Form Na 1278 - Notice Of Action - Approve - Approved Relative Caregiver (Arc) Payment
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1
2STATE OF CALIFORNIA
COUNTY OF
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
NOTICE OF ACTION - APPROVE
Notice Date
:
APPROVED RELATIVE
Case Name
:
CAREGIVER (ARC) PAYMENT
Number
:
Worker Name :
Number
:
Telephone
:
Address
:
(ADDRESSEE)
Questions? Ask your Worker.
For Approved Relative Caregivers participating in the
Approved Relative Caregiver Funding Option Program
(ARC Program):
The County has approved your application, dated ____________,
MM/DD/YYYY
for cash aid for ___________________________________ under
NAME OF CHILD
the ARC Program. The cash aid payment for your first month of aid
is $____________. Your first day of cash aid is _______________.
MM/DD/YYYY
The cash aid payment for your first month of aid may only be for a
part of the month. It is for the time from your first day of cash aid,
shown above, through the end of the month. If nothing changes,
your ongoing monthly cash aid amount will be $_________.
This cash aid will be issued via:
A check mailed to you; or
Direct deposit
EBT: Keep your EBT card if you use EBT, even if your aid is
terminated. Please do not throw your card away. If your ARC cash
aid will be issued on a new EBT card, you will receive the new EBT
card within 10 business days for this case. If your family currently
receives CalWORKs or other benefits on an EBT card, and the
child’s county of court jurisdiction is the same as the child’s county
of residence, the child’s ARC payments will be consolidated onto
the family’s existing EBT card. If the child is a non-minor
dependent, he/she will receive his/her own EBT card.
Medi-Cal: This notice DOES NOT change or stop Medi-Cal
benefits. Keep using your plastic Benefits Identification Card(s).
You will get another notice telling you about any changes to your
health benefits.
CalFresh: This notice DOES NOT stop or change your CalFresh
benefits. You will get a separate notice telling you about any
changes to your CalFresh benefits.
Rules: These rules apply. You may review them at your county
welfare office: Welfare and Institutions Code section 11461.3,
Senate Bill 855 (Chapter 29, Statutes of 2014); Section 58 of
Chapter 20 of the Statutes of 2015; All County Information Notice
I-42-14; All County Letters 14-89, 15-20, 15-20-E,15-83, and 16-92;
and County Fiscal Letters 14-15-45, 14-15-52, 14-15-58, 15-16-07,
and 15-16-24.
NA 1278 (11/16)
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