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Commonwealth of Virginia Department of Social Services ADMINISTRATIVE DISQUALIFICATION HEARING DECISION

Name and Address

Case Name

Case Number

Locality

Based on evidence presented at the Administrative Disqualification Hearing held on ________________, it has been determined that you:

DID NOT COMMIT an intentional violation of a Child Care Subsidy, Supplemental Nutrition Assistance Program (SNAP), or Temporary Assistance for Needy Families (TANF) rule.

DID COMMIT an intentional violation of a Child Care Subsidy, SNAP, or TANF rule.

If you did commit an intentional program violation, the local department of social services will disqualify you from receiving benefits for the time shown below:

Child Care Subsidy 3 months, 1st violation 12 months, 2nd violation permanently, 3rd violation

SNAP ____ months, 1st violation _____ months, 2nd violation _____ permanently, 3rd violation ____ Other (Specify)

TANF 6 months, 1st violation 12 months, 2nd violation permanently, 3rd violation

If you are not receiving TANF benefits now, the disqualification period will be postponed until you apply for TANF benefits and are found eligible again.

The local department of social services is responsible for notifying you of the date the disqualification will take effect. Also, the local department of social services is responsible for notifying you of the effect the disqualification will have on the benefits to be received by any remaining household members.

This hearing decision does not prevent the local agency, State or Federal government from asking you to pay back the amount of any extra Child Care Subsidy, SNAP, or TANF benefits your household was not eligible to receive. The local department of social services is responsible for sending you a letter requesting repayment.

If you are not satisfied with the hearing decision, you can ask for a review of this decision by the Commissioner, Virginia Department of Social Services by sending a written request within 10 days of receipt of this notice to:

Virginia Department of Social Services

Hearings and Legal Services Manager

5600 Cox Road

Glen Allen, VA 23260

Hearing Officer

Date

032-03-0723-11-eng (09/2024)