2.10 Ethnic, Political, and Religious GroupsĬounty Information Description.2.3 Business, Commerce, and Occupations.1.3 Winnebago County, Illinois Record Dates.I have read, understood and accept the penalty statement above.I amĪware that if I purposely give false information, my children may lose meal benefits, and I may be prosecuted under applicable Is given in connection with the receipt of federal funds, and that school officials may verify (check) the information. That my child did not attend school in person for a school-approved COVID-related reason. I certify (promise) that all information on this application is true and that the dates specified in my application are days Illinois provides reasonable accommodations according to Section 504 of the Rehabilitation Act of 1973 and the Americans withĪttestation and Signature Penalty Statement IDHS, HHS, and USDA are equal opportunity providers and employers. You may also write the Illinois Department of Human Services (IDHS) at Illinois Department of Human Services, Bureau of CivilĪffairs, 401 South Clinton St., 6th Floor, Chicago, Illinois, 60607 or call the IDHS Helpline Number at 1-80 orĨ6 TTY/Nextalk or 711 TTY Relay. email: Illinois Nondiscrimination Information.Office of the Assistant Secretary for Civil Rights Submit your completed form or letter to USDA by: To request aĬopy of the complaint form, call (866) 632-9992. Office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. Program Discrimination Complaint Form, (AD-3027) found online at: To file a program complaint of discrimination, complete the Who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339.Īdditionally, program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print,Īudiotape, American Sign Language), should contact the agency (State or local) where they applied for benefits. The USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibitedįrom discriminating based on race, color, national origin, sex, (including sexual orientation and gender identity), religiousĬreed, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Department of Agriculture (USDA) civil rights regulations and policies, In accordance with federal civil rights law and U.S. For additional questions, visit the IDHS website and the P-EBT FAQ, email or call the P-EBT Call Center at 1-83. It could also include, again at the discretion of the school or the State, a parent/guardian's decision to keep their child home after exposure at school in cases where the school does not direct the child to stay home.īy completing this form, you attest that your child missed access to an in-school meal that was COVID-related. At the discretion of the school or the state, this could include a parent/guardian's decision to keep their child home after a positive test or possible exposure to COVID. This would include a school-ordered quarantine of a student, a group of students, a classroom, or a school (2) Any other stay-at-home order mandated by the school, whatever its duration, if it is part of the school's or the State's protocol for managing COVID outbreaks, positive tests, and/or potential exposure and (3) An absence initiated by the parent that is recognized and accepted by school officials as COVID-related. Eligibility for P-EBT benefits is only for the days your child missed school due to a COVID-related reason.ĬOVID-related absences for purpose of P-EBT eligibility include: (1) Any absence where the school directs students to stay home for a COVID-related reason.
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