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FOOD STAMP HANDBOOK Handbook ____FORMS AND INSTRUCTIONS 63-1230 (Cont,) |

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

NA 96OY (1/84) (Instructions Revised 4/6/84)

Form Instructions (for the Eligibility Worker}

NOTICE OF ACTION (CA 7 INCOMPLETE--DISCONTINUANCE/REMINDER)

Purpose:

The NA S60Y 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 NA 960Y is also used to request missing

verification or additional information from a food stamp household when the CA 7 is also incomplete.

The back of the NA 960Y 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.

NOTE: When a CA 7 submitted by a food stamp household is complete, but is missing other

verification/information, the DFA 377.4, Food Stamp Notice of Change, must be used instead of the NA 960Y.

Preparation:

The NA 960Y 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 960Y entering the following identifying information:

- Recipient's name and mailing address - Case Name

- Case Number

- Worker

- Phone Number

- Date of Notice

Complete the discontinuance portion of the notice as follows:

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

Check the appropriate box for the action the recipient must take to reverse the discontinuance.

ff applicable, specify in the space provided the information and/or verification which must be provided.

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

Additional Information Requested (Food Stamps Only). Check this box when an incomplete CA 7 is missing verification/information of a deduction and/or contains questionable information

for the Food Stamp Program. Specify in the space provided the additional verification and/or information which is required.

CALIFORNIA-DSS-MANUAL-SS Issue 652g

issued 2/15/84