Page 164

"FOOD STAMP HANDBOOK £3:1251 (Cont) FORMS AND INSTRUCTIONS Handbook

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

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

NA 960X (1/84) (Criteria Revised 1/30/84)

Notice of Action (CA 7 Not Received— Discontinuance) Required Form - No Substitutes Permitted, Placement -~ No Modification permitted (Manual only). - No modification permitted except those related to EDP requirements (EDP only).

Language - No modification permitted except that on the back, the address for submitting a hearing

request may be modified in counties with state hearing intake at the local level (EDP and Manual only}.

Data Elements - No modification permitted except that the two data elements concerning the timing of benefits (late or on time) may be deleted.

- No modification permitted except that (1) the two data elements concerning the timing of benefits (late or on time) may be deleted: and (2) all other data elements need not appear on one form; i.e, computer prints out only applicable message(s), but all messages are contained in the computer program (EDP only).

CALIFORNIA-DSS-MANUAL-SS Rev. 1402 replaces issue 2283 Effective 2/15/84

(MANUAL LETTER NO, 84-13) ca ok