Required Application Notifications

Required Application Notifications. Each application form must include the following: A. Notice of a household’s right to file with an applicant’s name, address and signature of a responsible household member or the household’s authorized representative. B. Notice that, if eligible, benefits will be provided from the date of application. C. A description of expedited services on the first page of the application. D. A statement to be signed under penalty of perjury as to the truthfulness of the information contained in the application by an adult household member. E. A prominent description of the civil and criminal penalties for violating the Food and Nutrition Act of 2008. F. Notice that information available through the income and eligibility system (IEVS) will be requested, used, and may affect eligibility and benefit levels. G. Notice that non-citizen status of applicant household members may be subject to verification by United States Citizenship and Immigration Services (USCIS) through the use of the Systematic Alien and Verification and Entitlements (SAVE) system that may affect eligibility and benefit levels. H. The USDA non-discrimination statement and the Privacy Act statement.