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VIRGINIA DEPARTMENT OF SOCIAL SERVICES REQUEST FOR CONTACT

10/24 OLUME V, PART XXIV, PAGE 61

Request for Contact

FORM NUMBER - 032-03-0148

PURPOSE OF FORM - To request a household provide clarification or verification of the household's circumstances.

USE OF FORM - The BPS must complete the form to request clarification, verification, or action taken by an applying or participating household. The household must take the requested action within ten days. The BPS must follow this form with an Advance Notice of Proposed Action or Notice of Action if the agency alters the household's eligibility or benefit level in response to the Request for Contact.

This form is not intended to amend the request for information or verification needed for an application. The BPS should send a revised Checklist of Needed Verifications in this instance. This form is also not intended to be sent to clarify circumstances the household is not required to report unless the partially reported change suggests the household is ineligible for SNAP benefits. See Part XIV.A.1.

NUMBER OF COPIES - Two.

DISPOSITION OF FORM - The agency must mail the form to the household and retain a copy of the completed form.

INSTRUCTIONS FOR PREPARATION OF FORM - The BPS must complete the general case information and note the specific request for which the household is responsible for completing. The BPS must also include the deadline for the submission of the information that is ten days after the mailing date.

TRANSMITTAL #35