685 Option A, C/U 71 – TCA Eligible with TMA

SYSTEM GENERATED

You do not qualify for TANF cash assistance because your income is over the income limits for TANF cash assistance. See the back of this notice for the income used to determine that you do not qualify. Because you are working at least ____ hours per week, you do qualify for transitional cash benefits of $50 twice a month for 3 months, beginning ________. You will get your last $50 benefit on ________. Beginning ______, you qualify for medical assistance in the Transitional Medical Assistance Program (TMA) program. If you receive S NAP and there is any change, you will receive a separate notice regarding those benefits. L egal Authority: 62 P.S. §§ 403(b) and 432(1); 55 Pa. Code §§ 140.401, 140.421, 141.71 and 181.1