Page 40

FOOD STAMP HANDBOOK FORMS AND INSTRUCTIONS ——__ Handbook

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

DFA 285-A2 (12/83)

Manual Information Question Section Requested EW Action 5, 63-408 Voluntary If checked yes, determine if action meets Quit criteria for voluntary quit. Check applicable box in county-use section. if yes, deny the application and disqualify the household for two months beginning with the month of application, 8. 63-402.8 Food lf checked yes, verify that participation Distribution in the Food Distribution Program has Program been terminated. Note: No household shall be allowed +o participate simultaneously in the Food Stamp Program and a Food Distribution Program operated by an Indian reservation. 7. 63-501.6 Transfer of Check circumstances of any resource Resources transter to determine if program eligibility is affected. If yes, deny application and disqualify the household for the appropriate number of months. 8. 63-102(i) Disabled lf checked yes, determine if individual 63-409.112 Veterans/ meets definition of “disabled” person and 63-502.3 Spouses/ document that a DFA 285-C was given 63-503,3 Chiidren to the household, Allow excess shelter costs and medical deductions, and use the net income eligibility test for any house- hold with such a member, 3. 63-300.531 Purchase or If checked yes, determine if individual 63-402.27 Prepare should be excluded from the household. Separately Document accordingly in cournty-use

CALIFORNIA-DSS-MANUAL-SS

section.

Effective 2/15/84

(MANUAL LETTER No. a4-1a) [A