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FOOD STAMP HANDBOOK §3-1230 (Cont), FORMS AND INSTRUCTIONS Handbook

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

DFA 377.9 (3/81) |

- The balance of the unpaid claim, if any, or zero if the entire amount of the unpaid claim was offset.

Signature Block

Enter Eligibility Worker's name, telephone number and date.

Distribution:

The original and one copy are mailed to the household. The second copy is filed in the case record.

' Rev. 1391(1) replaces . CALIFORNIA-DSS-MANUAL-SS issue 2235 Effective 2/15/84

(MANUAL LETTER NO. 84-13) nA