Such notice shall:

(i) indicate that a refusal or failure to participate has occurred;

(ii) indicate the specific instance or instances of willful refusal or failure to comply without good cause with the requirements of this Title;

(iii) indicate that the individual has a right to provide reasons for such refusal or failure to participate or to avoid a pro rata reduction in public assistance benefits;

(iv) include an explanation of what constitutes good cause for non-compliance and acceptable forms of evidence that may warrant an exemption from work requirements including, but not limited to, evidence of domestic violence, and/or physical and/or mental health conditions. Such evidence may be provided at the reengagement/conciliation conference;

(v) indicate that the individual’s case was reviewed before sending the notice required pursuant to this section and that the social services district has determined, based on the information available at the time of the review, that appropriate child care, transportation and accommodations for a disability as reasonably known to the social services district to have been appropriate to the individual were available at the time of the refusal or failure to participate;

(vi) include the necessary actions that must be taken to avoid a pro rata reduction in public assistance benefits, including reengaging in work activities as assigned by the social services district for a minimum of 5 business days but no more than 10 business days. An individual may also avoid a pro rata reduction in public assistance benefits by documenting an exemption pursuant to section 385.2 of this Part; and

(vii) indicate that the individual shall have 10 calendar days from the date of the reengagement/conciliation notice to request reengagement/conciliation.