Form Na 1270 - Notice Of Action - Discontinue
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1
2NOTICE OF ACTION -
STATE OF CALIFORNIA
COUNTY OF
HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
DISCONTINUE
Notice Date :
Case
Name
:
Number
:
Worker
Name
:
Number
:
Telephone :
Address :
(ADDRESSEE)
Questions? Ask your Worker.
State Hearing: If you think this action is wrong, you can
ask for a hearing. The back of this page tells how. Your
benefits may not be changed if you ask for a hearing
before this action takes place.
As of _______________________, the County is stopping your cash
aid.
Here’s why:
■ ■
You no longer live with an approved relative.
■ ■
You no longer meet the age rules.
■ ■
You no longer meet one of the five eligibility conditions:
■ ■
Finishing high school or getting your GED.
■ ■
Enrolling in college or a vocational education program.
■ ■
Participating in a program or activity to help you find and keep
a job.
■ ■
Working at least 80 hours per month.
■ ■
Unable to do any of the above due to a verified medical
condition.
■ ■
You are no longer supervised by the juvenile court.
■ ■
You did not cooperate with the 6-month Review Hearings.
■ ■
You moved out of the State of California.
Rules: These rules apply. You may review them at your county
welfare office: WIC 11253, AB 12 (Chapter 559, Statutes of 2010).
Page 1 of ____
NA 1270 (11/11) DISCONTINUE NON-MINOR DEPENDENT - REQUIRED FORM - SUBSTITUTE PERMITTED
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