Form Dss-8222 - Notice Of Work First Family Assistance Job Bonus - North Carolina
Download a blank fillable Form Dss-8222 - Notice Of Work First Family Assistance Job Bonus - North Carolina 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 Dss-8222 - Notice Of Work First Family Assistance Job Bonus - North Carolina 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
2Notice of Work First Family Assistance Job Bonus
County Department of Social Services
Product Delivery Case Number ____________________
Date: ______________________
_______
Dear
_______________________________________
A change is about to take place in your benefits. Because of your new earned income, you are over the income
limits to receive a Work First Family Assistance (WFFA) cash payment. Your WFFA case will terminate effective
________________. The State regulations requiring this change are found in the Work First Manual.
You may be eligible to receive a Job Bonus of $100.00 for a period of up to three months. Job Bonus is an incentive
for families to continue working and to ease the transition into economic self-sufficiency. Job Bonus can be received
once in a lifetime when a Work First household member becomes employed.
If you choose to decline the Job Bonus, your WFFA cash payment will end without further notice on the date
shown above. You may be eligible for Job Bonus in the future if you chose to decline the Job Bonus at this time.
Check the box below if you wish to receive Job Bonus.
I was informed of my eligibility for Job Bonus and want to receive the Job Bonus. The Job Bonus period is
from ____________________ to ___________________.
I understand that this serves as my notice for the change in my WFFA cash payment to $100 during
the Job Bonus period. This also serves as my notice of termination from Work First Family Assistance
at the end of the Job Bonus period.
Check the box below if you do not wish to receive Job Bonus.
I was informed of my eligibility for Job Bonus and do not want to receive the Job Bonus at this time.
I understand that this notice serves as my notice of termination from Work First Family Assistance.
____________________ ______________________
Participant Signature
Date
Telephone Number
Return the completed notice to your caseworker no later than ________________________. If you do not
return this notice by the above date you will not receive the Job Bonus. Your WFFA case will terminate
without further notice.
Please continue reading for important information
DSS-8222 (rev.03-15)
Economic and Family Services
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Na 991 - Notice Of Action - Refugee Cash Assistance (rca)/entrant Cash Assistance (eca) Mc-decrease/expiration (time-expiration)
Legal
Form Dss 5120a - Redetermination Of Foster Care Assistance Benefits And/or Medical Assistance - North Carolina Department Of Social Services
Legal
Form Dss-1688 - Designation Of Authorized Representative - North Carolina Department Of Health And Human Services
Legal
Related Categories
Parent category: Legal