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FOOD STAMP HANDBOOK _ ____.FORMS AND INSTRUCTIONS 63-1230 (Cont.}

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

Handbook

DFA 377.1 (12/83} Form Instructions {for the Eligibility Worker)

FOOD STAMP NOTICE OF ACTION

Purpose:

The DFA 377.1 is used by the Eligibility Worker to notify a household of the approval, pending or denial status of its food stamp application.

The back of the DFA 377.1 explains the household’s right to request a hearing and provides instructions on how to appeal the action.

Preparation:

Complete an original and two copies of the DFA 377.1 entering the following identifying information:

- Head of household’s name and mailing address - Case Name

~ Case Number

- District (if applicable)

~ Worker

- Phone Number

- Date of Notice

Complete the action portion of the notice by checking the heading box for the Approval, Pending or Denial Sections and entering all other required information.

NOTE: If the date by which the household must take some action falls on a weekend or holiday, enter the date for the business day immediately following the weekend or holiday.

Approval

Check the Approval box when an_ initial application or application for recertification has been approved. Enter the beginning and ending dates of the household's certification period, the

amount of the allotment, the amount and dates of any known changes in the allotment, and any of the following, as applicable. ‘

- if the first allotment contains more than one month’s benefits (prorated first-month benefits and second-month benefits issued in the second month), check the box for this message.

- lf the first-month benefits were prorated, check the proration box,

- lf the household's first-month benefits are suspended, check the suspension box. Enter the month for which benefits have been suspended and enter the reason for the suspension.

Rev. 1380 replaces F CALIFORNIA-DSS-MANUAL-SS Issue 2208 Effective: 2/15/84

(MANUAL LETTER NO eect, fp 7D