United States Department of Agriculture (USDA)/Food and Nutrition Service (FNS) Instruction 113-1
(dated 11/8/05) delineates the civil rights requirements for participants in the Child and Adult
Care Food Program (CACFP).
A. Public Information Responsibilities
1. Ensure that all forms of communication and printed program information distributed include the
following nondiscrimination statement.
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights
regulations and policies, the USDA, its Agencies, offices, and employees, and institutions
participating in or administering USDA programs are prohibited from discriminating based on race,
color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights
activity in any program or activity conducted or funded by USDA.
Persons with disabilities who require alternative means of communication for program information
(e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency
(State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or
have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339.
Additionally, program information may be made available in languages other than English.
To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint
Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_ cust.html, and at any
USDA office, or write a letter addressed to USDA and provide in the letter all of the information
requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your
completed form or letter to USDA by:
mail: U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW
Washington, D.C. 20250-9410;
fax: (202) 690-7442; or
This institution is an equal opportunity provider.
If material is too small to permit the full statement, this institution is an equal opportunity
provider will be included at a minimum in print size no smaller than the text.
Example: If the document was typed in 12 point font, “This institution is an equal opportunity
provider” must be in 12 point font or higher.