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Handbook
UCTIONS 83-1230 (Cont)
63-1230 STATE FORMS & INSTRUCTIONS (Continued) 63-1230
NA 960X (1/84)
State of California
Departmant of Sacial Services Health and Weitara Agency
Notice of Action
if you have questions or want more information Case Name about this action, please contact your worker. Case Number Worker . * Phone
Date of Notica :
We have not received your monthly report (CA 7} due this month.
Your Oo Food Stamps oO Cash Aid will stop effective
. To stap this action, provide your complete CA 7 so that we recaive it by the first working day of next month.
oO if we get your complete CA 7 by , we will send you your benefits on time.
oO Even if you stop this action by getting your CA 7 in, your benefits will be up to 10 days late next month.
Penalty For Families With Earned Income (Cash Aid Oniy}. Even if you stop this action by getting your CA 7 in, you will not get credit for your work expense disregards because you failed to report or verify al! earned income on time. Work expense disregards ara the standard work expense, dependent care expanse, and the §30 and 1/3 earnings disregards. If you had & good reason for being fate, this penalty will not be applied. You must tell your worker the reason.
Medi-Cal. {f your Medi-Cal aligibility changes, we will tell you before we make the change.
Reguiations. This action is required by the folowing State regulations which are available for your review at the County Welfare Department. Manual of Policies and Procedures: 40-108.1, 40-181.22, 44-119.2 (Cash Aidh 63-504.27, 63-504.3 (Food Stamps).
Chiid Support. The District Attorney's Office can halp you locate an absent parent, legally establish your child's paternity. and collect child support. To obtain or continue these services, you must ask the District Attorney's Office.
Family Planning Services. information is available fram the County Welfare Department on request,
State Hearing. If you are dissatisfied with this action, your benatits may continue unchanged if you ask fara State Hearing befora the effective date of this action. Read the back for important information about your right to appeal this action,
NA 960X {1-84} CA 7 Not Received: Discontinuance
CALIFORNIA-DSS-MANUAL-SS Issue 652b Issued 2/15/84