Form Rca 43 - Refugee Cash Assisstance (Rca) - Notice Of A Participation Problem
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2STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
REFUGEE CASH ASSISTANCE (RCA)
ISSUE DATE:
NOTICE OF A PARTICIPATION PROBLEM
CASE NAME:
CASE NUMBER:
WORKER NAME:
WORKER NO.:
TO:
If you have any questions, please call your worker.
There is a problem with your participation in the RCA Program. In order to discuss this problem, we have scheduled an interview with you on:
at
o'clock at
.
HERE'S THE PROBLEM:
You did not participate in _____________________________________________________ on _______________________.
You did not go to a job interview on __________________________.
You did not accept a job with ___________________________________________when referred on ___________________.
You quit your job on ______________________________________.
You reduced your earnings on ______________________________.
Other ______________________________________________________________________________________________.
If you cannot keep this interview, please call your worker by ____________________to schedule another interview.
YOU MAY RESCHEDULE THIS INTERVIEW ONLY ONCE
AND THE INTERVIEW MUST BE CONDUCTED BY NO LATER THAN ____________________.
WHAT IS THE PURPOSE OF THE INTERVIEW?
The purpose of the interview is to find out if you had a good reason for not doing what RCA requires. If it is decided that you did not have a
good reason, you can correct the problem by working with us to agree on a compliance plan. If you had a good reason for not participating, we
will work with you so that you are able to do what RCA requires.
See back of this notice for more important information
RCA 43 (5/03) RECOMMENDED FORM
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