USDA Nondiscrimination Statement
SNAP and FDPIR State or local agencies, and their subrecipients, must post the following Nondiscrimination Statement:
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. Additionally, program information may be made available in languages other than English.
To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:
(1) MAIL TO: U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410;
(2) FAX: (202) 690-7442; or
(3) EMAILl: email@example.com.
USDA is an equal opportunity provider and employer.
For initial client certification, please print the entire APPLICATION PACKET. With that packet you will see a form called ADDITIONAL INFO. This shows you all the various documentation that we need to get you certified. You may not need all of the forms, so read each one carefully and see what pertains to you and your household. Please complete the APPLICATION, answering all the questions truthfully. If you don't know the answer to a question, call and we will assist you. Leaving a question blank or with N/A will slow down the certification process and will delay you getting your food. A ZERO INCOME form must be completed by all adults who claim to have no income. Have a FULL month of income verification for all working adults. If you are paid weekly, we will need to have 4 check stubs or a print out of the full months pay. If you are paid every 2 weeks, have 2-3 paystubs. If paid twice monthly have 2 check stubs. If you are receiving any kind of SS benefit, please have a benefit letter or a bank statement showing the amount deposited in your account from Social Security.
Once you have completed the APPLICATION PACKET, mail it to:
CTSI - USDA
P.O. Box 549
Siletz, OR 97380
Or bring it in person to 815 Logsden Rd. in Siletz. If it is closer for you to come to the Salem site, the address to come in person is 3160 Blossom Drive. We do no get mail delivery at the Salem site.
Shelter Utility Expense Verification
FDPIR Final Rule Changes
Monthly Income Standards Exhibit M- FY 2017 FDPIR Income Deductions
Zero Income Form
Exempt Income Document
Excess Medical Expense Deduction