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Handbook

~““"EOOD STAMP HANDBOOK

63-1230 (Cont.)

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

DFA 285-A2 (12/83)

Form Instructions (For the Eligibility Worker}

APPLICATION FOR FOOD STAMPS — PART 2

Purpose:

The DFA 285-A2 is Part 2 of the food stamp application form completed by all households when first applying for food stamps and at recertification.

Part 2 is used to gather information to determine the household's eligibility for food stamps. The application also contains information for the household concerning hearing rights, reporting

responsibilities, and a notice of penalty for the fraudulent receipt or use of coupons or for knowingly providing incorrect information.

Preparation: Manual Information

Question Section Requested EW Action

County 63-300.5 N/A Complete requested information. Date

Use Only 63-402.1 received is the date Part 2 is received. 63-402.2 Check box if application is new or 63-407

recertification, and check appropriate box if application is for expedited service.

‘ Follow applicable verification requirements

SS

CALIFORNIA-DSS-MANUAL-

Rev. 1352 replaces

issue.2174

for the type of application.

The county-use section of Item 3 is to be used as a summary of household composition completed at the end of the interview. in the space provided, enter the appropriate code or date for all persons listed in 3. For all household members exempted from work registration, enter the work exemption code. For all other house- hold members, note the date that each member registers for work. For persons excluded from the household, enter the non- household member code (reason for exclusions). Enter number of persons to be included in the household in the space provided.