Form Na 1273 - Electronic Notification Agreement
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1STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
ELECTRONIC NOTIFICATION AGREEMENT
CASE NUMBER
CASE NAME
COUNTY WORKER NAME
Q: What are electronic notifications? A: Electronic notifications, or e-notifications, are email alerts
that let you know there is correspondence to be viewed in your secure personal online account.
I agree to get all correspondence from the County Welfare Department (CWD) by
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e-notification, except notices regarding state hearings, which will be sent by US mail.
I agree to read all e-notifications sent to my email account and to view the documents through
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my secure personal online account.
I agree to check my email account on a regular basis (we recommend at least every three
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days) to make sure that I view time sensitive correspondence in a timely manner.
I agree to keep the CWD informed if my email address changes by filling out a new Electronic
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Notification Agreement within ten days of the change.
I understand that notices sent to my personal secure online account are considered received
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by me when the e-notification is received by my email, even if I do not read them.
I understand that the CWD must give me a paper copy of any document posted in my secure
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personal online account, if I ask for one.
I understand that the CWD will go back to sending me traditional paper correspondence if the
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e-notifications sent to my email could not be received by the email address I have provided.
I understand that, I can stop getting e-notifications at any time and go back to getting notices
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and forms by US mail. To do so I only need to contact my CWD at __________________ and
inform them of my decision to change back to paper correspondence.
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