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

DFA 285-C (11/83)

Question Manual information No. Section Requested EW Action 2 63-502.33 4. Identify which items of expense are insured, (Cont.) uninsured, and which items (if any} are hospital bills, and document in the county-use section. Determine the applicable amount for each deduc- tion.

63-503.25 5. Determine which items of expense are recurring, one-month-only, or should be averaged over the certification period.

Certification Check that the application contains all required signatures. CALIFORNIA-DSS-MANUAL-SS Issue 644 Issued 2/15/8

(MANUAL LETTER NO. 84-13) [5571