PA 600 ERA 6/21
3
Rights and Responsibilities
RIGHT TO NONDISCRIMINATION
This institution is prohibited from discriminating on the
basis of race, color, national origin, disability, age, sex
and in some cases religion or political beliefs.
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. Additionally, program information
may be made available in languages other than English.
To file a complaint of discrimination regarding a program
receiving federal financial assistance through the U.S.
Department of Health and Human Services (HHS):
(1) mail: U.S. Department of Health and Human Services (HHS)
HHS Director, Office for Civil Rights, Room 515-F
200 Independence Avenue, S.W.
Washington, D.C. 20201; or
(2) call: (202) 619-0403 (voice) or (800) 537-7697 (TTY).
This institution is an equal opportunity provider.
RIGHT TO CONFIDENTIALITY
We will keep your information private. It will only be
used to decide which programs you may be eligible
for. Any person knowingly violating any of the rules
and regulations of this department shall be guilty of a
misdemeanor and, upon conviction shall be sentenced to
pay a fine, not exceeding one hundred ($100) dollars, or
to undergo imprisonment, not exceeding six months, or
both (62 P.S. section 483).
RESPONSIBILITY TO PROVIDE INFORMATION
You must give true, correct and complete information.
You must help in proving the information, you give.
Benefits may be denied if you fail to provide certain proof.
If you are contacted by Department of Human Services
(DHS) or the Office of State Inspector General, you must
fully cooperate with those persons or investigators.
PRIVACY ACT STATEMENT
The collection of this information, including the Social
Security number (SSN) of each household member, is
authorized under 42 U.S.C. § 405(c)(2)(C)(i-iv) and 62
P.S. § 432.2(b)(3).
The information will be used to determine whether
your household is eligible or continues to be eligible
to participate in the Emergency Rental Assistance
Program. We will verify this information through
computer matching programs. This information will
also be used to monitor compliance with program
regulations and for program management.
This information may be disclosed to other federal
and state agencies for official examination, and to law
enforcement officials for the purpose of apprehending
persons fleeing to avoid the law. Failure to provide
an SSN may result in the denial of Emergency Rental
Assistance to each individual failing to provide an SSN.
Any SSNs provided will be used and disclosed in the
same manner as SSNs of eligible household members.
If someone wants help getting an SSN:
(1) call: 1-800-772-1213 or 1-800-325-0778 (TTY); or
(2) visit: www.ssa.gov.
RIGHT TO APPEAL
You have the right to ask for a hearing to appeal a
decision if you believe it is unfair or incorrect, or if the
provider fails to act on your application for benefits.
You may file the appeal through the county agency
by following the information provided on the eligibility
determination notice from the ERAP agency for your
county.
If you appeal, you may also request a conference with
the ERAP agency before the hearing.
At the hearing you may represent yourself, or someone
else, such as a lawyer, friend or relative may represent
you.
