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ESS STAMP HANDBOOK Handbook ________________FORMS AND INSTRUCTIONS 83-1230 (Cont,}

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

DFA 377.2 (12/83)

mine FOOD STAMP NOTICE OF EXPIRATION OF CERTIFICATION

i you have any questions of want more information about this action, please contact your worker.

Case Name

Case Number

District

Worker

Phone : . Date of Notice :

1, Your current food stamp certification period will end on:

Your application lor recertilrcation is being processed.

Your certification period has been shortened becau:

se the following change(s} in circumstances may afiect your food stamp eligibility of benefits:

2. NM you want to continue receiving food stamps after the end of your current certification period, without 8 bresk in benefits. you must

Submit your complete monthly report (CA 7} $0 tt Is received by no later than . fil out the attached application and submit it to the county weltare department by no later than your recertification imerview (see 3 below},

A Submit your complaie monthly report (CA 7} 80'lt is recaived by no later then poe Fill out and submit an application so it is received by the county welfare department by no later than

3. To be sure your application for recertification is processed promptly, you must:

i} Appear for an interview on: at

You may bring your complete monthly repart te your recertification interview H you wish,

Call tor an interview appointment,

Mail/bring your application ta:

Cati for an application.

Do the following so we can finish processing your application:

iF YOU REAPPLY LATER THAN THE DATE SPECIFIED IN NO, 2 ABOVE, YOU MAY HAVE TO WAIT UF TO 30 DAYS BEFORE FINAL ACTION IS TAKEN ON YOUR APPLICATION. IN ADDITION, YOUR SENEFITS MAY BE PRORATED FOR THE FIRST MONTH OF YOUR NEW CEATIFICATION PERIOD, O If you have a good reason for not applying on time, you should teil the county welfare department. You may be entitied to hava any iost benefits restored if the county wellara depariment decides you had e pood tessan. IF YOU MISS YOUR SCHEDULED INTERVIEW AND YOU HAVE A GOOD REASON, YOU SHOULD TELL THE COUNTY WELFARE

DEPARTMENT. if THE COUNTY WELFARE DEPARTMENT DECIDES THAT CIRCUMSTANCES BEYOND YOUR CONTROL PREVENTLD YOU FROM ATTENDING THE INTERVIEW, A SECOND INTERVIEW WILL BE SCHEDULED, .

You have the right to request an application from the county waltare department at any tims and to have the county welfare deparnment eccept your application. If you and/or your authorized representative are unable to reapply in parson at the county wellera department and you have a good reason for nat being able to do #0, you should call the county waltace department at the above number, We can arrenge ta have # worker interview you or your authorirad representative at home or by lelephons

The above action uw required by the faliowing Food Stamp Manual Sections}:

You have the right to requent

® stele hearing if you ditagrae with any of thesa requirements. See ihe bach of this notice fora hearing request.

aoe

DFA QT? 2 (12/83 Aequied form No Substitutes Permitted

Rev. 1383 replaces , CALIFORNIA-DSS-MANUAL-SS __[ssue 2208 Effective 2/15/84

TRAARST TAY 1 Moores ares ma an) of