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FOOD STAMP HANDBOOK
Handbook _____FORMS AND INSTRUCTIONS 63-1230 (Cont.) 63-1230 STATE FORMS & INSTRUCTIONS (Continued) 63-1230
NA 960Y (1784)
State of Calitornie Depertment of Social Services Heaith and Welfara Agency
Notice of Action
‘ if you have questions or want more information Case Name about this action, please contact your worker. Case Number Worker i . . Phone :
Date of Notice :
The monthly report (CA 7) you sent us this month is not complete.
Your | Food Stamps oO Cash Aid will stop effective . To stop this action, provide your compiete CA 7 so that we receive it by the first working day of next month. You must:
im Complete the circled itams an the enclosed CA 7, and send or bring it to this office.
O Send or bring to this office the following information:
im if we get your compiete CA 7 by
, wa will send you your benefits on time.
Oo Even if you stop this action by getting yous CA 7 in, your benefits will be up to 10 days late next month.
a) Additional Information Requested (Food Stamps Only}. in addition ta doing the above, you must give us the following information so that we can figure out the amount of your food stamps. You must get this information to us by the first working day of next month. If we ask for proof of an expense and you do nat give it, the expense will not be allowed. Aiso, 1 you do not give other information we ask for, your food stamps may be decreased or stopped.
oO Penalty (Cash Aid Only), Even if you stop this action by getting your CA 7 in, you will not get credit for your work expanse disregards because you failed to report or verify all earned income on time. Work expense disregards are the standard work expense, dependent care expansa, and the $30 and 1/3 earnings disregards. If you had a good reason tor being late, this panaity will not be applied. You must tell your worker the reason.
Medi-Cal. if your Medi-Cal eligibility changes, we will tell you before we make the change.
Regulations. This action is required by the following State regulations which are available for your raview at the County Welfare Department. Manual of Policies and Procedures: 40-106.1, 40-181.22, 40-181.24, 44-113.2 (Cash Aid}: 63-804.27, 63-504.3 (Food Stamps}.
Chitd Support. The District Attorney's Office can help you locate an absent parent, legally establish your child’s paternity, and callect child support. To obtain or continue these services, you must ask the District Attorney's Office.
Family Planning Services. Information is available from the County Weltare Department on request.
State Hearing. } you are dissatisfied with this action, your benefits may continue unchanged if you ask fora State Haaring before the effective date of this action. Read the back for important information about your right to appeal this action,
NA 960 (1/84) CA 7 Incomplete--Discontinuance Reminder
CALIFORNIA-DSS-MANUAL-SS issue 652e Issued 2/15/84