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Handbook FORMS AND INSTRUCTIONS __63-1230 (Cont)

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

DFA 377.2 (12/83)

Form Instructions (for the Eligibility Worker)

FOOD STAMP NOTICE OF EXPIRATION OF CERTIFICATION

Purpose:

The DFA 377.2 is used by the Eligibility Worker to notify a food stamp household of the following information concerning its certification period:

- the regular expiration of a nonassistance (NA) household's certification period; or,

- the regular expiration of a public assistance (PA) household's certification period when recerti-

fication was not completed with the PA redetermination in the month prior to the last month of certification; or,

- the shortening of an NA or PA household's certification period; and,

~ the requirements for recertification,

The back of the DFA 377.2 explains the household's right to request a hearing and provides instructions on how to appeal the action.

Preparation:

1. For the expiration of a regular certification period, the DFA 377.2 must be completed so it is received by the household not earlier than 15 days prior to, nor later than the first day of, the last month of certification, except as noted in No. 3 below.

2. For the expiration of a shortened certification period, the DFA 377.2 must be completed so it is received by the household no jater than the first day of the last month of certification.

3. For a household assigned a certification period which ends in the same month the application is approved, the DFA 377.2 must be completed at certification and provided to the household with the notice of approval (DFA 377.1).

Complete an original and two copies of the DFA 377.2 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

Rev. 1385 replaces . CALIFORNIA-DSS-MANUAL-SS Issue 2210 Effective 2/18/84