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Handbook ------——-FORMS AND INSTRUCTIONS ——__ _-63-1230 (Cont) 63-4230 STATE FORMS & INSTRUCTIONS (Continued) 63-1230 DFA 285-A2 (12/83) Manual Information Question Section Requested EW Action 63-300.41 Cartification Determine if the household will be monthly 63-505.1

reporting or nonmonthly reporting and check

63-505.2 the box for the reporting responsibilities

63-505.3 applicable to the household,

63-505.4 :

63-505.5 Explain the household's rights and res- ponsibilities. Check that both copies of page 5 of the application contain all required signatures and dates. Give the second copy of page 5 to the household.

CALIFORNIA-DSS-MANUAL-SS Issue 643 Issued 2/15/84

(MANUAL LETTER No, 84-13) (4 3