Form Fa-001 - Application For Benefits Page 8
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31What
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Do you need help with this application? Visit
or call 1-855-HEA-PLUS (432-7587)
What are the rules and Penalties?
Has been found by a court of law to give false identification or residence information in order to get
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benefits in more than one case. This person is not eligible to get benefits for 10 years.
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State agencies must use the Systematic Alien Verification and eligibility (SAVE) System. A court of law
finds you guilty of having trafficked benefits for an aggregate amount of $500 or more, you will be
permanently ineligible to participate in the Program upon the first occasion of such violation.
The alien status of persons requesting benefits may be subject to verification by USCIS through the
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submission of information from the application to USCIS, and that the submitted information received
from USCIS may affect the HH's eligibility and level of benefits.
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For Cash Assistance if you refuse to sign and comply with the Personal Responsibility Agreement (PRA). We
give you the PRA during the interview process.
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Is an adult recipient (18 years or older) of Cash Assistance when any of the following apply:
The recipient does not return the completed Illegal Drug Use Statement. We send the Illegal Drug Use
Statement by U.S. Mail after Cash Assistance has been approved.
The recipient fails to take a required drug test.
The recipient fails the drug test.
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For Nutrition Assistance the following applies:
A person who is convicted of a felony offense which has as an element of the offense “the use
or possession of a controlled substance”, may be eligible for Nutrition Assistance if the person agrees to
random drug testing and meets at least one of the following:
Is currently accepted for treatment in a substance abuse treatment program but is on a waiting list. The
person remains enrolled in the treatment program and enters the treatment program at the first available
opportunity.
Is currently accepted for treatment, and is participating in a substance abuse treatment program.
Has successfully completed a substance abuse treatment program after the offense in question.
Is determined by a licensed medical provider to not need substance abuse treatment.
If on probation for a felony drug conviction, is in compliance with the terms of probation.
You must pay DES back for any Nutrition Assistance and/or Cash benefits you received for which your household
was not eligible. You can make a repayment agreement. If you do not keep your repayment agreement, we may
reduce your Nutrition Assistance and/or Cash Assistance benefits, take your income tax refunds, or take other legal
action, including taking the amounts from your earnings.
End for the CA Drug Conviction Sanction
The person who is convicted August 9, 2017 or later, can end the sanction when they agree to
random drug testing and meet at least one of the following criteria:
• Successfully completes, or is accepted into, a substance abuse treatment program. The person also meets
this criteria if they are either of the following:
o Currently accepted for treatment in a substance abuse treatment program but is on a waiting list. The
person remains enrolled in the treatment program and enters the treatment program at the first available
opportunity.
o Currently accepted for treatment, and is participating in a substance abuse treatment program.
• Is determined by licensed medical provider to not need substance abuse treatment.
• If applicable, is in compliance with all terms of probation related to the conviction they were sanctioned for.
The person convicted of the felony drug conviction will be permanently disqualified. The remaining
budgetary unit member's benefits may be restored the following month after the sanction is ended.
End for CA Voluntary Quit Sanction
Customer’s benefits will be returned to the previous benefit level for the following month after the minimum
one month sanction has been imposed.
FA-001 (10-17)
Page H
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