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FOOD STAMP HANDBOOK

83-1230 (Cont) _ FORMS AND INSTRUCTIONS __ Handbook

63-1230 STATE FORMS & INSTRUCTIONS (Continued) 63-1230

DFA 377.7B (3/84)

Extra Food Stamps Were Issued

Complete this section unless the notice is Sent because the individual did not repay as agreed. Check the appropriate box for the individual against whom collection action is initiated.

- Check the first box for all collection actions, except those initiated against the sponsor of an alien household.

~ Check the second box when collection action is initiated against the sponsor of an alien house- hold. Enter the sponsored alien’s name.

in the space provided, explain the reason for the overissuance. This is What You Owe

Enter the following information for all cases:

- The amount of food stamps overissued,

- The period of time food stamps were overissued.

- The amount of lost benefits not restored and/or payments received used to offset the amount of food stamps to be repaid.

- The amount that the individual now owes,

This is What You Must.Do

- Check the first box if this is the first time the DFA 377.7B is being sent to the individual. Attach a Food Stamp Repayment Agreement. In addition, check the first box if the DFA 377,7B has pre- viously been sent for an administrative error or to a household not currently participating in the

Program, but the individual did not sign and return a Food Stamp Repayment Agreement. Attach a Food Stamp Repayment Agreement,

- Check the second box when the claim was established for an inadvertent household error or an intentional program violation, and the househoid is currently participating in the Program (the first box must also be checked.) Enter the amount the household's allotment will be reduced to if allotment reduction is invoked, and enter the effective date of the reduction.

You Did Not Repay As Agreed - Check the first box if the individual has failed to make repayment as agreed,

- Check the second box if the CWD will reduce a participating household's allotment because the individual failed to repay as agreed a claim based on an inadvertent household error or an intentional program violation (the first box must also be checked), Enter the amount the house- hold’s allotment will be reduced to, and enter the effective date of the reduction.

Revs. 1390j & k replace . CALMORNAOSSMaNUALSS FAS legua 2206 Eectve 2/18/84

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