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Commonwealth Of Virginia Department Of Social Services Supplemental Nutrition Assistance Program (SNAP)
SNAP Sanction Notice for Non-Compliance with a Work Requirement
Case Number
Locality
BPS
Date
Name: ______________________________________________
Voluntarily quit a job without good cause.
Voluntarily reduced work hours to less than 30 hours per week without good cause.
The following sanction will be applied in your SNAP case as a result of the action:
The person named above is disqualified and will not be eligible to receive SNAP benefits for the months of _________________.
Your household’s SNAP benefit of $_________________ will be changed to $_________________ effective_________________.
Your entire household will not be eligible to receive SNAP benefits for the months of ________________.
The sanction indicated above may be lifted before the end of the sanction period if your household is otherwise eligible and the person named above leaves the household or becomes exempt from the requirement to register for work.
If you do not agree with the proposed action, you may write or call me at the address and phone number below and ask for a conference or, you may have a fair hearing on your case. At the hearing, you will have a chance to explain why you think we made a mistake, and a hearing officer will decide if you are right. To request a fair hearing, call or write me, or write:
Virginia Department of Social Services
5600 Cox Road
Glen Allen, VA 23060
Attention: Hearing and Legal Services Manager
You may also request a fair hearing by calling toll free 1-800-552-3431. Please see the back of this form for additional information about the appeals process.
You must request your fair hearing within 90 days. If you appeal the action on your case before _________________ assistance may continue. However, if assistance is continued, you may have to repay benefits you receive during the appeal process if the hearing decision supports the agency action.
Benefit Program Specialist:
Agency Address
Agency Telephone
For free legal advice call: 1-866-534-5243
032-03-0174-09-eng (09.2024)