Form Na 1275 - Electronic Notification Cancellation Notice
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1STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
ELECTRONIC NOTIFICATION CANCELLATION NOTICE
CASE NUMBER
CASE NAME
COUNTY WORKER NAME
This notice is to inform
you that you are being switched back to traditional paper
correspondence because:
■ ■
An email was undeliverable to the email address you provided the County Welfare Department
(CWD). The email address on record is: _____________________________________ .
■ ■
You contacted the CWD and told them you wanted to switch back to regular mail.
■ ■
Other_________________________________________________________________________.
In order to resume receiving electronic notices you will need to complete the e-notification enrollment
process again. If you want to go back to electronic notifications please contact the CWD immediately
at _________________________________________ .
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