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(3) If the individual does not contact the social services official within 10 calendar days from the date of the reengagement/conciliation notice, the social services official shall make a finding of whether the alleged refusal or failure to comply was willful and without good cause. The social services district shall consider any evidence in the possession of the social services district indicating that the participant has good cause. If the individual is otherwise participating in work activities as assigned by the social services district, there shall be no finding of willfulness without good case based on a single missed appointment or infraction. If the social services district determines that the noncompliance was willful and without good cause, the individual has not reengaged in work requirements as assigned by the social services district and the individual has not documented that he/she is exempt from the assigned work requirement, the social services district shall issue a notice of denial or a 10-day notice of intent to discontinue or reduce public assistance. Such notice shall:
(i) be designed by the office; provided, however, that the social services official may submit for approval a local equivalent form which meets the requirements of this paragraph;
(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 social services district has determined, based on the information available to the social services district at the time of the review, that appropriate child care, transportation and accommodations for a disability as reasonably known to the social services district were available at the time of the failure to participate;
(iv) indicate the necessary actions that must be taken to avoid a pro rata reduction in public assistance benefits including reengaging in work requirements as assigned by the social services district or documenting that he/she has become exempt from the requirement to participate in work activities pursuant to section 385.2 of this Part; and
(v) include a statement approved by the commissioner, and in accordance with the provisions of Part 358 of this Title, indicating that the individual has the right to a fair hearing related to such denial, discontinuance or reduction.