In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights and policies,
the USDA, its Agencies, offices, employees, and institutions participating in or administrating USDA programs
are prohibited from discriminating based on race, color, national origin, sex, disability, age, 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. brail, large print, audio tape, American Sign Language, etc.) should contact the Agency
(state of 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 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,
or at any USDA office, or write a letter addressed to USDA and provide in the letter all 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: U.S. Department of Agriculture
Office of the Assistant Secretary
1400 Independence Avenue, SW
Washington, D.C. 20250-9410
2. fax: (202) 690-7442
3. email: email@example.com
This Institution is an