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204 income that would cause the total amount to exceed the maximum monthly income level allowed for a family of its size in the locality where the child care services have been requested. This form is available in VaCMS and generated 45 days prior to the end of the quarterly update month. The form is centrally printed and sent to the applicant. The form must be completed and signed by the applicant and returned to the LDSS prior to the end of the update month.

Appendix M. Child Care Subsidy Program Notice of Action Form Instructions

NUMBER 032-12-0128-01-eng (07/18)

PURPOSE OF FORM The purpose of this form is to inform applicants or recipients of child care subsidy and services of the action and the date of the action to be taken on their child care case.

USE OF FORM To give the applicant/recipient of child care subsidy a ten-day notice before an action is taken. More than one action may be indicated on a single NOA. This form is generated from the VaCMS to be printed by the worker and sent to the applicant. The Correspondence ID # of the form and the mailing date must be recorded in the case narrative, if printed locally, to verify the form was mailed to the applicant/recipient.

COPIES One copy will be stored in the VaCMS, and one copy must be mailed to the applicant/recipient.

INSTRUCTIONS FOR PREPARING THE FORM A NOA completed in and generated from the VACMS must be sent 10 days in advance of the action when a case action affecting eligibility, copayment or the amount of services authorized is taken. A copy of the applicant’s NOA must never be sent to a Provider.

Information will be preprinted on the form that is generated from the VaCMS.

The back of the form provides information on the fair hearings and appeal process.

Appendix N. Child Care Notice of Redetermination Form Instructions

FORM NUMBER 032-12-0131-00-eng (08/17)