Form 377.1 Notice Of Approvalfor Calfresh Benefits
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1
2STATE OF CALIFORNIA
COUNTY OF
HEALTH AND HUMAN SERVICES AGENCY
NOTICE OF APPROVAL
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Notice Date :
FOR CALFRESH BENEFITS
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.
The back of this page tells you how.
Your benefits may not be changed if
you ask for a hearing before this
action takes place.
I
YOUR APPLICATION FOR CALFRESH BENEFITS HAS BEEN APPROVED.
Your initial amount of benefits is: $____________ for _____________. Your benefit amount for the rest of your certification
period will be $ __________ from ________________________ through_______________________.
IF YOU ALSO APPLIED FOR CASH AID, and it has not yet been approved, your CalFresh benefits may be lowered or
stopped without another notice if your cash aid is approved.
I
Your CalFresh eligibility starts the same day as your cash aid.
I
Your first month’s benefits include more than one month’s benefits because of the date your application was
approved.
I
Your first month’s benefits were prorated from the date you filed your application.
I
BECAUSE YOU RECEIVED CALFRESH BENEFITS RIGHT AWAY, we did not require you to give us the following
verification:
You must give us this verification before_____________________ or your CalFresh eligibility will stop. You will not get another
notice. If the verification you send changes your eligibility or benefits, we will make the change. You will not get an advance
notice before we take this action.
Your CalFresh household may be eligible to a State Utility Assistance Subsidy (SUAS) payment. If eligible, the county will
award you a $20.01 SUAS cash payment. This is a one-time per year payment and if eligible it will be put into your cash EBT
account. If you do not have a cash EBT account, one will be set up for you on your CalFresh EBT card. You will not have to do
anything to get a new card, but you can use it to cover expenses not otherwise covered by CalFresh. This payment allows the
county to use the highest utility deduction (Standard Utility Allowance - SUA) for food benefits. You may use this $20.01 when
you use your EBT card. If you want to know more, please contact your local county office.
Rules:
These rules apply:
You may review them at your welfare office.
CF 377.1 (9/15) REQUIRED FORM-SUBSTITUTE PERMITTED
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