“AND JUSTICE FOR ALL”

In accordance with Federal 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, (including limited English proficiency), sex, 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 for program information (e.g., braille, large print, audiotape, American Sign Language) should contact the responsible State or local Agency that administers the program or contact USDA through the Telecommunications Relay Service at 711 (voice and TTY).

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 AD-3027 (from any USDA office, by calling (866) 632-9992, 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 Office of Assistant Secretary for Civil Rights (OASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to:

Mail:
USDA Food and Nutrition Administration,
1320 Braddock Place, Room 334
Alexandria, VA 22314; or
Email: FNSCIVILRIGHTSCOMPLAINTS@usda.gov

This institution is an equal opportunity provider.

Form AD-475-B SNAP and FDPIR Poster Revised October 2024

Your Rights

Sample Written Notice of Beneficiary Rights for
CSFP and TEFAP

Written Notice of Beneficiary Rights

Name of Organization: Cary Grove Food Pantry

Because The Temporary Food Assistance Program (TEFAP) is supported in whole or in part by financial assistance from the
Federal Government, we are required to let you know that:

1. We may not discriminate against you on the basis of religion, a religious belief, a refusal
to hold a religious belief, or a refusal to attend or participate in a religious practice;

2. We may not require you to attend or participate in any explicitly religious activities
(including activities that involve overt religious content such as worship, religious
instruction, or proselytization) that are offered by our organization, and any
participation by you in such activities must be purely voluntary;

3. We must separate in time or location any privately funded explicitly religious activities
(including activities that involve overt religious content such as worship, religious
instruction, or proselytization) from activities supported with direct Federal financial
assistance; and

4. You may report violations of these protections, including any denials of services or
benefits by an organization, by contacting or filing a written complaint with the

U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights Executive Director
Center for Civil Rights Enforcement
1400 Independence Avenue SW
Washington, DC 20250–9410, or by email to program.intake@usda.gov

5. If you would like to seek information about whether there are any other federally
funded organizations that provide these kinds of services in your area, please contact

The USDA Hunger Hotline
• By Phone: 1-866-3-HUNGRY or 1-877-8-HAMBRE to speak with a representative
from 7:00 AM – 10:00 PM Eastern Time

State of Illinois TEFAP
• By phone: 1 -217-558-0030

Or visit the University of Illinois Find Food map
Website: https://eat-move-save.extension.illinois.edu/

This written notice must be given to you before you enroll in the program or receive services
from the program, unless the nature of the service provided or exigent circumstances make it
impracticable to provide such notice before we provide the actual service. In such an instance,
this notice must be given to you at the earliest available opportunity.