The Emergency Food Assistance Program (TEFAP)

Wisconsin Household Income Eligibility Guidelines

Pautas de Elegibilidad de Ingresos del Hogar de Wisconsin

I certify, by self-attesting, that I am eligible to receive USDA foods being that I reside in Wisconsin, and my total household income is 200% or less of the Federal Poverty Guidelines listed below or current level on addendum. I will use this food only for home consumption. This form is in connection with the receipt of federal assistance. Application is valid for up to one year, changes in household information must be reported immediately. I release USDA, the State of Wisconsin and its agents from any liability resulting from my receipt of this food. False information may subject me to prosecution and require me to repay the value of the benefits. Gross income before taxes and deductions-of all household members.

Yearly

1 person: $31,300 2 people: $42,300 3 people: $53,300 4 People: $64,300 5 people: $75,300 6 people: $86,300

7 people: $97,300 8 people: $108,300

Monthly

1 person: $2,608 2 people: $3,525 3 people: $4,442 4 people: $5,358 5 people: $6,275 6 people: $7,192 7 people: $8,108 8 people: $9,025

Weekly

1 person:$602 2 people: $813 3 people: $1,025 4 people: $1,237 5 people:$1,448 6 people: $1,660 7 people: $1,871

8 people: $2,083

Written Notice of Beneficiary Rights for Wisconsin CSFP and TEFAP

Because this organization, Antgio Area Community Food Pantry, is supported in whole or in part by financial assistance from the Federal Government, we are required to let you know that:

1. We may not discriminate against you on the basis of religion, a religious belief, a refusal to hold a religious belief, or a refusal to attend or participate in a religious practice. 

2. We may not require you to attend or participate in any explicitly religious activities (including activities that involve overt religious content such as worship, religious instruction, or proselytization) that are offered by our organization, and any participation by you in such activities must be purely voluntary. 

3. We must separate in time or location any privately funded explicitly religious activities (including activities that involve overt religious content such as worship, religious instruction, or proselytization) from activities supported with direct Federal financial assistance; and 

4. You may report violations of these protections, including any denials of services or benefits by an organization, by contacting or filing a written complaint with the U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights Executive Director Center for Civil Rights Enforcement 1400 Independence Avenue SW Washington, DC 20250–9410, or by email to program.intake@usda.gov 5.

 If you would like to seek information about whether there are any other federally funded organizations that provide these kinds of services in your area, contact The USDA Hunger Hotline:

• By Phone: 1-866-3-HUNGRY or 1-877-8-HAMBRE to speak with a representative from 7:00 AM – 10:00 PM Eastern Time.

• By Text: 914-342-7744 with a question that may contain a keyword such as “food," “summer,” “meals,” etc. to receive an automated response to resources located near an address and/or zip code.

This written notice must be available to you before you enroll in the program or receive services from the program, unless the nature of the service provided, or exigent circumstances make it impracticable to provide such notice before we provide the actual service. In such an instance, this notice must be given to you at the earliest available opportunity.