Form AGR-2246 "Notification of Eligibility Determination - Commodity Supplemental Food Program (Csfp)" - Washington

What Is Form AGR-2246?

This is a legal form that was released by the Washington State Department of Agriculture - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2019;
  • The latest edition provided by the Washington State Department of Agriculture;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form AGR-2246 by clicking the link below or browse more documents and templates provided by the Washington State Department of Agriculture.

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Download Form AGR-2246 "Notification of Eligibility Determination - Commodity Supplemental Food Program (Csfp)" - Washington

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Food Assistance
PO Box 42560
Olympia WA 98504-2560
foodassistance@agr.wa.gov
Commodity Supplemental Food Program (CSFP)
Notification of Eligibility Determination
Date:
Applicant Name:
You are eligible to participate in the Commodity Supplemental Food Program (CSFP) Program,
effective ____________________. Your initial certification period is 12 months. You shall pick up/receive
your CSFP package at the following location and time:
______________________________________________________________________________________.
You have been placed on the waiting list. When space becomes available, you will be notified.
You have been found ineligible to participate in CSFP for the following reason(s):
Do not meet the age requirement of 60 years of age or older
Do not reside in Washington State
Do not reside in the CSFP service area
Do not meet income requirements
Other: ____________________________________________________________
If any of the above changes, you may reapply for services.
If you or your caretaker do not agree with this decision and wish to appeal, you may request a fair hearing
by making a clear expression, in writing or verbally, to the state or local agency official within 60 days from
the date of this notice.
Contractor:
WSDA Food Assistance
1111 Washington Street SE, 2nd Floor
Address:
PO Box 42560
Olympia WA 98504-2560
Phone:
(360) 725-5640
Participants who are denied benefits at initial certification, participants whose certification period has expired,
or who become categorically ineligible will not continue to receive benefits while awaiting the decision on
their appeal.
Agency Staff Contact
Title
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AGR-2246 (R/5/19)
Food Assistance
PO Box 42560
Olympia WA 98504-2560
foodassistance@agr.wa.gov
Commodity Supplemental Food Program (CSFP)
Notification of Eligibility Determination
Date:
Applicant Name:
You are eligible to participate in the Commodity Supplemental Food Program (CSFP) Program,
effective ____________________. Your initial certification period is 12 months. You shall pick up/receive
your CSFP package at the following location and time:
______________________________________________________________________________________.
You have been placed on the waiting list. When space becomes available, you will be notified.
You have been found ineligible to participate in CSFP for the following reason(s):
Do not meet the age requirement of 60 years of age or older
Do not reside in Washington State
Do not reside in the CSFP service area
Do not meet income requirements
Other: ____________________________________________________________
If any of the above changes, you may reapply for services.
If you or your caretaker do not agree with this decision and wish to appeal, you may request a fair hearing
by making a clear expression, in writing or verbally, to the state or local agency official within 60 days from
the date of this notice.
Contractor:
WSDA Food Assistance
1111 Washington Street SE, 2nd Floor
Address:
PO Box 42560
Olympia WA 98504-2560
Phone:
(360) 725-5640
Participants who are denied benefits at initial certification, participants whose certification period has expired,
or who become categorically ineligible will not continue to receive benefits while awaiting the decision on
their appeal.
Agency Staff Contact
Title
Page 1 of 2
AGR-2246 (R/5/19)
USDA 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, 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. 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:
https://www.ascr.usda.gov/filing-program-discrimination-complaint-usda-customer
or 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:
Mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410
Fax:
(202) 690-7442; or
Email:
program.intake@usda.gov
This institution is an equal opportunity provider.
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AGR-2246 (R/5/19)
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