 

applicant, signs the application form beneath the following pre-printed 

statement. The statement must be read by, or to, the applicant (or adult 

parent or caretaker) before signing.

    ``This application is being completed in connection with the receipt 

of Federal assistance. Program officials may verify information on this 

form. I am aware that deliberate misrepresentation may subject me to 

prosecution under applicable State and Federal statutes. I am also aware 

that I may not receive both CSFP and WIC benefits simultaneously, and I 

may not receive CSFP benefits at more than one CSFP site at the same 

time. Furthermore, I am aware that the information provided may be 

shared with other organizations to detect and prevent dual 

participation. I have been advised of my rights and obligations under 

the program. I certify that the information I have provided for my 

eligibility determination is correct to the best of my knowledge.

    I authorize the release of information provided on this application 

form to other organizations administering assistance programs for use in 

determining my eligibility for participation in other public assistance 

programs and for program outreach purposes. (Please indicate decision by 

placing a checkmark in the appropriate box.)





YES [ ]



NO [ ]''





(Approved by the Office of Management and Budget under control number 

0584-0293)