Indiana
Notice Regarding Rights and Responsibilities for Supplemental Nutrition Assistance Program (SNAP) and Cash Assistance (Spanish) 54106
No One Left Outside provides source-based information. The issuing agency or plan decides eligibility, acceptance and availability.
Source / last checked DFR: Forms - 2026-11-02
- Form number
- 54106
DFR: Forms - Reviewed 2026-11-02
- What it is for
- Notice Regarding Rights and Responsibilities for Supplemental Nutrition Assistance Program (SNAP) and Cash Assistance (Spanish) 54106
DFR: Forms - Reviewed 2026-11-02
- Issuing agency
- Indiana Family and Social Services Administration (FSSA); this form appears in the DFR forms catalog.
DFR: Forms - Reviewed 2026-11-02
- Program
- SNAP and cash assistance
DFR: Forms - Reviewed 2026-11-02
- Jurisdiction
- Indiana
DFR: Forms - Reviewed 2026-11-02
- Category
- SNAP
Notice Regarding Rights and Responsibilities for Supplemental Nutrition Assistance Program (SNAP) and Cash Assistance (Spanish) 54106 - Reviewed 2026-11-02
- Form type
- form
DFR: Forms - Reviewed 2026-11-02
- Who fills it out
- Not listed yet. Call to confirm.
- How to submit
- Not listed yet. Call to confirm.
- Documents to include
- Not listed yet. Call to confirm.
- Languages
- Spanish edition
DFR: Forms - Reviewed 2026-11-02
- Official page
- https://www.in.gov/fssa/dfr/forms-documents-and-tools/forms
DFR: Forms - Reviewed 2026-11-02
- Direct form link
- https://forms.in.gov/Download.aspx?id=10674
DFR: Forms - Reviewed 2026-11-02
- Revision date
- R20 / 12-25
Notice Regarding Rights and Responsibilities for Supplemental Nutrition Assistance Program (SNAP) and Cash Assistance (Spanish) 54106 - Reviewed 2026-11-02
- Signature
- Not listed yet. Call to confirm.
- Accessibility
- Las personas con discapacidades que necesiten medios alternativos de comunicación para obtener información sobre el programa (por ejemplo, Braille, letra grande, cinta de audio, lengua de señas estadounidense, etc.), deben ponerse en contacto con la agencia estatal o local que administra el programa o con el USDA a través del Servicio Federal de Retransmisión al (711) 877- 8339 (voz y TTY). La información del programa también puede estar disponible en otros idiomas además del inglés.
Notice Regarding Rights and Responsibilities for Supplemental Nutrition Assistance Program (SNAP) and Cash Assistance (Spanish) 54106 - Reviewed 2026-11-02
- What the form says
Debe responder a todas las preguntas de los programas que solicita o en los que está inscrito. Debe proporcionar información completa y correcta según su mejor conocimiento. Una persona que reciba beneficios dando intencionadamente información falsa o por no brindar información puede ser procesada penalmente bajo la ley estatal y federal.
Notice Regarding Rights and Responsibilities for Supplemental Nutrition Assistance Program (SNAP) and Cash Assistance (Spanish) 54106 - Reviewed 2026-11-02
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