Dinner Program
Discrimination Complaint Form and Instructions
The U.S. Department of Agriculture prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.)
In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights
regulations and policies, this institution is prohibited from discriminating on the basis of race,
color, national origin, sex (including gender identity and sexual orientation), disability, age, or
reprisal or retaliation for prior civil rights activity.
Program information may be made available in languages other than English. Persons with
disabilities who require alternative means of communication to obtain program information (e.g.,
Braille, large print, audiotape, American Sign Language), should contact the responsible state or
local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and
TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.
To file a program discrimination complaint, a Complainant should complete a Form AD-3027,
USDA Program Discrimination Complaint Form which can be obtained online
at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form0508-0002-508-11-28-17Fax2Mail.pdf from any USDA office, by calling (866) 632-9992, or by
writing a letter addressed to USDA. The letter must contain the complainant’s name, address,
telephone number, and a written description of the alleged discriminatory action in sufficient
detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an
alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:
Texas Department of Agriculture | Food and Nutrition Division
Short And Long Funding Statement_English And Spanish.Docx | 5/9/2022 | Page 3 of 3
1. mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
2. fax:
(833) 256-1665 or (202) 690-7442; or
3. email:
[email protected]
This institution is an equal opportunity provider.
regulations and policies, this institution is prohibited from discriminating on the basis of race,
color, national origin, sex (including gender identity and sexual orientation), disability, age, or
reprisal or retaliation for prior civil rights activity.
Program information may be made available in languages other than English. Persons with
disabilities who require alternative means of communication to obtain program information (e.g.,
Braille, large print, audiotape, American Sign Language), should contact the responsible state or
local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and
TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.
To file a program discrimination complaint, a Complainant should complete a Form AD-3027,
USDA Program Discrimination Complaint Form which can be obtained online
at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form0508-0002-508-11-28-17Fax2Mail.pdf from any USDA office, by calling (866) 632-9992, or by
writing a letter addressed to USDA. The letter must contain the complainant’s name, address,
telephone number, and a written description of the alleged discriminatory action in sufficient
detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an
alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:
Texas Department of Agriculture | Food and Nutrition Division
Short And Long Funding Statement_English And Spanish.Docx | 5/9/2022 | Page 3 of 3
1. mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
2. fax:
(833) 256-1665 or (202) 690-7442; or
3. email:
[email protected]
This institution is an equal opportunity provider.
Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at [email protected].