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FOOD STAMP HANDBOOK Handbook FORMS AND INSTRUCTIONS 83-1230 (Cont)

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

‘ NA 960X (1784) (Instructions Revised 4/13/84)

Form Instructions (for the Eligibility Worker)

NOTICE OF ACTION (CA 7 NOT RECEIVED--DISCONTINUANCE)

Purpose:

The NA 960X is used by the Eligibility Worker to notify a recipient of the discontinuance of Food Stamps and/or Cash Aid because of a late CA 7.

The back of the NA 960X explains the household’s right to request a state hearing and provides instructions on how to appeal the action. The back also provides information needed by the household to receive continued benefits pending a hearing if benefits are decreased or discontinued.

Preparation:

The NA 960X must be mailed or given to the recipient no later than ten days before the end of the current month.

Complete an original and two copies of the NA 960X entering the following identifying information:

- Recipient’s name and mailing address - Case Name

- Case Number

- Worker

- Phone Number

- Date of Notice

Check the appropriate box(es) for Food Stamps and/or Cash Aid and enter the effective date of the discontinuance.

Benefits On Time/Benefits 10 Days Late - DO NOT USE THESE BOXES. Either leave the check-boxes blank or cross out both statements.

Distribution:

The original and one copy are provided to the recipient. The second copy is filed in the case record.

CALIFORNIA-DSS-MANUAL-SS Issue 652d Issued 2/15/84