FRANSTERIT Commodity Supplemental Food Program (CSFP) Application Form

Submit the completed form to your local CSFP agency. Forms can be emailed to program.intake@usda.gov, faxed to (860) 424-5729, or mailed to the Department of Social Services, Office of Legal Counsel, Regulations and Administrative Hearings, 55 Farmington Ave, Hartford, CT 06105. Always check for specific instructions or deadlines with your local agency.

The CSFP application form may have specific deadlines depending on your local agency. It's best to check directly with the agency for the most accurate and up-to-date information on submission deadlines for 2024 and 2025.

The purpose of this form is to collect necessary information from applicants to determine their eligibility for the Commodity Supplemental Food Program (CSFP). The CSFP offers nutritional assistance to seniors over the age of 60 who meet certain income requirements. By providing accurate personal, household, and income details, applicants can ensure they receive the support they need through this program. Additionally, the form outlines applicants' rights, responsibilities, and the non-discrimination statement, providing a clear understanding of what is expected from both the applicants and the program administrators. Completing this form accurately and promptly is crucial to initiating or maintaining participation in the CSFP, ensuring that eligible individuals receive the nutritional assistance they need. Proper completion of the form also allows the program to function efficiently, directing resources to those who meet the established criteria and supporting community health and well-being.

• 1. Name: The applicant's full name.
• 2. Application date: The date the application is filled out.
• 3. End date: The termination date of eligibility.
• 4. Street address: The applicant's residential street address.
• 5. Apt. number: The apartment number of the residence.
• 6. City: The city of the applicant's residence.
• 7. State: The state of the applicant's residence.
• 8. Zip: The ZIP code of the residence.
• 9. E-mail address: The applicant's contact email.
• 10. Date of Birth: The applicant's date of birth.
• 11. Primary phone number: The primary contact number for the applicant.
• 12. Alternate phone number: An alternative contact number for the applicant.
• 13. Total number of people in household: The total number of individuals living in the household.
• 14. Number of people age 60 or older in household: The number of household members aged 60 or above.
• 15. Proxy Form: Information for proxies picking up food on behalf of the applicant.
• 16. Race and Ethnicity: Optional field for race and ethnicity data collection for reporting purposes.
• 17. Family Unit's Gross Monthly Income: Gross monthly income from all sources for the family unit.

Failure to submit this form results in ineligibility for the CSFP benefits. It’s important to submit promptly to avoid any disruptions in receiving food assistance.

• Ineligibility for Benefits: You won’t be able to receive CSFP food aid without submission.
• Missed Deadlines: Filing after deadlines can disqualify you from the current period's aid.
• Update Requirements: Without submitting updated forms, your eligibility status may not be extended.

• 1. New Applications: First-time applicants for CSFP should use this form to provide initial details.
• 2. Renewal Applications: Current beneficiaries must resubmit to renew their eligibility.
• 3. Information Updates: Any changes in household composition or income should be reported using this form.