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FOOD STAMP HANDBOOK

Handbook _ _ FORMS AND INSTRUCTIONS __ 63-1230 (Cont.) 63-1230 STATE FORMS & INSTRUCTIONS (Continued) 63-1230 DFA 377.1 (12/83)

Diste Ol KetHot ie Deparment of Social Servers

Heath and Weitere Agency

FOOD STAMP NOTICE OF ACTION | M you Rave any questions or want more information q about this action, please contact your warker,

Case Name; Case Number : Disteiet : Worker : Phone i Date of Notica:

LT aperovat. Your application for food stamps has been approved,

Your food stamp certification covers the period from through

Your benefits have bear: computed for your certification period based onthe information You provided. Uniess thera are changes, you will receive the foliowing benefits for each manth:

‘ for through it for \ though : ‘ for through 8 for through 3 &. for througt 18 tor through, : :

© Your first alictmant inctudes more than one month’s benefits because of the date your application was approved, Q Your first-month benefits were prorated from the date you filed your application, DB Your, benefits tor ee KBVO been suspended because:

Even though you will not receive any benefits for this period, you must complete and submit your monthly report {CA 7} 80 we can determine the correct amount of your benefits for the ext month. if you do not submit & completa CA 7 as required, your food stamp participation will be terminates .

{I Because you needed food stamp benefits right away, we did not taquire you to give us the lotlowmg anformanon:

ff you do not give us this information by _. you will not receive any benefus for and your participation in the Food Stam6 Program wilt be terminated without further notice. If the information requested results ina change in your eligibility or benefits, the change will be made without an additional advance nates. 7

“iF You ALSO APPLIED FOR CASH All nd it has not yet been approved, your food Stamp benetits may be reduced ar termunaied without further notice f your cash aid is approved.

—! PENDING Your application lor lood stamps is still being processed O You have dane everything you need to do. We will continue POCESSING your Appircetion and you will hear tram us toon O You must do the following befors we can finish processing your appication:

{you do nat de this by recewe food stamp benefits

+ your application will be denied and you will have to teapply you want to

— DENIAL Your appiication for food stamps has been denied because

Df you do the lotiowing by ame YUU apphcation will be reopened

if yuu do nat take the required action by Ihe above Gale you weil Nave to saappiy if YOU WARE LO Tey ee (hot samp bene lite

© Bases on the reason your applicauon was domed, your Household 1s also divquatihed Hom paticmpaing 1 the Food Siam Program unl svtcnee YOu may tmaphiy lor benetan at the end af tha deequaldicaion nt ace

he above actiontl is required by Ihe following Food Stamp Manual Secnans)

Kel thie notes tues heoring smqumet

‘ou have the cght to te

Pee ee ees nee ‘sil sbtiiitcar Eat

Rev. 1378 replaces . CALIFORNIA-DSS-MANUAL-SS issue 2204 Effective 2/15/84

PRE mame me

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