Page 5

Page Five

web page noted below within the next few weeks.

FS 22 QR – “Applying for Food Stamp Benefits” – This form is revised to include a description of the new requirements for the SUA, LUA and TUA on the top of Page 2, second column. This form is a “master copy” only and is not stocked in the state warehouse.

DFA 285 A2 – “Statement of Facts” – This form is revised on page 5 of the County Use Section to include new formatting for the SUA, LUA and TUA. This form comes in “sets” and is stocked in the state warehouse.

DFA 285B – “Food Stamp “Budget Worksheet” – The title of this form is changed to “Food Stamp Budget Worksheet/Change Reporting Households” and the “Child Support Deduction” section is deleted. This form comes in “pads” and is stocked in the state warehouse.

DFA 285 D – “Food Stamp Budget Worksheet” – This form is revised to delete the “Child Support Deduction” section. This form comes in “pads” and is stocked in the state warehouse.

DFA 377.5 – “Food Stamp Household Change Report” – This form is revised to delete language on claiming actual utility costs and is replaced with SUA only language. This form is a “master copy” only and is not stocked in the state warehouse.

SAWS 2 – “Statement of Facts for Cash Aid, Food Stamps, and Medi-Cal” – This form is revised to reformat the County Use Section to eliminate reference to actual utility costs and replaces actual utility costs with the SUA, LUA and TUA. This form will not be revised by October 1, 2006 due to other program changes taking place at the same time FSP changes are also needed. Therefore, until the new revision is released, counties are to note in the County Use Section the utility allowance given to the household: the SUA, LUA or TUA. This form comes in “sets” and is stocked in the state warehouse.

SAWS 2A QR – “Rights, Responsibilities, and Other Important Information” – This form is being revised to replace wording which describes the election of actual utility costs. The language is replaced with a description of the SUA, LUA and TUA (Page 8 of the form). This form will not be revised by October 1, 2006 due to other program changes taking place at the same time FSP changes are also needed. Therefore, until the new revision is released, counties are to give the flyer found in Attachment D of this document along with the SAWS 2A QR. County Welfare Departments must note in the case file that the flyer was given to the new applicant. This form comes in “sets” and is stocked in the state warehouse.

Temp 2225 – “Notice to All Food Stamp Recipients” – This is the mass change informing document to be sent to all food stamp recipients in accordance with MPP 63-504.39. CWDs have the option of sending this mass change notice in lieu of sending individual Notices of