Form 02-362-1014-05 - Status Update Regarding Ineligibility 2014

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Massachusetts Department of Transitional Assistance
Status Update Regarding Ineligibility
 
 
Date
 
 
Name
APID/Last Four Digits of Client’s SSN
 
 
Address
 
City/Town/ZIP
 
The Department has determined that you have now met the TAFDC rule(s) concerning
 
.
 
However, you continue to be ineligible for benefits for yourself because you do not meet the TAFDC rule(s)
checked below:
 Child Support cooperation
106 CMR 203.700 through
 Work Program requirements
106 CMR 203.400
 Employment Development Plan requirements 106 CMR 207.110, 207.200
 Teen Parent School Attendance
106 CMR 203.600, 203.610
 Immunization requirement
106 CMR 203.800
 Court conviction for fraud
106 CMR 706.305
 Third-Party Liability for
 medical services cooperation
106 CMR 203.785
 Intentional Program Violations (IPV)
106 CMR 706.300, 706.305
 Multiple Benefits
106 CMR 706.305
 Drug Felony
106 CMR 701.110
 Fleeing Felon
106 CMR 701.110
 Outstanding Warrant
106 CMR 701.110
 
 
Because you are not currently included in the TAFDC grant for your household, the amount of your benefits will
not change at this time.
 
You should be aware that sanctions for Employment Development Plan requirements or Teen Parent School
Attendance can result in your entire case closing. Information about these sanctions is included in the TAFDC
Program brochure that you received. If you need another copy of the brochure, please contact DTA to get one. You
will receive a separate notice if your case will be closed.
 
You must continue to meet all other TAFDC rules, even though you are not currently a recipient. Please contact
DTA if you have any questions. If you disagree with this decision, you have the right to a fair hearing. The reverse
side of this notice contains important information about your hearing rights. To request a hearing, complete the
reverse side of one copy of this notice.
 
 
Department Representative
DTA Telephone Number: 1-877-382-2363
 
 
Supervisor
 
Page 1 of 2
Original and First Copy to Client—Second Copy to Case Record
SURI (Rev. 10/2014)
02-362-1014-05

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