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YOUR RIGHTS AND RESPONSIBILITIES

YOU HAVE THE FOLLOWING RIGHTS

RIGHT TO WRITTEN NOTICE – We must always give you a written notice explaining your benefits

when we approve your case. We must always give you written notice when we change your

benefits, deny or close your case. You have 90 days from the notice date to ask for a hearing. If

you ask for a hearing within 10 days, you may be able to keep getting benefits while you wait for the

hearing.

RIGHT TO APPEAL – Ask for a hearing if you disagree with the Department’s decision. Your case

manager can help you write your appeal. At the hearing, you can speak for yourself or bring a

lawyer, friend or relative to speak for you.

EQUAL RIGHTS – Federal law and U.S. Department of Agriculture (USDA) and U.S. Department of

Health and Human Services (HHS) policy state we cannot discriminate against you because of race,

color, national origin, sex, age, or disability. Under the Food and Nutrition Act and USDA policy, we

also cannot discriminate against you because of religion, political beliefs or retaliation.

If you think we have discriminated against you contact USDA or HHS. To contact USDA write

USDA, Director, Office of Civil Rights, 1400 Independence Avenue SW, Washington, DC

20250-9410. You may also call toll free, 1-866-632-9992 (voice). TDD users can contact

USDA through local relay or the Federal Relay at 1-800-877-8339 (TDD) or 1-866-377-8642

(relay voice users). To contact HHS, write Office for Civil Rights, Health and Human

Services, 150 S. Independence Mall West – Suite 372, Philadelphia, PA 19106-3499. You may

also call HHS toll free at 1-800-368-1019 (voice) or 1-800-537-7697 (TDD). You may also send

an email to OCRMail@hhs.gov. USDA and HHS are equal opportunity providers and

employers.

For the Food Supplement Program, if you need this information in a different format (Braille,

large print, audiotape, etc.), contact the USDA’s TARGET Center at 202-720-2600 (Voice or

TDD). If you need information about this program, activity or facility in a language other than

English, contact the USDA agency responsible for the program or activity, or any USDA

office.

RIGHT TO PRIVACY – You are giving personal information in the application. We use the

information to see if you are eligible for benefits. If you do not give the information, we may deny

your application. You have a right to review, change, or correct any information. We will not show

your information or give it to others unless you give us permission or federal and state law allows us

to do so.

RIGHT TO CLAIM GOOD CAUSE – If you want Temporary Cash Assistance (TCA), you must help

the Department get child support. You may not have to help if it puts your or your family in danger.

RIGHT TO REFUSE HELP – You do not have to accept help from a religious organization if it is

against your religious beliefs.

RIGHT TO TIMELY APPLICATION PROCESSING – If you are eligible for expedited Food

Supplement Program benefits we must give you your benefits within 7 days. For the regular Food

Supplement Program and other programs, except for certain Medical Assistance programs, we must

process your application within 30 days. There are times when there is a delay in processing. If

there is a delay, we will send you a letter to tell you why there is delay in processing your application.

DHR/FIA CARES 9701 Revised 9/09

Application For Assistance (Snap Application Form) - Maryland Department Of Human Resources Family Investment Administration Page 9