Page 163

FOOD STAMP HANDBOOK

Handbook FORMS AND INSTRUCTIONS _ 63-1251 (Cont.)

63-1251 FORM MODIFICATION POLICY — APPENDICES (Continued) 63-1251 .3 Appendix 3 — Form-Specific Modification Criteria (Continued) (DFA 386 (8/80) Repealed by Manual Letter No. 84-13, 2/15/84) DFA 842 (6/81) Claim Determination Worksheet Required Form - Substitutes Permitted Placement - Modification permitted to accommodate data element revisions. Language - Madification permitted. Data Elements - The following data elements may not be deleted from the form: Items 1, 2, 3. 8, 9, 10, 12, 13, 15, 16, all signatures, and Review by County Review Officer

section. Items 11 and 14 may not be deleted except for Issuance Verification section as long as verification of issuance is documented elsewhere.

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Page 163

Official source

FOOD STAMP HANDBOOK

Handbook FORMS AND INSTRUCTIONS _ 63-1251 (Cont.)

63-1251 FORM MODIFICATION POLICY — APPENDICES (Continued) 63-1251 .3 Appendix 3 — Form-Specific Modification Criteria (Continued) (DFA 386 (8/80) Repealed by Manual Letter No. 84-13, 2/15/84) DFA 842 (6/81) Claim Determination Worksheet Required Form - Substitutes Permitted Placement - Modification permitted to accommodate data element revisions. Language - Madification permitted. Data Elements - The following data elements may not be deleted from the form: Items 1, 2, 3. 8, 9, 10, 12, 13, 15, 16, all signatures, and Review by County Review Officer

section. Items 11 and 14 may not be deleted except for Issuance Verification section as long as verification of issuance is documented elsewhere.