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COMMONWEALTH OF VIRGINIA DEPARTMENT OF SOCIAL SERVICES SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) NOTICE OF ACTION AND EXPIRATION

This is to inform you of action taken on your SNAP application

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CASE NUMBER

DATE

COUNTY/CITY

SECTION 1. ACTION ON APPLICATION DATED _______________________________________________

Approved for following months ________________________________

Amount first month $_______ Months covered___________________________ Amount for following months $_________

You selected _______________________________as Head of Household. If all adult members do not agree, contact me within 10 days.

YOU MUST REPORT IF YOUR HOUSEHOLD'S INCOME GOES OVER THE LIMIT OF $_______. If necessary, you may call collect.

If you do not agree with the action we have taken or the amount of SNAP benefits you are receiving, 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. You may also request a fair hearing by calling toll free 1-800-552-3431. You must request your fair hearing within the next 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 received during the appeal process if the hearing decision supports the agency action. For additional information about appeals and fair hearings, please see the back of this notice.

SECTION 2. ACTION REQUIRED TO RECEIVE UNINTERUPTED BENEFITS

Your SNAP certification period will end on ______________________________________________________________

Your eligibility for SNAP benefits is expiring. For uninterrupted benefits, you must file a new application by ________________________________ have an interview, and be found eligible based on the information you give. If you do not file an application by this date, there may be an interruption in your benefits.

We can only start the renewal process once you file an application. You or your authorized representative may file an application that has at least your name, address, and your signature. • In person at the address shown above or below; • by mail, fax, by e-mail; or

 Please use only one method to renew. • online at https://commonhelp.virginia.gov/access/.

 in the office You must have an interview. We have scheduled an appointment for an interview on

 by telephone _________________________ at _________________________ a.m./p.m. If this interview appointment is not convenient, please let us know immediately. If you miss this interview appointment, it will be your responsibility to reschedule it.

In addition to the application and interview, you must give us proof of your income, expenses, or other information to help us make a decision on your application. Please have your information available when you file the application or have your interview.

If a telephone interview is scheduled, you must: • complete the enclosed application form; • return the completed application by _________________________ to the address above or below; • provide a telephone number where you can be reached during the scheduled time.

If everyone in your house receives Supplemental Security Income (SSI) or plan to apply for SSI, you may renew your eligibility for SNAP benefits at the Social Security Administration (SSA) office instead of filing you application at the local social services department. The Social Security office must also receive your application by the date indicated above.

Benefit Program Specialist

Telephone Number For Free Legal Advice Call

1-866-534-5243

032-03-0460-05 (09/2024)