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VIRGINIA DEPARTMENT

OF SOCIAL SERVICES ENERGY ASSISTANCE

06/11 VOLUME IX, CHAPTER D, APPENDIX E, PAGE 1

CLIENT NOTICE OF ACTION

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COMMONWEALTH OF VIRGINIA ENERGY ASSISTANCE PROGRAM

DATE: WORKER # PHONE #: CASE #: CITY/COUNTY

CLIENT NOTICE OF ACTION YOU HAVE BEEN APPROVED FOR $ IN FUEL ASSISTANCE BENEFITS. A CREDIT AUTHORIZATION WILL BE SENT TO:

AUTHORIZING PAYMENT BY FUEL ASSISTANCE UP TO THE MAXIMUM AMOUNT FOR HEATING EXPENSES PROVIDED TO YOUR HOUSEHOLD BY MARCH 31ST. YOU WILL BE RESPONSIBLE FOR PAYING ANY AMOUNT NOT PAID BY FUEL ASSISTANCE TO YOUR VENDOR. ANY MONIES NOT PAID TO YOUR VENDOR WILL REVERT TO THE STATE. YOU ARE NOT ELIGIBLE TO RECEIVE ANY ADDITIONAL FUEL ASSISTANCE BENEFITS THIS YEAR. KEEP COPIES OF ALL FUEL BILLS AND ATTACH THEM TO NEXT YEARS FUEL APPLICATION.

IF YOU DO NOT AGREE WITH THE ACTION TAKEN ON YOUR APPLICATION OR CASE, YOU MAY REQUEST AN AGENCY CONFERENCE OR A HEARING. CALL YOUR WORKER AT THE PHONE NUMBER ON THE TOP OF THIS NOTICE FOR A CONFERENCE. IF YOU WOULD LIKE A HEARING, WRITE TO THE ADDRESS BELOW WITHIN 30 DAYS OF THE WRITTEN NOTICE OF ACTION TAKEN ON YOUR APPLICATION OR CASE.

MAIL TO: HEARING AND LEGAL SERVICES MANAGER VIRGINIA DEPARTMENT OF SOCIAL SERVICES 801 EAST MAIN STREET RICHMOND, VA. 23219-2901

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