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FOOD STAMP HANDBOOK 83-1251 (Continued) FORMS AND INSTRUCTIONS Handbook

63-1251 FORM MODIFICATION POLICY — APPENDICES (Continued) 63-1251 3) Appendix 3 — Form-Specific Modification Criteria (Continued)

DFA 377.9 (3/81) Notice of Restoration of Lost Food Stamp Benefits and Right to Request a State Hearing Required Form - Substitutes Permitted Placement - No modification permitted (Manual only). - No modification permitted except those related to EDP requirements (EDP only).

Language - No modification permitted except (1) to accommodate county procedures for handling restorations; i.e, contact for questions or requests for installments; (2) on the back, the address for submitting a hearing request may be modified in counties with state hearing intake at the iocal fevel; and, {3) the reference on the back to 10 days to request aid paid pending may be modified to meet the requirements of Ortiz vs. Woods and Harley vs. Woods (Manual only).

- No modification permitted except (1) to accommodate county procedures for handling restorations; i.e., contact for questions or requests for instailments; (2) on the back, the address for submitting a hearing request may be modified in counties with state hearing intake at the local level; (3) wording may be modified to accommodate a high frequency payment system, and, (4) the reference on the back to 10

days to request aid Paid. pending may be modified to meet the requirements of Ortiz vs. Woods and Harley vs. Woods {EDP only),

Data Elements - No modification permitted except to accommodate County procedures for handling restorations (Manual only).

- No modification permitted except (1) to accommodate county procedures for handling restorations; and, (2) all data elements need not be on one form; i.e., computer prints out oniy applicable message(s) but all messages are contained in computer Program (EDP only).

Rev. 1400d replaces . cee ESS MANUALSS Issue 2281 Effective 2/15/84

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