Form Cf 377.7d Calfresh Overissuance Noticefor Administrative Errors (Ae) Only
Download a blank fillable Form Cf 377.7d Calfresh Overissuance Noticefor Administrative Errors (Ae) Only in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Cf 377.7d Calfresh Overissuance Noticefor Administrative Errors (Ae) Only with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
COUNTY OF
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CALFRESH OVERISSUANCE NOTICE
FOR ADMINISTRATIVE
Notice Date
:
ERRORS (AE) ONLY
Case
Name
:
Number
:
Worker
Name
:
Number
:
Telephone
:
Address
:
(ADDRESSEE)
State Hearing: If you think this action is
wrong, you can ask for a state hearing.
The back of this page tells how. Your
benefits may not be changed if you ask
for a hearing before this action takes
place.
POSSIBLE COLLECTION ACTIONS:
Too many CalFresh benefits were issued to:
■ ■
your household.
•
Your repayment agreement will be based on your current
■ ■
the household, whom you sponsored.
ability to pay as figured by the county. Any changes in your
ability to pay may change your monthly payments.
Here's why:
•
If you do not repay, the county may use other ways of
collecting the amount owed, such as through the courts, other
collection agency methods and by a federal government
■ ■
collection action.
The unreported earned income does not qualify for the 20%
deduction.
•
If this error is later reviewed by the court or hearing and
$__________ in extra CalFresh benefits were issued for the
determined to be your fault, penalties will apply even if you
period ___________________________.
agree to repay what you owe.
The household received $ _________ in CalFresh benefits.
•
If the claim becomes delinquent or the household is sued, you
may be subject to additional processing charges or court
The household should have received $ ________ in CalFresh
costs.
benefits. $ ________ (extra CalFresh benefits) is what you
received minus what you should have received.
•
If you do not repay the amount owed, the county may take
your state/federal income tax refund and/or ask the court to
This amount was reduced by $ ___________ because we
attach your wages or any property you own.
received repayment of part of the amount owed. You now owe
$ ____________.
See how we figured the extra amount you got on the
worksheet that came with this notice.
REPAYMENT
Rules: These rules apply:
MPP 63-801.22, 63-801.4,
You must repay the extra CalFresh benefits.
63-801.43, 63-801.7. You may review them at your county office.
1.
You may pay for the extra CalFresh benefits in full, or
2.
Complete, sign and retur n the enclosed Repayment
Questions? Ask your Worker.
Agreement (CF 377.7E1) form and pay as agreed, or
3.
If you do not sign and return the agreement within 30 days
after the date of this notice the amount of CalFresh benefits
Warning: If you believe this overissuance is wrong, this is your
you get will be reduced by ______% beginning__________.
last chance to ask for a hearing. If you stay on CalFresh, the
• You do not have to use any SSI benefits you get to repay
county can collect the overissuance by lowering your monthly
this overissuance.
• Collection will be from all adults in the household when
benefits. If you go off CalFresh before the overissuance is paid
the overissuance occurred.
back and do not make repayment arrangements, the county may
• If you are not receiving CalFresh benefits, your AE
take what you owe out of your state/federal income tax refund as
overissuance must be repaid if the overissuance is more
allowed by law.
than $125.
CF 377.7D (1/14) USE FOR AE O/I PRIOR TO 10/1/96 - REQUIRED FORM - NO SUBSTITUTE PERMITTED
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Cf 377.2d - Calfresh Notice Of Status Change For Households With Only Elderly And/or Disabled Members
Legal
Form Cf 377.2c - Calfresh Notice Of Expiration Of Certification For Households With Only Elderly And/or Disabled Members
Legal
Form Cf 377.2b - Calfresh Notice Of Expiration Of Certification For Households With Only Elderly And/or Disabled Members
Legal
Related Categories
Parent category: Legal