Form Cf 377.7b Calfresh Overissuance Notice For Inadvertent Household Errors (Ihe) Only
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1
2STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
COUNTY OF
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CALFRESH OVERISSUANCE NOTICE
FOR INADVERTENT HOUSEHOLD
Notice Date
:
ERRORS (IHE) ONLY
Case
Name
:
Number
:
Worker
Name
:
Number
:
Telephone
:
Address
:
(ADDRESSEE)
Questions? Ask your Worker.
State Hearing: If you think this action
is wrong, you can ask for a hearing
unless you already had a hearing on
the amount you owe. The back of
this page tells how. Your benefits
may not be changed if you ask for a
hearing before this action takes
place.
Too many CalFresh benefits were issued to:
YOU MUST EITHER:
■ ■
the household.
Pay for the extra CalFresh benefits in full, or complete, sign and
■ ■
the household, whom you sponsored.
return the enclosed Repayment Agreement (CF 377.7C) form
and pay as agreed.
Here's why:
PROGRAM ACTIONS:
•
Your repayment agreement will be based on your current
■ ■
ability to pay as figured by the county. Any changes in your
The unreported earned income does not qualify for the 20%
ability to pay may change your monthly payments.
deduction.
•
If you do not sign and return the agreement within 30 days
You must repay the extra CalFresh benefits.
after the date of this notice, the amount of CalFresh benefits
_________ in extra CalFresh benefits were issued for the period
you get will be reduced by _________ % beginning
__________.
______________________________ .
•
If you do not repay, the county may use other ways of
The household received $ __________ in CalFresh benefits.
collecting the amount owed, such as through the courts,
other collection agency methods and by a federal
The household should have received $ _________ in CalFresh
government collection action.
benefits. $__________ (extra CalFresh benefits) is what you
•
If this error is later reviewed by the court or hearing and
received minus what you should have received.
determined to be your fault, penalties will apply even if you
■ ■
agree to repay what you owe.
This amount was reduced by $ _________ because we
owed the household benefits from past months or we
•
If the claim becomes delinquent or the household is sued,
received repayment of part of the amount owed. You now
you may be subject to additional processing charges or court
owe $ __________.
costs.
See how we figured the extra amount you got on the
•
If you do not repay the amount owed, the county may take
worksheet that came with this notice.
your state/federal income tax refund and/or ask the court to
attach your wages or any property you own.
•
You do not have to use any SSI benefits you get to repay this
Warning: If you believe this overissuance is wrong, this is your
overissuance.
last chance to ask for a hearing. If you stay on CalFresh, the
county can lower your CalFresh benefits to collect the
•
You may ask for a hearing if you feel you received extra
CalFresh benefits because the County Welfare Department
overissuance. If you go off CalFresh before the overissuance is
made a mistake.
paid back, the county may take what you owe out of your income
tax refund.
•
Collection will be from all adults in the household when the
overissuance occurred.
Rules: These rules apply: MPP 63-801.21, Duarte v. Saenz.
You may review them at your welfare office.
CF 377.7B (2/14) - REQUIRED FORM - NO SUBSTITUTE PERMITTED
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