Form Fa-001-P - Application Signature Pages Page 4
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4TAKE THIS PAGE WITH YOU FOR YOUR RECORDS.
What are the Rules and Penalties?
If you, your representative, or any household member hides information or gives false information on purpose to get or continue
to get Nutrition Assistance and/or Cash Assistance benefits that you are not entitled to, that person will be subject to:
Criminal Prosecution
Fines
Imprisonment
Other penalties provided for by state and federal laws
If you get Nutrition Assistance and/or Cash Assistance, you must follow the rules below:
Do not make false statements or hide information. If you are not truthful, you may have to pay back DES for benefits you
receive and you may be taken to court.
Do not do anything dishonest to get benefits that you are not supposed to get.
Do not buy, sell, trade, exchange or otherwise transfer your or someone else’s Nutrition Assistance benefits or EBT card.
Do not buy containers with deposits for the purpose of discarding the product and returning the containers to get cash refund
deposits.
Do not sell products bought with Nutrition Assistance benefits to exchange them for cash or items other than eligible food.
Do not buy products originally bought with Nutrition Assistance benefits to exchange those products for cash or items other
than eligible food.
Do not steal Nutrition Assistance or Cash Assistance benefits.
Do not use your Nutrition Assistance benefits to buy non-food items such as alcohol and tobacco.
Do not alter an EBT card.
Do not use someone else’s EBT card unless you are an authorized user approved by DES.
If you knowingly break the rules and get Nutrition Assistance and/or Cash Assistance benefits, we will disqualify you from getting
benefits for:
12 months for the first violation
24 months for the second violation
Permanently for the third violation
You or a household member will not be eligible to get Nutrition Assistance and/or Cash Assistance benefits if you or the
household member:
Is a fleeing felon or probation/parole violator.
Has been convicted of using or getting Nutrition Assistance benefits in a transaction involving the sale of firearms, ammunition
or explosives. This person can never get Nutrition Assistance benefits again.
Has been found guilty of using or getting Nutrition Assistance benefits in a transaction involving the sale of a controlled
substance. This person is not eligible to get Nutrition Assistance benefits for 2 years for the first violation and permanently for
the second violation.
Has committed and was convicted of a federal or state felony on or after August 23, 1996 for the possession, use or
distribution of a controlled substance.
Has been found by a court of law to have given false identification or residence information in order to get benefits in more
than one case. This person is not eligible to get benefits for 10 years.
Refuses to sign and comply with the Personal Responsibility Agreement (PRA). We give you the PRA during the interview
process.
Is an adult recipient (18 years or older) of Cash Assistance when any of the following apply:
The recipient does not return the completed Illegal Drug Use Statement. We send the Illegal Drug Use Statement by
U.S. Mail after Cash Assistance has been approved.
The recipient fails to take a required drug test.
The recipient fails the drug test.
You must pay DES back for any Nutrition Assistance and/or Cash Assistance benefits you received for which your household
was not eligible. You can make a repayment agreement. If you do not keep your repayment agreement, we may reduce your
Nutrition Assistance and/or Cash Assistance benefits, take your income tax refunds, or take other legal action, including taking
the amounts from your earnings.
The following additional penalties apply to the Nutrition Assistance Program:
An additional disqualification, of up to 18 months, may be ordered by a court.
Any participant or household member who makes false statements or hides information can be fined up to $250,000.00,
imprisoned for up to 20 years, or both.
You and/or your household members may be subject to further prosecution under federal laws.
FA-001-P (Signature pages only) (7-17)
Page G
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