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NOTICE TO APPLICANTS

TANF and/or Medicaid/DC Healthy Families Applicants

You have a right to have your application resolved by DHS within Forty-Five (45) days. This means: • We will send to you your notice of eligibility or your notice of ineligibility no later than Forty-Five (45) days from the day after your application was received. In Medicaid cases where a disability is claimed and a medical review is required, you will receive your notice within Ninety (90) days. • If you are found eligible for TANF and/or Medicaid and wish to question the amount of your payment or your Medicaid coverage, you may contact your worker or request a Fair Hearing. • If you have not received your eligibility notice or your notice of ineligibility within Forty-Five (45) days (or Ninety (90) days in Medicaid cases requiring a medical review) from the day after your application was received, you have a right to request a Fair Hearing. Please see “All Applicants” section on the reverse side of this form for more information.

Food Stamps Applicants

You have a right to have your application resolved by DHS within Thirty (30) days. This means: • If you are eligible for Expedited Food Stamps, you will receive them within Seven (7) days after we receive your application. Expedited Food Stamps are available to you if (a) you have $100 or less in available resources and less than $150 in gross monthly income; (b) your monthly income and resources are less than your shelter costs; or (c) you are a migrant or seasonal farm worker. • We will send to you your notice of eligibility or your notice of ineligibility no later than Thirty (30) days from the day after your application was received. • If you are found eligible for Food Stamps and wish to question the amount of your benefit, you may contact your worker or request a Fair Hearing. • If you have not received either your eligibility notice or your notice of ineligibility within Thirty (30) days from the day after your application was received, you have a right to request a Fair Hearing. Please see “All Applicants” section on the reverse side of this form for more information.

Interim Disability Assistance Applicants

You have a right to have your application resolved by DHS within Sixty (60) days. This means: • We will send to you your notice of eligibility or your notice of ineligibility no later than Sixty (60) days from the day after your application was received. • If you are found eligible for Interim Disability Assistance and wish to question the amount of your benefit, you may contact your worker or request a Fair Hearing. • If you have not received your eligibility notice or your notice of ineligibility within Sixty (60) days from the day after your application was received, you have a right to request a Fair Hearing. Please see “All Applicants” section on the reverse side of this form for more information.

DHS Form 1400 (12/83) (OVER) Rev (1/03) Distribution: Original to Customer, Copy to Case Record Income Maintenance Administration Department of Human Services Government of the District of Columbia