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Handbook FORMS AND INSTRUCTIONS 63-1253 {Cont.)

63-1251 FORM MODIFICATION POLICY — APPENDICES (Continued) 63-1251

3 Appendix 3 — Form-Specific Modification Criteria (Continued)

DFA 285-D (12/83) Food Stamp Budget Worksheet — Special Medical/Sheiter Deductions

Required Form - Substitutes Permitted

Placement - The order of the sections in Parts 1, 2 and 3 may not be modified though the data

entry elements within the sections may be modified as jong as the result of the computation is correct (Manual only).

+ The order of the sections in Parts 1, 2 and 3 and their data entry elements may be

modified due to EDP requirements as long as the result of the computation is correct (EDP only).

Language - Regulatory language in Parts 1, 2 and 3 may not be modified although additions will be considered (EDP and Manual).

Data Elements - The foliowing data elements may not be deleted from the form: case name, case number, classifications, all data elements in Parts 1, 2 and 3, first- month budget column, documentation column, EW initials and date, and all data elements in Sections K and L of Part 5 (Manual only).

- The following data elements may not be deleted from the system; case name, case number, and all data elements in Parts 1, 2, and 5 (EDP only)

- All other data elements may be modified if documented elsewhere in the case record/system (EDP and Manual).

CALIFORNIA-DSS-MANUAL-SS Rev. 1396 replaces Issue 2271 Effective 2/15/84