Page 80

83-1230 (Cont)

FOOD STAMP HANDBOOK FORMS AND INSTRUCTIONS _ Handbook

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

DFA 377.2 (12/83)

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.

Complete the action Portion of the form by checking the appropriate box(es) and entering other required information in each of the three sections as follows:

1. Enter the expiration date of the current certification period.

- Check the first box if a PA household's recertification is not completed along with the PA redetermination in the month prior to the last month of certification,

- Check the second box if the certification period has been shortened because of a change in circumstances and enter an explanation, ,

2. Check the applicable box as indicated below and enter the required information.

+ Check the first box for NA monthly reporting households and PA monthly reporting households whose certification periods are not aligned with a PA redetermination.

Enter the eleventh day of the last month of the household's certification period,

- Check the second box for PA monthly reporting households whose application for recerti- fication is pending.

Enter the eleventh day of the last month of the household's certification period.

- Check the third box for nonmonthly reporting households. Enter the fifteenth day of the last month of the household's certification period unless it is a short certification (certification period expires the same month the application is approved). If it is a short certification period, enter the date which is 15 days after the date the household will receive the notice.

3. Check the applicable box and enter the required information.

~ Check the first box if an interview has been scheduled for the household. Enter the date, time and location of the interview. If the interview for a monthly reporting household is scheduled before the eleventh of the last month of the certification period, check the small box in this section.

- Check the second box if the household must call for an interview appointment. Enter the name and number of the person the household must call for an interview appointment.

Rev. 1386 replaces : CALIFORNIA-DSS-MANUAL-SS Issue 2211 _ Effective 2/1 5/84